Clinical practice guideline/policy change

In the Literature: Physiologic, evidence-based oxytocin protocol reduces tachysystole

As part of a larger program to achieve zero preventable birth injuries, this project’s goal was to avoid tachysystole or appropriately intervene when tachysystole occurred. Tachysystole is defined as more than 5 contractions in 10 minutes, averaged over a 30-minute window, and is often associated with induced or augmented labor.

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Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical practice guideline/policy change, Educational materials for health professionals, Health professions education, Improved liability system, Performance measurement, Progress, Team building on Tue., Oct 18, 2011

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From the Field: Practice Guidelines for Trial of Labor after Cesarean

As a Patient-Centered Maternity Home, two components of our Maternal-Child Health Care are evidence-based practice and shared decision-making. While ACOG guidelines are not always evidence-based, they have recently released guidelines allowing us all to offer trial of labor to women with two prior cesareans or twins. Our cesarean rate is 19% and our VBAC rate is 50%. North Carolina Medicaid is currently reimbursing cesarean birth at the same rate as vaginal birth.They were proactive in setting the rates pretty close to each other in years past.

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Filed in Clinical controversies, Clinical practice guideline/policy change, New care delivery model, Performance measurement/reporting, Scope of covered services, Shared decision making, Stories from the Field on Tue., Sep 20, 2011

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In the Literature: San Francisco General Hospital implements skin-to-skin care in the operating room for mothers and infants after cesarean surgery

The improvement team altered the process of care in the operating room to enable routine, early skin-to-skin contact after cesarean birth, with the aim of increasing the success of breastfeeding initiation.

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Filed in Blueprint, Care coordination, Clinical practice guideline/policy change, Educational materials for health professionals, Performance measurement/reporting, Team building on Thu., Aug 11, 2011

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In the Literature: Surgical checklist improves teamwork and compliance with best practice

For all scheduled cesarean deliveries, the hospital introduced a preoperative checklist to verify patient identity, indication for caesarean section, allergies, and presence of neonatology staff and a postoperative check to verify analgesia, oxytocic prescription, antibiotics, thromboprophylaxis and skin contact between mother and baby. Researchers examined staff attitudes before and after introduction of the checklists, checklist compliance, and whether patients experienced anxiety or were reassured by the process.

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Filed in Blueprint, Care coordination, Clinical practice guideline/policy change, Improved liability system, Team building on Wed., Aug 10, 2011

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From the Field: Eliminating Preventable Perinatal Injuries and Reducing Malpractice Claims and Costs: Creating High Reliability Obstetrics Units

We intend to reduce perinatal harm and decrease malpractice events by eliciting improved compliance in 4 clinical care bundles and implementation of an evidence-based simulation training methodology focused on improving clinical staff’s ability to work in teams. We are measuring our impact through a culture of safety survey and a high reliability survey, various outcomes measures.

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Filed in Blueprint, Care coordination, Clinical audit, case review, or analysis of adverse events, Clinical controversies, Clinical practice guideline/policy change, Decision making and choice, Health professions education, Improved liability system, Performance measurement, Performance measurement/reporting, Risk management/liability reform, Shared decision making, Skills training or drills for health professionals, Strategies, Team building on Mon., Aug 1, 2011

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In the Literature: At Intermountain, process improvement reduces inductions, cesareans, NICU admissions, and costs

As a result of process improvement efforts bolstered by robust information systems, the proportion of all inductions that lacked strong indications for clinical appropriateness fell from 28 percent to less than 2 percent. The project also resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that the elective induction protocol reduces health care costs in Utah by $50 million per year.

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Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical controversies, Clinical practice guideline/policy change, Health information technology, Health information technology, In the Literature, Payment reform, Performance measurement, Performance measurement/reporting on Fri., Jul 29, 2011

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From the Field: Patient Safety and Patient & Family-Centered Care

NH Patient Voices’s mission is education and advocacy for safe, quality, compassionate healthcare that puts patients & their families at the center of care in both policy and practice. Since 2005, we’ve worked tirelessly to bring the collective voice of patients to healthcare providers, administrators, legislators, public policy, and public health leaders.

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Filed in Clinical practice guideline/policy change, Community education/outreach, Consumer advocacy or political action, Decision making and choice, Educational materials for health professionals, Nursing/medical/midwifery curriculum change, Performance measurement, Performance measurement/reporting, Shared decision making, Stories from the Field on Wed., Jul 20, 2011

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From the Field: Postpartum Depression Task Force

The Postpartum Depression Task Force of Monroe County seeks to improve identification and treatment for women with perinatal mood disorders. The Task Force is a coalition of providers from all aspects of maternal-child health, including doctors, nurses, psychiatrists, psychologists, social workers, doulas, childbirth educators, hospital and medical office administrators, and consumers. Measures include attendance at continuing education events; numbers of in-services and outreach events; as well as improved identification and referral systems within the hospital as well as in the community.

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Filed in Care coordination, Clinical audit, case review, or analysis of adverse events, Clinical practice guideline/policy change, Community education/outreach, Educational materials for health professionals, Health professions education, Shared decision making, Staffing/care coordination change, Stories from the Field, Team building on Thu., Jul 14, 2011

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From the Field: Becoming a Baby Friendly Facility

We wanted to design a center where the needs of the mother and the baby come first. A place where every aspect of care is based on supporting natural birth and breastfeeding.

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Filed in Care coordination, Clinical controversies, Clinical practice guideline/policy change, Decision making and choice, Disparities, Educational materials for health professionals, Performance measurement/reporting, Shared decision making, Skills training or drills for health professionals, Staffing/care coordination change, Stories from the Field, Team building on Thu., Jul 14, 2011

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From the Field: Rattle Wraps – Patient Advocacy for Infant Caregivers

James’s Project sets out to reduce the US infant mortality rate and improve maternal health by raising awareness of patient safety issues in these areas. This is done by using the tools of education, communication and collaboration.

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Filed in Blueprint, Care coordination, Clinical practice guideline/policy change, Community education/outreach, Consumer advocacy or political action, Decision making and choice, Educational materials for health professionals, Health professions education, Risk management/liability reform, Shared decision making, Staffing/care coordination change, Stories from the Field, Strategies, Team building on Mon., Jul 11, 2011

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