Striving To Attain High Reliability In Perinatal Services: Perinatal Safety SMART Lean Process Improvement
Title: Striving To Attain High Reliability In Perinatal Services: Perinatal Safety SMART Lean Process Improvement
- • Utilize best available evidence to improve patient outcomes and safety for key clinical practice associated with risk of harm to mothers and babies.
- • Explain strategies learned to achieve and sustain lasting changes in clinical practice.
- • Apply the methodologies employed and lessons learned by LRMC to improve safety and quality of care provided to mothers and babies.
This program covers quality initiatives to decrease the incidence of birth trauma, enhance our culture of patient safety and teamwork, and standardize key clinical practices associated with risk of harm to mothers and babies by bringing evidence and best practice to the bedside.
Proposed change:
A strategic and purposeful focus on Perinatal Safety using a SMART Lean methodology with engagement from the perinatal team serves a critical role toward achieving high reliability in Perinatal Services at Lakeland Regional Medical Center (LRMC). The work of the Perinatal Safety Initiative is accomplished through multidisciplinary teams. All teams are supported by a dyad partnership that includes an expert physician and operational/clinical leader, which are in turn supported by a sophisticated team including project management, performance improvement, informatics, industrial engineering, information technology, and risk management. The Perinatal Safety Working Team provides support to the Steering and Project Teams. The Perinatal Safety Steering Team meets monthly and is comprised of a group of clinical experts (nurse leaders and physicians representing OB/Gyn, Neonatology, and Anesthesiology), as well as key members of the Executive Team. This team provides operational oversight and decision making, driving priorities, professional practice standards, strategy, and clinical expertise for the Initiative. The Project Teams are comprised of providers, nurses, and other LRMC team members as appropriate. Project Team work focuses on a specific clinical opportunity and includes: review of current evidence and professional practice standards, policy development, defining expectations and educational requirements, measuring progress, and providing feedback and recommendations to the Steering Team.
Implementation, outcomes and evaluation:
Outcomes measures: Adverse Outcome Index (AOI), Weighted Adverse Outcome Score (WAOS), Severity Index (SI), Neonatal Mortality, and Patient Safety Indication (PSI) #17: Birth Trauma, Joint Commission Measures: PC-01 Elective Delivery and PC-02 Cesarean Section, AHRQ Survey on Patient Safety Culture, and Focus Studies for Bundle Compliance.
Major accomplishments include:
- Hard stop for early elective deliveries
- Standardized schedule and checklist for oxytocin administration focused on uterine and fetal response
- SBAR and twice daily Team Briefs
- Chain of Communication policy
- TeamSTEPPS and Simulation training
- Quarterly Strip Reviews
- Electronic Fetal Monitoring (EFM) Management Model
- Advanced Practice Solutions - GNOSIS for EFM
- Newborn hyperbilirubinemia risk assessment and intervention
- Obstetric Hemorrhage Protocol
Implications for nursing practice:
Key Measures of Success:
- Top Leadership Support
- Dyad Partnership (MD/Nurse)
- SMART Lean Methodology
- Steering Committee representation from key stakeholders
- Data>Information>Knowledge>Thoughtful Actions
- Emphasis on Evidenced Based Practice
- Standardization with Technology
- Operationalizing Perinatal Safety
Keywords:
Perinatal Safety, Evidence-Based Practice, High Reliability