Improved Birth Outcomes With Implementation Of A Perinatal Quality and Patient Safety Collaborative

Purpose for the program: In February 2012, the Roper St. Francis Healthcare Perinatal Quality and Patient Safety Collaborative was formed to replace the Perinatal Care Committee that was more of a reporting mechanism of adverse events versus examining clinical competency, data analysis, process improvement, and evidence based practice.  Taking a proactive versus retrospective approach, the Roper St. Francis Healthcare Perinatal Quality and Patient Safety Collaborative pulled an interdisciplinary of physicians, nurses, and staff to ensure that care was patient-centered, effective, safe and evidence-based.

Proposed change: The development of a Perinatal Quality and Patient Safety Collaborative is a relatively new concept in perinatal care due to the differences in models of nursing care, organization resources of data collection and staff, and cultural and regional norms of accepted practice.  The RSFH Perinatal Quality and Patient Safety Collaborative is transforming healthcare by meeting national and organization best practice standards and are committed that each patient and their family receive the best care they deserve.

Implementation, outcomes and evaluation:

Lean Methodology was utilized by the Clinical Nurse Specialist (CNS) and Clinical Informatics Specialist (CIA), both trained in Six Sigma in January 2012.  The charter was developed by the CNS and CIS and a team was formed composed of the Service Line Director, two physician champions for Quality and Patient Safety, to address the initiatives to standardize care across a three hospital system.

Results/Outcomes: Since its conception, the Perinatal Quality and Patient Safety Collaborative has:

• Effectively reduced its < 39 weeks elective delivery rates to 0% YTD for 2013.
• Required completion of an electronic fetal monitoring course by 100% of obstetricians to standardize communication between physicians and nurses. 
• Standardized Pitocin administration for induction and augmentation and protocols   utilized 100%
•  Implementation of a postpartum hemorrhage protocol and emergency cart with a decrease in system-wide postpartum hemorrhage rate from 0.82% in 1^st QTR 2012 to 0.73% in 1^st QTR in 2013.
• Decreased Cesarean Section Surgical Site Infection rate from 0.27% in 1^st QTR 2012 to 0.15% in 1^st QTR in 2013.
•  Instituted an OB Laborist program to ensure patient safety and teamwork by January 2013.

Implications for nursing practice: As quality initiatives continue to drive patient care processes, it is imperative to involve nursing staff, physicians, and other disciplines.  Today's environements calls for everyone caring for patients to step outside of silos and colalborate as a global team.  Although perinatal core measures are important, the next step is implementing nurse-driven quality measures to improve periantal quality and patient safety.

Keywords: Quality, patient safety, evidence based practice