IOL < 39 weeks initiative

May 2012

Patricia McAfee, RN, MSN

Why the need for initiative?

Although we are not talking about infants this small

Infants close to term can be placed at risk

H&HN Faily

Estimated up to 10% of all U.S. deliveries are induced before 39 weeks

April

26, 2012

Recognized as an issue of growing concern

ACOG working on initiative since 1979 National Quality Forum; 2008 Joint Commission; 2009 Institute of Healthcare Improvement; 2010 March of Dimes supporting with toolkit California Maternal Quality Care Collaborative “Quality Care for Moms & Babies Act” of 2011

(H.R. 3620)

Our plan

Investigate the issueInvestigated the issue:

identified we could do better.

Informed physicians at OB-section meeting we were going to monitor IOL <39 weeks for medical indications.

Developed & empowered

Developed a tool to use at time of scheduling

Empowered nurses to ask for indications.

Designed & monitoredDesigned variance report for data collection.

Monitored several months to trend behavior.

Reporting findingsBegan reporting findings at OB-section meetings.

Section Chairman, Ramani, Physician Champion

Our results

Performance IndicatorsPerformance Indicators

©2010. pmcafee

Department/Committee: Maternal Child Health Nursing Year: 2010/11

Volume Measures/Statistics

L&D Jul Aug Sep Oct Nov Dec Jan Feb Mrc Apr May Jun YTD

# of deliveries 184 203 197 201 187 216 191 197 157 163 170 191 2257

HMC preterm rate =

US preterm rate = 12.2% in 2009; www.childbirth.com)

information retrieved 3/2011

21

11%

22

10.5%

18

9%

16

7.8%

27

14.%

24

10.8%

21

10.8%

24

12%

13

7.9%

21

12%

23

11.8%

# of live births 181 204 197 201 191 213 189 196 157 164 171 191

Nurse deliveries 5 0 0 3 4 0 1 3 1 4 1

Induction rate 31% 31% 30% 30% 25% 28% 24% 25% 23% 28% 24.7 29%

# of inductions < 39 weeks/

(% W/medical indication)

6

50%

6

67%

6

83%

8

75%

7

86%

15

40%

7

72%

2

100%

3

100%

4

100%

2

100%

5

100%

July 2011-March 2012 PERFORMANCE indicators

Department/Committee: Maternal Child Health Division Revised 4/17//2012 p.mcafee Year: 2011-2012

Volume Measures/Statistics July 11

Aug Sept Oct Nov Dec

2011

Jan

2012

Feb Mrch Apr May June total

L&D Jul Aug Sep Oct Nov Dec Jan Feb Mrc Apr May Jun Totals

# of deliveries from QS 191 187 174 161 159 175 180 152 194

# of live births 192 187 174 162 162 175 179 153 192

PHH preterm rate =

(US preterm rate = 12.2% in 2009; www.childbirth.com) information retrieved 3/2011

5%

5%

7%

14.8

11.6%

15.6%

12.7%

7.79%

28

14.2%

Nurse deliveries 5 4 5 1 1 3 2 3 2

Induction rate 28% 30% 30% 30.4 26.4% 26.2 25% 32.8% 26.8%

# of total inductions 48 49 48 49 42 46 46 50

# of failed inductions

Failed induction %

6

12.5%

12

24.4%

4

8%

9

18%

7

16%

8

17%

4

.08%

9

18%

11

21%

# of inductions < 39 weeks/

(% WITH medical indication)

1

100%

1

100%

4

100%

1

100%

2

100%

4

100%

2

100%

4

100%

0

n/a

Improvement achieved

• IOL < 39 weeks reduced from 6-8/ month to 2-4/month; with many months at one

• Documentation of approved medical indication improved from 40-50% to 100%

• DRAMATIC improvement seen in December; from 15 in 2010 to 4 in 2011 with 100% meeting approved criteria

Collaboration between physicians & nurses results in improved safety

Goal: reduction of IOL < 39 weeks

w/o indication

Plan, Do,

Study, Act

Provided tools/

empowered nurses

Physician Support