Team building

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: The Safe Motherhood Quilt Project

The Safe Motherhood Quilt Project, originated by midwife Ina May Gaskin, is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States. The Quilt honors American mothers who have died of pregnancy or childbirth related causes since 1982, the last year there was a reduction in maternal mortality.

The goal of the Safe Motherhood Quilt Project is to demand an equivalent system of counting, analyzing, and learning from mistakes made in our maternity care system here, regardless of where babies are born or what caregiver is the birth attendant. Until we do that, doctors, midwives, and nurses in the US will continue to work without a good system of feedback about what is and is not dangerous in maternity care, and preventable maternal deaths will continue to take place.

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Filed in Clinical audit, case review, or analysis of adverse events, Clinical controversies, Community education/outreach, Consumer advocacy or political action, Disparities, Educational materials for health professionals, Health information technology, Improved liability system, Performance measurement, Performance measurement/reporting, Stories from the Field, Team building on Mon., Sep 12, 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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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: Community Doula Initiative

HPC Community Doulas is a non profit 501(c) 3 maternal-infant agency dedicated to serve low income pregnant women receiving prenatal care at federally qualified health centers in Hudson County, NJ. Our grant is committed to reducing perinatal disparities in birth outcomes, so we offer free community doulas to pregnant women on Medicaid and/or enrolled in the WIC program.

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Filed in Care coordination, Community education/outreach, Decision making and choice, Disparities, Educational materials for health professionals, Health professions education, New care delivery model, Performance measurement, Shared decision making, Skills training or drills for health professionals, Stories from the Field, Team building, Workforce 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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From the Field: Call of Excellence Family Bonding Program

Alignment of care for all healthcare teams to deliver services to mother/newborn/family. Main goal is to improve direct patient communication and services from all heathcare teams by promoting family bonding in preparation for a successful discharge to home. Will begin with a survey to go to physicians, nurses and patients to define rooming in and what that means to them.

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Filed in Care coordination, Educational materials for health professionals, Shared decision making, Stories from the Field, Team building on Thu., Apr 21, 2011

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