Nursing Sensitive Quality Indicators in the Perinatal Setting

NURSING SENSITIVE QUALITY INDICATORS IN THE PERINATAL SETTING

 Objective:   Development of nursing sensitive quality indicator in the perinatal setting

 Background:  Perinatal areas have struggled to identify nursing sensitive indicators that are meaningful and representative of the care provided in this specialty. National indicators and benchmarks have primarily focused on topics common in the medical/surgical and critical care areas of nursing. In an effort to measure and improve the valuable care provided in Labor and Delivery (L&D), the unit based Nursing Quality Committee at an urban teaching hospital developed a Labor and Delivery Quality Dashboard of indicators that are specific to perinatal nursing care.

 Design:   Evidence-based quality improvement project.

 Sample:   random sampling of patients from a labor and delivery unit at a large urban teaching hospital

 Methods:   A review of literature on nursing sensitive quality indicators revealed limited recommendations specific to L & D.  Indicators were identified from a review of hospital wide indicators, Institute for Health Improvement (IHI) evidence based evidenced-based care bundles, national trends, and event reports with relevance to L&D. 

 Implementation Strategies:  The unit based Nursing Quality Committee developed the following dashboard of indicators for the perinatal setting:  retained material after vaginal or cesarean deliveries, perinatal falls, maternal and neonatal hypothermia, placement of newborns skin-to-skin following both vaginal and cesarean deliveries, induction/augmentation safety, surgical safety, assessment of risk for skin breakdown, and management of tachysystole associated with the use of oxytocin. Data is collected monthly through retrospective chart reviews.   

 Results:   Benefits of perinatal specific indicators include:  transformational leadership, engagement of staff in data collection that is meaningful to practice, and data driven decision making. Data included in the L&D Quality Dashboard has been used to guide the purchase of new equipment for the unit, facilitate design of a new Labor and Delivery Suite, develop interdisciplinary simulation training, and initiate a nursing research project related to falls in the perinatal population.

 Conclusion/Implications for nursing practice:  The L&D Quality Dashboard is a dynamic tool that has improved communication between staff, leadership, and administration. It has empirically guided decision making and promoted accountability at the bedside and in the boardroom to transform practice in the perinatal setting.

 Keywords: Dashboard, Quality Indicators, Labor and Delivery, Perinatal