Multidisciplinary Antepartum Model of Care to Improve Perinatal Outcomes
Title: Multidisciplinary Antepartum Model of Care to Improve Perinatal Outcomes
- Describe the challenges and obstacles the antepartum patient, her family, and all members of the health care team encounter, while pursuing the mutual goal of the lengthening pregnancy to improve maternal and neonatal outcomes.
- Identify methods to empower nursing staff to provide individualized physical, emotional, and spiritual support to patients and their families experiencing long term hospitalization during their pregnancy.
- Describe the methods utilized to develop specialized, individualized plans of care for the antepartum patient, including the use of regular multidisciplinary meetings and evidence-based practice that are unique to the patient’s diagnoses and emotional needs.
The Maternal Child Health Services Multidisciplinary Antepartum Team Project was developed to identify evidence-based practice and guide nursing care with a model of approach that involves all disciplines of care, plus the patient and her family. The goal of the multidisciplinary antepartum team is to utilize all members of the health care team, to address needs of the patient, to potentially lengthen pregnancy, improve fetal well-being, decrease maternal adverse events, and reduce the need for neonatal intensive care admits.
Proposed change:
To improve maternal/fetal outcomes through early identification and communication of maternal risk factors by developing a multidisciplinary individualized plan of care. This team will utilize evidenced-based nursing research to improve patient outcomes, decrease the emotional and physical stressors of a long term hospitalization, and to positively impact the patient’s perception of the health care team.
Implementation, outcomes and evaluation:
The Maternal Child Health care team identified the need for improved communication and collaboration for long term hospitalized antepartum patients. A multidisciplinary team that included members from education, nursing, social services, research, and management convened to examine the need to improve antepartum care.
As a result of the initial team planning, new nursing processes have been implemented. Specific changes include a daily huddle to discuss patient diagnoses, diagnostics, consultations, plan of care for the day, and the use of the antepartum SBAR tool to improve communication. The primary nurse reviews the daily plan of care with the team and the patient, and also solicits information from the patient to identify urgent needs, with specific attention to emotional and physical well being. A weekly meeting that includes the patient’s obstetrician, perinatologist, neonatologist, nursing team, social services, pastoral care, and unit educators, is planned to continue the collaborative care model to achieve the best possible outcome for patient and baby.
Implications for nursing practice:
The patient’s status is reviewed and evaluated daily by the nursing team at the daily huddle. The goals for the previous plan of care are reviewed, to be certain goals were met or refined. Patient provides information to the nursing team daily to identify any needs that have yet to be addressed or resolved. The multidisciplinary team continues to meet, update and communicate goals for the patient, until patient reaches delivery or discharge.
Keywords: antepartum, multidisciplinary team, high-risk pregnancy, evidence-based nursing care, communication