Empowering Nurses to help Reduce the Rate of Primary Cesarean Births

Abstract

Poster Presentation Purpose for the Program Cesarean birth has come to the forefront of discussion by The Joint Commission, Association of Women's Health, Obstetric and Neonatal Nurses, and American College of Obstetricians and Gynecologists because of its effect on the increased risk of maternal morbidity. Of particular focus is the primary cesarean. A program to facilitate the safe prevention of the primary cesarean will optimize patient outcomes, decrease hospital length of stays, and decrease the rate of repeat cesarean births. Proposed Change To promote positive patient outcomes and reduce the rate of primary cesarean births by incorporating a collaborative effort between leaders, nurses, and health care providers. A change in culture will directly affect outcomes. The change encompasses hard‐stop guidelines for early elective inductions, nursing education for techniques to manage various stages of labor, and the use of innovative equipment to optimize movement for the woman in labor. Implementation, Outcomes, and Evaluation The unit implemented hard‐stop guidelines to prevent early elective inductions of labor, the use of wireless fetal monitoring to encourage mobility in labor, the use of labor techniques to optimize vaginal births, and education for staff on the management of the stages of labor. As a collaborative effort with health care providers, we decreased the early elective induction rate to 0% within the first year. Leadership supported the opening of a triage unit to promote a decrease in triage hours, which facilitated prompt discharge for those patients who were not in labor. Program evaluation occurs during a monthly Perinatal Collaborative meeting, which includes leaders, nurses, and health care providers to discuss progress and process improvements. The team is dedicated and focused on optimizing patient outcomes and decreasing the rate of primary cesarean births. Implications for Nursing Practice By empowering and educating nurses on their active involvement in the process, we reduced the rate of primary cesarean birth by 12% from fiscal year 2013 to fiscal year 2014. In August 2014, the unit announced 208 deliveries with a primary cesarean rate of 9%. The implementation of the wireless fetal monitoring system, labor techniques, and the childbirth education conference was directly correlated with a decrease in the rate of primary cesarean birth.