Multidisciplinary Team Strives to Improve Care of High-Risk Patients Using a Proactive Collaborative Approach

Purpose for the program: Caring for complex obstetrical patients presents many challenges to obstetrical nurses. Current evidence indicates that maternal mortality rates and near-misses are increasing. According to the Centers for Disease Control, chronic health conditions such as hypertension, diabetes, and obesity are rising and place women at higher risk for complications or adverse outcomes during pregnancy and delivery. Research has shown that approaches to reducing risk involve identifying those at high risk, and using multidisciplinary care planning to optimize outcomes. Limited communication between nurses and obstetricians regarding high risk patients leads to nurses feeling frustrated and ill prepared. A proactive versus reactive approach to managing these patients is needed. The purpose of this project was to create a mechanism to facilitate interdisciplinary communication and develop an individualized plan of care to promote patient safety, and improve patient and nurse satisfaction.

Proposed change: A multidisciplinary High-Risk Obstetrics Committee (HROC) was formed to facilitate interdisciplinary communication and collaboration. High risk patients are identified prior to admission and an individual plan of care is developed aimed at promoting patient safety.

Implementation, outcomes and evaluation: The Labor & Delivery Shared Decision Making Council recognized the need for identifying and planning care for high risk patients. The Iowa Model for Evidence-Based Practice guided implementation. HROC membership includes nurses, obstetricians, perinatologists, neonatologists, anesthesiologists, management, and other specialties. Meetings are held monthly to plan care of future patients and evaluate outcomes of delivered patients. Set criteria help identify cases for referral such as maternal cardiac conditions or neonatal fetal anomalies requiring special needs post delivery. Referrals come from physicians and nurses during antepartum checks. New cases are presented, discussed, and recommendations from various disciplines are used to develop an optimal plan of care which is shared with appropriate staff. Post delivery cases are also reviewed to evaluate outcomes and determine opportunities for improvement.  Since July 2009, 140 patients have been referred. Feedback from staff has been positive: improved communication and coordination of care, increased nurse confidence, ability to research rare conditions prior to patient arrival and include patients in multidisciplinary care conferences, and offer NICU tours. Policy changes have also been recommended leading to system improvements.

Implications for nursing practice: Planning care for patients with known high risk conditions can prevent near misses and decrease morbidity and mortality for mother and baby. Communication is key in providing quality patient care and creating a culture of safety.  

Keywords: high-risk obstetrics, patient safety, communication