A Quality Improvement Project to Reduce the Incidence of Nonmedically Indicated Elective Deliveries Before 39 Weeks

Abstract

Poster Presentation Objective To decrease the rate of non‐medically indicated elective deliveries (NMIED) at 37 to 38 weeks to less than or equal to 5.0%. Design A plan‐do‐study‐act quality methodology. Sample All inductions and cesareans between 37 to 38.6 weeks from January, 1, 2011 to the present. Methods The March of Dimes (MOD) 39‐week toolkit was used to guide the project. The toolkit supported efforts to design policies and best practice guidelines, choose quality improvement tools, and educate physicians, staff, and patients. Implementation Strategies Our team also implemented a measuring tool developed by the Advocate System Obstetric Safety Committee to help drive appropriate patient scheduling and data collection. The project was introduced to staff obstetricians at a monthly meeting and in their offices, was presented at staff meetings, and was championed by the lead charge nurses, unit manager, and obstetric chairman. The project was further supported by perinatal network Maternal Fetal Medicine physicians and Level‐III hospital sites. Results In 2010, our preintervention rate for NMIED was 25.0%. After implementing the MOD toolkit in 2011, this rate decreased to 11%, representing a greater than 50% reduction by the year's end. Since 2011 we have continued to see a steady decline in NMIED with a current rate of 0.0% for the last 18 months. Conclusion/Implications for Nursing Practice This quality improvement project demonstrates that strong teamwork, project champions, and a working roadmap can lead to improved patient outcomes. Continued monthly data collection with submission to the Advocate System Obstetric Safety Committee and the reporting of patient cases through the chain of command will keep us on track for continued success.