NYSPFP-ACOG District II Joint Webinar on Maternal Emergencies February 9, 2015 A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association
Agenda
NYSPFP and ACOG DII to Reduce Maternal Harm NYSPFP is supporting implementation of ACOG District II Safe Motherhood Initiative bundles of hemorrhage and severe hypertension through: Bimonthly(every other month) educational webinars/ coaching calls that will reinforce the clinical components of the ACOG SMI bundles and highlight process improvement that can lead to reduction in harm arising from maternal hemorrhage and hypertension. Hands-on technical support from Project Managers and ACOG District II Measure alignment measures to be submitted in NYSPFP data portal Begins with December 2015 performance period Data submission due 45 days after close of month (Feb. 15)
Safe Motherhood Initiative Update 4 February 9, 2016
NYSPFP Data Entry Wing Lee, NYSPFP 5 February 9, 2016
Summary of Measures
Data Submission: FAQs 7
Data Entry Page 8 www.nyspfp.org
Data Entry Page: Maternal Hemorrhage 9 www.nyspfp.org
Data Entry Page: Hypertension in Pregnancy 10 www.nyspfp.org
Data Entry Page: PC-01 11 www.nyspfp.org
Case Review: Maternal Hemorrhage Marina Gore, NP, CNM Perinatal Network Manager Northwell Health
HEMORRHAGE CASE
01/29/2016, 08:40
01/29/2016 AT 11:56
01/29/2016, 13:25 PACU
CONT PACU
CONT. PACU
TRANSFERRED TO SICU
SICU
LESSONS TO BE LEARNED:
LESSONS TO BE LEARNED:.
Process Improvement Case Study Deborah Tuttle, NYSPFP
PDSA Example Test #1 SMI OB Hemorrhage Risk Assessment Tables https://www.acog.org/-/media/districts/district-ii/pdfs/smi/v2/hemriskassessmentldadminintrapartum.pdf?la=en
PDSA Example Test #1(continued) Do Describe what actually happened when you ran the test. The test was conducted by two nurses for one week. Both nurses worked at least three 7am 7pm shifts and achieved a cumulative 96% hemorrhage risk assessment completion rate. Study Describe the measured results and how they compared to the predictions Test successful, but limited. Plan Retest with 3 nurses to ensure capturing effectiveness of the process 24/7, and weekends.
PDSA Example Test #2 26
PDSA Example Test #2 (continued) Do Describe what actually happened when you ran the test. The test was conducted by the three nurses on different shifts as described in the plan. The nurses who worked Monday through Friday on any shift were able to complete the risk assessment 97% of the time, but were concerned with the time it took to access another tool/screen. Saturday and Sunday results were less than 60%. Study Describe the measured results and how they compared to the predictions Weekend hours presented some challenges due to high labor and delivery volume. It was felt that if the questions were incorporated into the EHR assessment, it would flow naturally, and eliminate the need to go to another screen. Plan: All agreed process was successful and would flow well if added to EHR. Jane Smith to meet with IT to discuss incorporating risk assessment into EHR nursing assessment with input from nurses on placement and flow. IHI PDSA Worksheet: http://www.ihi.org/resources/pages/tools/plandostudyactworksheet.aspx 27
Next Steps Deborah Tuttle, NYSPFP
Polling Question o What can NYSPFP/ACOG do to better support your implementation work? o More webinars o More process improvement teaching o More information on clinical bundles o Site visits from clinical faculty o Site visit from process improvement experts o Site visits from both faculty and process improvement experts together o Other (please describe in Chat Box ) 29
Summary & Next Steps 30
Upcoming & Recorded Webinars 31 February 9, 2016
Contacts NYSPFP Contacts Lorraine Ryan, GNYHA ryan@gnyha.org Loretta Willis, HANYS lwillis@hanys.org Wing Lee, GNYHA wlee@gnyha.org ACOG District II Contacts Kristin A. Zielinski, MA, MPP Director, Medical Education kzielinski@ny.acog.org Norain A. Siddiqui, MPH Manager, Medical Education nsiddiqui@ny.acog.org Deborah Tuttle, HANYS dtuttle@hanys.org 32
Appendix: Measure Definitions for Reference 33 February 9, 2016
NYSPFP: Maternal Hemorrhage - Outcome Measure 34
NYSPFP: Maternal Hemorrhage - Process Measure* *Sampling Permitted
NYSPFP: Persistent Hypertension In Pregnancy - Outcome Measure 36
NYSPFP: Persistent Hypertension in Pregnancy - Process Measure Definitions: Persistent hypertension: two (2) severe blood pressure values taken within 15 60 minutes apart. Severe blood pressure values do not need to be consecutive Treatment: includes labetalol, hydralazine, oral nifedipine 37
NYSPFP: Early Elective Delivery (PC-01) 38