Are You Ready for the Ccreta Family to Deliver? Designing a Multidisciplinary Accreta Program

Purpose for the program:

The rise in cesarean section has led to an increase in placenta accreta/increta/percreta, medical conditions that occur when an abnormal placenta implantation results in massive bleeding and potential multi-organ failure.  One Tertiary Perinatal Center recognized this need and developed a program using a multi-disciplinary approach to pro-actively improve the process delivery methods and clinical outcomes using a comprehensive patient centric model that addresses the antepartum, intrapartum and postpartum phases of care.   

Proposed change:

 Baseline data indicated these patients required extensive use of blood products and a post-delivery ICU admission. Recognizing that a comprehensive program encompassing the entire hospital stay was needed for this patient population, healthcare providers from the main OR, trauma, blood bank, interventional radiology, and the obstetrical units were organized into four teams to address patient management for both scheduled and emergent situations.  Additional program components addressed development of quality indicators, financial review, and marketing efforts to OB/GYN physicians throughout the state, as well as community education on this subject. 

Implementation, outcomes and evaluation:

Our comprehensive program began in January 2012. This presentation will cover identified patient/family needs antepartum/intrapartum/postpartum, along with addressing: 

1. Discuss the four different teams- Anterpartum Care, OR team, Community Outreach, Financial  
2. Plan of care checklist content
3. Staff education  
4. Stat OR mock drills for emergent situations  
5. Marketing channels and materials for referring physicians 
6. Use of public relations resources to increase public education  
7. Creation of a data bank using identified outcome criteria
8. Program evaluation  

Since implementation, we have seen an increase of 33% of percreta patients cared for at the facility Clinical improvements in the care of accreta patients after program implementation have shown a reduced post-delivery ICU admission, and shorter post-surgical length of stay.  Evaluation of over 60 patients from 2009-2013 confirms our observations are consistent with the other articles' findings such as decreased blood loss and reduced blood transfusions, (Tan 2007). Positive personal accounts from patients reflect increased patient satisfaction of their continuum plan of care during prolonged hospital stay

Implications for nursing practice:

Nurses need to be aware of the high-risk complexity of these patients and have defined protocols to utilize in their care. Tertiary facility nursing leaders should work to create an organized multidisciplinary program at their facility to be ready to care for the medical and nursing needs of this new high risk population to achieve the best possible outcomes for mother and baby.  

Keywords:

Placenta accreta/increta/percreta, multidisciplinary accreta program,  care of accreta patients