Striving to Attain High Reliability in Perinatal Services: Perinatal Safety SMART Lean Process Improvement

Abstract

<h2>Poster Presentation</h2><h3>Purpose for the Program</h3> This program addresses quality initiatives to decrease the incidence of birth trauma, enhance the culture of patient safety and teamwork, and standardize key clinical practices associated with risk of harm to mothers and infants by bringing evidence and best practice to the bedside. <h3>Proposed Change</h3> A strategic and purposeful focus on perinatal safety using a SMART Lean methodology with engagement from the perinatal team serves a critical role toward achieving high reliability in perinatal services at Lakeland Regional Medical Center (LRMC). The work of the Perinatal Safety Initiative is accomplished through multidisciplinary teams. All teams are supported by a dyad partnership, which includes an expert physician and operational/clinical leader who are in turn supported by a sophisticated team including project management, performance improvement, informatics, industrial engineering, information technology, and risk management. The Perinatal Safety Working Team provides support to the Steering and Project Teams. The Perinatal Safety Steering Team meets monthly and is comprised of a group of clinical experts (nurse leaders and physicians who represent obstetric–gynecology, neonatology, and anesthesiology) as well as key members of the Executive Team. This team provides operational oversight and decision making, driving priorities, professional practice standards, strategy, and clinical expertise for the Initiative. The Project Teams are comprised of health care providers, nurses, and other LRMC team members as appropriate. Project Team work focuses on a specific clinical opportunity and includes review of current evidence and professional practice standards, policy development, defining expectations and educational requirements, measuring progress, and providing feedback and recommendations to the Steering Team. <h3>Implementation, Outcomes, and Evaluation</h3> Outcomes measures are adverse outcome index (AOI), weighted adverse outcome score (WAOS), severity index (SI), neonatal mortality, and patient safety indication (PSI) #17: Birth Trauma; Joint Commission Measures: PC‐01 Elective Delivery and PC‐02 Cesarean Section, Agency for Healthcare Research & Quality (AHRQ) Survey on Patient Safety Culture, and Focus Studies for Bundle Compliance. Major accomplishments include a hard stop for early elective deliveries; a standardized schedule and checklist for oxytocin administration focused on uterine and fetal response; implementation of Situation, Background, Assessment, Recommendation (SBAR), and twice‐daily team briefings; an established chain of communication policy; TeamSTEPPS and simulation training; quarterly strip review; Advanced Practice Solutions (GNOSIS for electronic fetal monitoring); a newborn hyperbilirubinemia risk assessment and intervention; and an obstetric hemorrhage protocol. <h3>Implications for Nursing Practice</h3> The implications and key measures of success include the following: top leadership support; dyad partnership (medical doctor/nurse); SMART lean methodology; Steering Committee representation from key stakeholders; emphasis on evidence‐based practice, standardization with technology, and operationalizing perinatal safety.