Nowhere is reliable, evidence-based care more important than in the obstetrics suite. Yet infants in the U.S. experience nearly three birth injuries for every 1,000 deliveries, many of which are preventable. Additionally, the U.S. ranks near the bottom of industrialized nations in infant mortality. These statistics are alarming and unacceptable.
Whats more, long-term implications can be devastating, causing lifelong disabilities that often end up in court with enormous liability verdicts.
To address this troubling issue, 16 hospitals from 12 states have collaborated with leading perinatal-care experts and the Premier healthcare alliance. These hospitalslarge and small, urban and rural, teaching and nonteachingare participating in the Perinatal Safety Initiative, a project designed to achieve consistent delivery of evidence-based care with the goal of eliminating preventable birth-related injuries and deaths. Project participants will comprehensively measure and document the steps and impact of the project, broadly sharing findings so that America can someday lead the world in the lowest incidence of birth-related injury.
Recent research suggests that miscommunication and other preventable factors contribute to a number of injuries sustained by some mothers and newborns during labor and delivery. Researchers believe that many of these cases can be prevented through the use of high-reliability healthcare teamsdoctors, nurses, nurse midwives and others who consistently provide patient care using evidence-based clinical guidelines. This collaborative is designed to increase teamwork and effective communications among perinatal teams.
Research has also shown that grouping essential processes together, or care bundling, helps clinical staff remember to take all the necessary steps to provide optimal care to every patient, every time. Although many hospitals have long followed these practices to improve outcomes in childbirth, the key is consistently using all the practices in concert. The care bundles are in adherence to published best practices and national standards established by leading womens health groups, such as the American College of Obstetricians and Gynecologists and Association of Womens Health, Obstetric and Neonatal Nurses.
Care-bundle use is scored in an all-or-none fashion; the care team must provide all elements of care in the bundle to be successful. For example, the goal of one care bundle is to reduce the risks associated with the drug Oxytocin, which is commonly used to accelerate a slow labor. This bundle has four elements that must be used consistently. If a team neglects to estimate the fetal weight before administering the medication, for example, it would not receive credit for the work, even if team members successfully implement the three other elements of the bundle.
Defining success in this fashion encourages doctors and nurses to work together and find new ways to consistently provide the right care for each patient.
To be prepared to take appropriate action during worst-case scenarios, especially during emergency situations and patient hand-offs between team members, simulations are conducted for certain high-risk protocols.
One example is Situation Background Assessment Recommendation-based communications. Originally designed for the militarythe U.S. Navy Nuclear Submarine Service used the tool as an effective situational briefing strategySBAR is a process by which relevant case facts are communicated clearly among team members in a respectful, focused and effective manner, especially during an urgent situation. SBAR is often used during nurse-to-physician communication or at the change of shift.
Another simulation exercise entails the use of mannequins to practice management of perinatal crisis situations. In fact, a pair of hospitals in the Texas Health Resources system has taken this exercise to a new level. They are using a simulated patient, named Mama Noelle, that has been programmed to do anything and everything a patient might do during the birthing process. Mama Noelle curses, screams and even gives birth to a Baby Hal. Texas Health Resources obstetric teams use this amazing technology to prepare for every possible scenario.
To help direct this collaborative and ensure project transparency, participants will benefit from the feedback from an advisory committee made up of recognized visionaries and opinion leaders in healthcare with a specific focus on perinatal care. The purpose of this committee is to provide a venue for open discussion and feedback regarding the initiative. Participants will look to the expertise of the committee to help determine clinical and quality best practices. Advisory committee members include the American College of Obstetricians and Gynecologists and Association of Womens Health, Obstetric and Neonatal Nurses, as well as the Institute for Healthcare Improvement and the National Association of Pediatric Nurse Practitioners.
Even one birth injury creates significant emotional trauma and costs everyone involvedpatients and families as well as hospital staff. By changing the way they work together, doctors and nurses are striving to eliminate preventable birth injuries. We are hopeful that all hospitals will take notice of this project, which will translate better teamwork into better care, and, ultimately, healthy and safe mothers and babies.