Transforming The Pre-Operative Process For Scheduled Cesarean Sections Using Patient and Family Centered Care
Title: Transforming The Pre-Operative Process For Scheduled Cesarean Sections Using Patient and Family Centered Care
- Identify the gap between traditional patient care delivery and Patient/Family Centered Care in scheduled Cesarean admissions.
- Describe methods used to create innovative solutions to common issues such as sustained high census and difficulty staffing.
- Examine impact of Patient and Family Centered Care pre-operative policy on patient satisfaction.
In a high risk maternal infant program at a large, academic medical center, patients admitted through Labor and Delivery for scheduled cesarean sections frequently waited hours for delivery due to priority, high risk transports coming into the hospital. Conversely, patients awaiting transport to UAMS were often declined or delayed due to high census. With the institutional push towards Patient and Family Centered Care (PFCC), staff was challenged to provide PFCC in light of sustained high census.
Proposed change:
Maternal Infant staff suggested admitting patients to the Post-partum floor where patients would ultimately reside after surgery instead of admitting through Labor and Delivery.
Implementation, outcomes and evaluation:
Patients are admitted to the Postpartum Unit by a pre-operative nurse who starts the IV, draws blood, performs the intake assessment, and notifies the physicians (anesthesia and OB). Once pre-operative preparation is completed, the patient is passed to the postpartum nurse who cares for the family prior to and after delivery. When ready for surgery, the patient is transferred to Labor and Delivery. After surgery, the mother recovers for two hours while the neonate is transitioned at her bedside. Then both mother and neonate return to the same room and nurse on the Postpartum Unit.
From April 1-July 1, 2013, 87 patients were routed using the new pre-operative process. Continuity of nursing care for scheduled cesarean section patients increased PFCC, patient safety, and efficiency in the pre-op process for both scheduled cesarean sections and the emergent transports. Patients report appreciating having a private area for the family to wait during the surgery and recovery.
Post-partum leadership has applied for IRB approval to formally evaluate this process. Currently, patients report high levels of satisfaction with this process as reported to unit leadership in daily rounds.
Implications for nursing practice:
Reorganization of traditional care delivery methods could be useful to any facility that sees the need for change to better assist the patient and their family. Nursing has recognized the need for safety, but holistic nursing requires the recognition of the importance of other concepts such as comfort and emotion which can positively be affected by continuity of nursing care and a comfortable, familiar environment.
Keywords:
Patient and family centered care (PFCC), staffing, efficiency, cesarean delivery