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Eliminating E lective D eliveries < 39 Weeks

Eliminating E lective D eliveries < 39 Weeks. Habersham Medical Center Kelly J. Allen, RN, BSN, RNC. Habersham Medical Center. Acute Care Hospital Licensed for 53 Bed Average Daily Census 24 Family Birthing Center Annual Census 450/yr. Level II Nursery Community Wellness Program

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Eliminating E lective D eliveries < 39 Weeks

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  1. Eliminating Elective Deliveries < 39 Weeks Habersham Medical Center Kelly J. Allen, RN, BSN, RNC

  2. Habersham Medical Center • Acute Care Hospital Licensed for 53 Bed • Average Daily Census 24 • Family Birthing Center • Annual Census 450/yr. • Level II Nursery • Community Wellness Program • Long Term Care for 84 Residents • HCMC Home Health Agency • Six Physician Practice Offices

  3. Mission Statement • Habersham Medical Center’s mission is to provide high quality, caring in a compassionate, professional and economical manner to all persons in Habersham County and adjacent areas.

  4. Established • How to determine “due date” • Brain development between 36-40 weeks. • Why it is important to wait 39 weeks to deliver • Organ growth • Vision and hearing impairment • Weight/warmth • Suck and swallow

  5. In the beginning… • 2006 HMC Blue Cross Blue Shield Quality Initiative for Perinatal Care (Joined 6 months into the active year)

  6. Perinatal Care 1 • - Does your hospital have a policy in place prohibiting elective deliveries prior to 39 weeks gestation? • (including elective C-Sections)

  7. Perinatal Care 2 • - Does your hospital have a policy in place requiring the use of ACOG recommended DVT/VTE prophylaxis for patients undergoing cesarean section delivery?

  8. Perinatal Care 3 • Does your hospital have a policy in place adopting ACOG recommendations for the appropriate use of corticosteroids for patients experiencing labor/birth prior to 34 weeks gestation?

  9. Perinatal Care 4 • - Does your hospital have a policy in place that requires bilirubin level screening of all infants prior to post-delivery discharge?

  10. POLICY • 2006-2012 • HMC identified our policy stated we did not perform elective deliveries <39 weeks but did not allow for the outliers related to best practice/ ACOG standards.

  11. GOAL- Revise Process- Step One

  12. Step Two

  13. Step Three

  14. Step Four • DO: • Describe what actually happened when you ran the test of change. • Found our documentation did not meet the expectation of our policy. • Found no screening tool available at the time the elective delivery was being scheduled.

  15. Step Five • STUDY: • Describe the measured results and how they compare to the predicted results. • After the implementation of the scheduling procedure, it brought a more focus on the policy. • Documentation improvement noted after revision of the policy and scheduling procedure.

  16. Step Six • ACT- • Describe what changes to the plan will be made for the next cycle from what you learned • All inductions are required to sign an Induction Instructions Form explaining the potential risks and benefits of Labor Induction. • Hardwiring the process into our education program would sustain the progress. • Including the monitoring of deliveries to the Credentialing and Privileging process. • 100% <39 week deliveries are reviewed.

  17. Community Education • Commercial • Supporting March of Dimes (making a change in national perception) • March of Dimes commercial educates the public the need to let the baby fully grow up to 39 weeks. • HMC Instruction Sheet supports the March of Dimes public commercial.

  18. Education • Incorporate standards into Family Birthing Center’s initial orientation and annual orientation. • Review 100% <39 week delivery for appropriateness of care and medical indications for delivery. • Provide staff feedback.

  19. Administrative Involvement • Send CEO, CFO, and Sr. VP Patient Care Treatment Services OB Adverse Event Data via email. • Place on Administration’s Communication Board. • Place on Family Birthing Center’s Communication Board. • Manage up the Family Birthing Center’s good work in meetings with leadership.

  20. “Objective” • Eliminate all non-medically indicated deliveries less than 39 weeks by January 1st, 2013.

  21. In conclusion… • Zero elective deliveries < 39 weeks gestation x 6 months. • Average APGAR at the 5 minute post birth check = 9 • 2012 HMC has had 7 transports to higher level of care: • 29 week with No Prenatal Care • 35.4 LUGR • 37.3 Labor-gastroschisis • 28.6 NRFHT’s • 36 & 38 week PIH • 38.2 Active Labor • HMC continues to improved outcomes save lives!

  22. New Beginnings…

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