AWHONN’s Perinatal/Neonatal Risk Assessment Survey (PRAS)

1. AWHONN’s Perinatal/Neonatal Risk Assessment Survey (PRAS) Now Features Peer-To-Peer Review for Both Nurses and Physicians

2. Presentation Objectives • What is AWHONN’s PRAS? • PRAS Process Overview • Why Select AWHONN? • How to Get PRAS for Your Facility

3. What is AWHONN’s PRAS?

4. AWHONN’s Perinatal/Neonatal Risk Assessment Survey • PRAS is a powerful quantitative performance improvement analysis that promotes the development of safer perinatal and neonatal units. • PRAS is designed to assist an institution with the early identification of areas prone to medical/clinical errors and to make recommendations that may minimize these potential errors. • PRAS features peer-to-peer review: • Nurses review Nurses • Physicians review Physicians—NEW!

5. PRAS Objectives During the PRAS, the Consultant(s) will: • Evaluate performance against standards and guidelines, thereby ensuring patient safety. • Establish performance expectations for your perinatal and/or neonatal patient care units. • Recommend methods to improve patient care and enhance patient safety. • Identify evidence-based resources to guide clinical practice. • Highlight areas of outstanding performance. • Provide hospital administrators, managers and staff with objective data that support ongoing quality improvement.

6. PRAS Process Overview

7. PRAS Overview • A hospital will contract with AWHONN to provide the PRAS. • The hospital will then begin the PRAS, which includes three distinct components: • A self-report package completed by the facility prior to Consultant visit, including: • Demographic data forms, nurse/physician collaborative practice questionnaire, quality/risk assessment questionnaire, list of documentation reviewed • A two-day on-site consulting analysis (may be longer if required) • A comprehensive written report that: • Highlights areas of success • Identifies performance problems • Provides recommendations for safe, effective and efficient solutions

8. On-site visit • Consultant(s) spends approximately two days on-site in order to: • Interview key administrative, nursing, medical and risk management leaders, which may include • OB/Neonatal Nurse Managers and Educators/CNS • Director of Women Services • Risk Managers/Patient Safety Officers • Medical Directors of Obstetrics, Neonatology and Quality Assurance • Staff Physicians and Residents/Interns • CNO, COO, CEO • Review open and closed medical records, policies, procedures and protocols • Lead a staff nurse and physician forum • Assess orientation and continuing education/licensure process, including annual competency program • Tour units and observe work flow • Review other aspects of care as requested by Client or as needed

9. Final Report • Completed by Consultant(s) immediately after site visit, and delivered to Client approximately 6-12 weeks after on-site visit. • Extremely comprehensive and objective; includes: • Executive summary • On-site consultation assessment and review with each finding listed with its respective conclusion and recommendation for correction/improvement (see slides 11-13 for sample). • Review of practices and areas that the facility is doing well. • Self-report review and analysis of the quality-risk assessment and nurse-physician collaborative practice survey • Key references, including on-line references and resources

10. Sample Final Report **The next series of slides are sample excerpts from a final report** Background Information: • Hospital ABC is a 263-bed facility with Level II obstetrical and nursery services. The hospital performed 1758 births in 200X and performs approximately 1400 outpatient obstetric procedures or tests per year. The labor and delivery service consists of 9 LDRP rooms, 10 postpartum beds, a 3 bed triage area and a treatment room. The OR suite consists of 2 operating rooms and 2 recovery beds. The Nursery has 28 bassinets/beds and provides care for Level I and Level II infants. • An underlying concern evident during all of the interviews with nursing staff, administrative staff and physicians was the need for better communication among practitioners.

11. Sample Final Report The significant areas of riskin perinatal care identified during this survey include: • Inadequate electronic fetal monitoring system that is outdated and frequently not working properly • Need for improved communication between nurses and practitioners (**this will be discussed in the next few slides) • Reports of inappropriate nurse and physician behavior resulting in intimidation of nursing staff • Lack of specific patient care protocols and policies for at-risk obstetrical patient situations, including shoulder dystocia, obstetrical emergent conditions and maternal codes • Confusion surrounding the role of the urgent OB physician • Incorrect interpretation of electronic fetal monitoring tracings • Inconsistent evaluation of fetal well-being prior to induction/augmentation of labor and pitocin administration • Incomplete documentation of nursing care • No staff access to practitioner privileges • Incomplete nursing personnel files

12. Sample Final Report: Findings Significant area of risk: Need for improved communication between nurses and practitioners Findings • There is clear evidence of administrative and management support for facilitating excellent patient care through collaborative relationships. • Every interview conducted identified the need for better nurse-physician relationships and collaboration. • The role of the Urgent OB is unclear to staff and is not carried out consistently by the physicians in that role. • Nurses do not feel that all nurses and some physicians they work with listen to their opinions or views. Staff also state that inappropriate behaviors by certain nurses and some physicians have led to feelings of intimidation and fear. • Nursing staff and physicians stated that nursing teamwork and nurse/physician teamwork is an area needing improvement.

13. Sample Final Report: Recommendations • Proper communication that promotes a multidisciplinary collaborative practice will decrease errors, enhance patient outcomes, and promote not only patient satisfaction but nursing and physician staff satisfaction as well. • Recommendation 23: Develop a nurse-physician communication committee to address issues and discuss ways to promote collaborative practice and mutual respect. Include staff nurse involvement in this committee. • Recommendation 24: Institute a “zero-tolerance” policy that prohibits inappropriate and intimidating behaviors and that includes consequences for such behaviors.

14. Sample Final Report: Recommendations • The Institute of Medicine recommends team training to ensure excellence in clinical practice. Communications, both verbal and written, are critical factors to patient safety. The 200X National Patient Safety Goals by JCAHO include improving effectiveness of communication among caregivers. Various techniques can enhance the communication process, particularly in emergent situations, thereby reducing liability as patient needs are met in a timely, coordinated fashion. • Recommendation 25: Formulate team-training sessions, including various communication techniques, such as charge nurse skills, working with difficult people, workload evaluation and shift reviews. • Conduct shift reviews at the end of each work day to evaluate workload and enhance team concept. • Evaluate coverage system and consider instituting an on-call system to optimize human resources, thereby permitting more flexibility. • Implement regular staff meetings to discuss issues identified and to allow for sharing of information. • Reward staff efforts at teamwork and provide incentives for continued improvement.

15. Why Select AWHONN?

16. Why Select AWHONN? • Credible: • AWHONN is the standard bearer and internationally recognized member organization for perinatal and neonatal nursing. • Patient Safety Focused: • The AWHONN Consulting Group’s service goals are to improve patient safety and expand the knowledge base of healthcare providers in order to deliver safer, more effective patient care. • Collaboration: • ACG collaborates with Physician partners for the development and delivery of the review. • Expertise and Experience: • ACG began conducting surveys in 1998 throughout the US and Canada, and has the expert Nurse and Physician Consultants to meet your facility’s unique needs.

17. How to Get PRAS for Your Facility If you are concerned about reducing medical errors, increasing patient safety and creating a culture of communication and collaboration in your facility, contact the AWHONN Consulting Group now about conducting the PRAS in your perinatal and neonatal units—it’s the best way to protect your patients, staff and facility: 202-261-2432 or acg@awhonn.org fees vary by hospital size