Leveraging Technology To Help Manage Oxytocin/Tachysystole, Hyperbilirubinemia, and Postpartum Hemorrhage

Purpose for the program:  Innovative technologies are rapidly flooding many health care institutions in response to the government mandate for meaningful use of electronic health records (EHR).  Technology that is introduced at the bedside must be innovative in order to improve quality, safety, and patient outcomes.  Technology was leveraged to assist clinical management of oxytocin/tachysystole, hyperbilirubinemia, and postpartum hemorrhage.  The challenge of managing these complex health issues was aided through clinical decision support system (CDSS) to guide the care of patient’s receiving oxytocin, neonatal hyperbilirubinemia management , and postpartum hemorrhage risk assessment. 

Proposed change:  Innovate and optimize the use of technology to assist clinicians in providing quality care to the obstetric and neonate patient population.

Implementation, outcomes and evaluation: Interdisciplinary collaboration was the key to success in the development and implementation of our CDSS.  Members of the perinatal safety committee worked with clinical informaticians and IT to present intuitive and critical information to clinicians.  Managing the patient on oxytocin required standardized electronic orders with detailed information on titration and discontinuation.  Creation of an electronic oxytocin checklist and reference link to the algorithm for managing tachysystole was a critical component to ensure seamless access to the best practices.  This work was recognized by The Joint Commission (TJC) and is being submitted to TJC leading practice library. 

Management of neonatal hyperbilirubin is complex.  In response to the complexity, rules were created in the electronic record based on best practices.  The system automatically fires orders based on clinical documentation of major and minor risk factors.  The system assists the clinician by providing that decision support. 

Early identification and treatment of postpartum hemorrhage is critical.  Leveraging technology to assist clinicians is also critical.  Our CDSS identifies a baseline assessment of each patient admitted to the labor unit.  The system continues to assess ongoing risk factors and identifies each patient as low, medium, or high risk for hemorrhage based on rules and nursing documentation.  The nurse is notified when the CDSS identifies a patient who is at risk.  Clinicians will employ a built –in blood loss calculator incorporating baseline dry weights of routine items and enabling accurate estimation of blood loss and early detection of a hemorrhage patient.

Implications for nursing practice:  Nursing is complex.  Leveraging technology to assist clinicians must be a commitment by nursing.  The tools that we have designed provide support for nurses serving our obstetric and neonate patient population.  

Keywords: technology, hyperbilirubinemia, oxytocin, tachysystole, postpartum hemorrhage