Reducing Pregnancy‐Related Morbidity and Mortality by Implementing a Comprehensive Quality and Patient Safety Program Beyond the Joint Commission's Perinatal Core Measures

Abstract

Paper Presentation Purpose for the Program To reduce pregnancy‐related morbidity and mortality in a large, academic, high‐risk obstetric service in a large, free‐standing, pediatric hospital in the southwestern United States. Proposed Change To develop and implement an evidence‐based perinatal quality and patient safety program. Implementation, Outcomes, and Evaluation An interprofessional team reviewed the literature to identify evidence‐based structures and processes that were associated with increased process reliability and improved patient safety outcomes. With support and approval from senior‐level organization leaders and strong partnerships with key stakeholders, the program was implemented in the spring of 2012. Key structures included safety as a core value and nurse staffing and educational preparation. Key processes included daily safety briefs, safety rounds, interprofessional team simulation training, and adherence to evidence‐based care guidelines. To augment the quality and safety program and to address active and latent threats to patient safety identified during event debriefs and safety rounds, an interprofessional subgroup developed and implemented a massive transfusion protocol. The rate of obstetric adverse events (OBAE) was selected as the program's outcome measure. The OBAE rate is a composite measure of quality and comprises eight maternal and four fetal measures, calculated as the number of monthly deliveries complicated by one or more maternal or fetal adverse events, multiplied by 100. The baseline rate of OBAE through November of 2012 was 2.01%. During the next 12 months, despite a rapidly increasing delivery volume, the OBAE was reduced 37%. As of August 2014, the OBAE rate in this obstetric service was 1.05%, which reflects an additional 17.3% reduction. Implications for Nursing Practice Although obstetric patient care is delivered by teams, nurses are in a unique position to guide, influence, and lead quality and safety improvements. Nurses have nearly constant presences, are broadly trusted as patient advocates, and are able to identify and report early signs of compromise. Supported by a comprehensive quality and patient safety program in partnership with other key members of the obstetric patient care team, nurses can reduce pregnancy‐related morbidity and mortality.