Nulliparous, Term, Singleton, Vertex C-Section . . . Oh My!: Deciphering the Perinatal Core Measures

Purpose for the program:

In late 2009, Joint Commission introduced the Perinatal Care Core Measure Set as a way for hospitals to use evidence-based practice to assess quality in perinatal care. By reviewing data collected and proposing changes to current state of care, patient safety and quality improves. Our Women’s and Children’s Services department started collecting data as a way to make staff aware of how we compare nationally and to identify areas needing improvement. Performance Improvement (PI) was introduced to the staff.

Proposed change:

Data collection began using the Perinatal Core Measures as a guide. That data was graphed, analyzed and communicated to physicians and nurses. The goals were to decrease the rate elective deliveries, give antenatal steroids as required and decrease the c-section rate.

Implementation, outcomes and evaluation:

Data collection began in late 2011. A scheduling form for labor inductions and c-sections was developed to capture reasons for elective deliveries and c-sections and as a tracking mechanism for assistance with data collection. Triage data was used to collect antenatal steroid usage. Exclusive breastfeeding rates have also become very important in the hospital’s move toward Baby Friendly designation. A staff report card was developed to see how well each person is doing to support exclusive breastfeeding. PI and data collection was introduced to staff in a non-threatening, simplified way.

There is a greater awareness of elective inductions among staff nurses and physicians. There is a better understanding of the importance of PI data collection. A preterm labor order set was developed to help remind staff about ordering and administering antenatal steroids. The elective delivery rate is decreasing since putting scheduling criteria in place. The exclusive breastfeeding rates are rising as everyone competes to have all 100% by their names on the breastfeeding report card.

There is still work to be done to continue to improve elective delivery rates as we strive to have no elective deliveries at all. Educating the staff and community will help with exclusive breastfeeding rates. The Core Measures are a springboard from which change comes. More nurses are becoming involved in PI at the unit level.

Implications for nursing practice:

The use of the Joint Commission Perinatal Care Core Measures helped improve communication with the staff nurses and physicians. Staff nurses learned that Performance Improvement doesn’t have to be incomprehensible. PI helps nurses keep patients safe!

Keywords: core measures, elective deliveries, c-section, antenatal steroids, exclusive breastfeeding