Transforming the Preoperative Process for Scheduled Cesarean Deliveries Using Patient- and Family-Centered Care

Abstract

Purpose for the Program In a high-risk maternal infant program at a large, academic medical center, patients admitted to the labor and delivery unit for scheduled cesarean deliveries frequently waited hours for delivery because of priority, high-risk transports coming into the hospital. Conversely, patients awaiting transport to the University of Arkansas for Medical Sciences (UAMS) often were declined or delayed because of high census. With the institutional push toward patient- and family-centered care (PFCC), the staff was challenged to provide PFCC in light of sustained high census. Proposed Change Maternal-infant staff suggested admitting patients to the postpartum floor where they would reside after surgery instead of to the labor and delivery unit. Implementation, Outcomes, and Evaluation Patients are admitted to the postpartum unit by a preoperative nurse who starts the intravenous (IV) fluid, draws blood, performs the intake assessment, and notifies the physicians (anesthesiologist and obstetrician [OB]). Once the preoperative preparation is completed, the patient is passed to the postpartum nurse who cares for the family before and after delivery. When ready for surgery, the patient is transferred to the labor and delivery unit. After surgery, the mother recovers for 2 hours while the neonate is transitioned at her bedside. Then the mother and neonate return to the same room and nurse on the postpartum unit. From April 1 to July 1, 2013, 87 patients were routed using the new preoperative process. Continuity of nursing care for scheduled cesarean delivery patients increased PFCC, patient safety, and efficiency in the preoperative process for scheduled cesarean deliveries and emergent transports. Patients reported appreciating having a private area for the family to wait during the surgery and recovery. Postpartum leadership has applied for Institutional Review Board (IRB) approval to formally evaluate this process. Currently, patients report high levels of satisfaction with this process as reported to unit leadership in daily rounds. Implications for Nursing Practice Reorganization of traditional care delivery methods could be useful to any facility that sees the need for change to better assist the patient and her family. Nursing has recognized the need for safety, but holistic nursing requires the recognition of the importance of other concepts, such as comfort and emotion, which can positively be affected by continuity of nursing care and a comfortable, familiar environment. In a high-risk maternal infant program at a large, academic medical center, patients admitted to the labor and delivery unit for scheduled cesarean deliveries frequently waited hours for delivery because of priority, high-risk transports coming into the hospital. Conversely, patients awaiting transport to the University of Arkansas for Medical Sciences (UAMS) often were declined or delayed because of high census. With the institutional push toward patient- and family-centered care (PFCC), the staff was challenged to provide PFCC in light of sustained high census. Maternal-infant staff suggested admitting patients to the postpartum floor where they would reside after surgery instead of to the labor and delivery unit. Patients are admitted to the postpartum unit by a preoperative nurse who starts the intravenous (IV) fluid, draws blood, performs the intake assessment, and notifies the physicians (anesthesiologist and obstetrician [OB]). Once the preoperative preparation is completed, the patient is passed to the postpartum nurse who cares for the family before and after delivery. When ready for surgery, the patient is transferred to the labor and delivery unit. After surgery, the mother recovers for 2 hours while the neonate is transitioned at her bedside. Then the mother and neonate return to the same room and nurse on the postpartum unit. From April 1 to July 1, 2013, 87 patients were routed using the new preoperative process. Continuity of nursing care for scheduled cesarean delivery patients increased PFCC, patient safety, and efficiency in the preoperative process for scheduled cesarean deliveries and emergent transports. Patients reported appreciating having a private area for the family to wait during the surgery and recovery. Postpartum leadership has applied for Institutional Review Board (IRB) approval to formally evaluate this process. Currently, patients report high levels of satisfaction with this process as reported to unit leadership in daily rounds. Reorganization of traditional care delivery methods could be useful to any facility that sees the need for change to better assist the patient and her family. Nursing has recognized the need for safety, but holistic nursing requires the recognition of the importance of other concepts, such as comfort and emotion, which can positively be affected by continuity of nursing care and a comfortable, familiar environment.