Improved Birth Outcomes With Implementation of a Perinatal Quality and Patient Safety Collaborative

Abstract

Purpose for the Program In February 2012, the Roper St. Francis Healthcare (RSFH) Perinatal Quality and Patient Safety Collaborative was formed to replace the Perinatal Care Committee. The committee functioned as a reporting mechanism of adverse events instead of a way to examine clinical competency, data analysis, process improvement, and evidence‐based practice. Taking a proactive rather than a retrospective approach, RSFH Perinatal Quality and Patient Safety Collaborative pulled an interdisciplinary team of physicians, nurses, and staff to ensure that care was patient centered, effective, safe, and evidence based. Proposed Change The development of a Perinatal Quality and Patient Safety Collaborative is a relatively new concept in perinatal care because of the differences in models of nursing care, organization resources of data collection and staff, and cultural and regional norms of accepted practice. The RSFH Perinatal Quality and Patient Safety Collaborative is transforming health care by meeting national and organization best practice standards and are committed that each patient and her family receive the best care they deserve. Implementation, Outcomes, and Evaluation Lean methodology was used by the clinical nurse specialist (CNS) and clinical informatics specialist (CIS), who were trained in Six Sigma. The charter was developed by the CNS and CIS, and a team of the service line director and two physician champions for quality and patient safety was formed to address the initiatives to standardize care across a three hospital system. Since its conception, the Perinatal Quality and Patient Safety Collaborative has effectively accomplished the following: reduced rate of elective delivery before 39 weeks of gestation to 0% year to date for 2013, required completion of an electronic fetal monitoring course by 100% of the obstetricians to standardize communication between physicians and nurses, standardized Pitocin administration for induction and augmentation; implemented a postpartum hemorrhage protocol and emergency cart that reduced the system‐wide postpartum hemorrhage rate from 0.82% in the first quarter of 2012 to 0.73% in the first quarter of 2013; decreased cesarean delivery surgical site infection rate from 0.27% in the first quarter of 2012 to 0.15% in the first quarter of 2013; and instituted an obstetric laborist program to ensure patient safety and teamwork by January 2013. Implications for Nursing Practice As quality initiatives continue to drive patient care processes, it is imperative to involve nursing staff, physicians, and members of other disciplines. The current environment calls for everyone caring for patients to step outside of silos and collaborate as a global team. Though perinatal core measures are important, the next step is implementing nurse‐driven quality measures to improve perinatal quality and patient safety. In February 2012, the Roper St. Francis Healthcare (RSFH) Perinatal Quality and Patient Safety Collaborative was formed to replace the Perinatal Care Committee. The committee functioned as a reporting mechanism of adverse events instead of a way to examine clinical competency, data analysis, process improvement, and evidence‐based practice. Taking a proactive rather than a retrospective approach, RSFH Perinatal Quality and Patient Safety Collaborative pulled an interdisciplinary team of physicians, nurses, and staff to ensure that care was patient centered, effective, safe, and evidence based. The development of a Perinatal Quality and Patient Safety Collaborative is a relatively new concept in perinatal care because of the differences in models of nursing care, organization resources of data collection and staff, and cultural and regional norms of accepted practice. The RSFH Perinatal Quality and Patient Safety Collaborative is transforming health care by meeting national and organization best practice standards and are committed that each patient and her family receive the best care they deserve. Lean methodology was used by the clinical nurse specialist (CNS) and clinical informatics specialist (CIS), who were trained in Six Sigma. The charter was developed by the CNS and CIS, and a team of the service line director and two physician champions for quality and patient safety was formed to address the initiatives to standardize care across a three hospital system. Since its conception, the Perinatal Quality and Patient Safety Collaborative has effectively accomplished the following: reduced rate of elective delivery before 39 weeks of gestation to 0% year to date for 2013, required completion of an electronic fetal monitoring course by 100% of the obstetricians to standardize communication between physicians and nurses, standardized Pitocin administration for induction and augmentation; implemented a postpartum hemorrhage protocol and emergency cart that reduced the system‐wide postpartum hemorrhage rate from 0.82% in the first quarter of 2012 to 0.73% in the first quarter of 2013; decreased cesarean delivery surgical site infection rate from 0.27% in the first quarter of 2012 to 0.15% in the first quarter of 2013; and instituted an obstetric laborist program to ensure patient safety and teamwork by January 2013. As quality initiatives continue to drive patient care processes, it is imperative to involve nursing staff, physicians, and members of other disciplines. The current environment calls for everyone caring for patients to step outside of silos and collaborate as a global team. Though perinatal core measures are important, the next step is implementing nurse‐driven quality measures to improve perinatal quality and patient safety.