Improving Safety Through Collaboration: The Interdisciplinary Perinatal Practice Committee Jean Salera-Vieira, MS, PNS, APRN-CNS, RNC-OB, C-EFM Kent Hospital Warwick, Rhode Island
Also known as Using the perinatal safety literature to guide practice change Thank the perinatal safety advocates and leaders Debra Bingham Holly Kennedy Audrey Lyndon Lisa Miller Kathleen Rice Simpson
Setting the stage What we know: Communication remains as one of the top three reasons for sentinel events Potential increase in risk when not following evidence-based guidelines and professional standards of care Time issues Want to provide the best care for patients Recommendations from the literature
Needs assessment Needed an opportunity for nursing and providers to come together Time to review current professional organization standards and scientific literature
Barriers Perception Already follow the standard of care. I know what s best for my patients. Time constraints Too many meetings on the calendar New idea
Engagement of stakeholders Formal and informal leaders Champions of change RNs and providers Administration support
IPPC Members Perinatal CNS Nursing Obstetric providers (MDs, DOs, CNMs) Neonatology providers (MDs, NNPs) Family practice resident Risk management Medical education Nursing administration Attendance at each meeting varies from 8 to 20 attendees.
How do we get everyone there?
Benefits PERCEIVED Improved communication Strengthening collaboration Use of research and EBP into practice Input into proposed changes on the unit Professional growth TANGIBLE Nursing contact hours CME for Providers Risk Management credits RISK REDUCTION IMPROVED PATIENT SAFETY
Expectations Homework Current nursing and medical research Updated professional reports and guidelines Environment and structure Open discussion Lively conversation Invites learning
First topic
The work of the IPPC Standardization of oxytocin orders Continued random audits show adherence to change Postpartum hemorrhage Collaborative development of PPH algorithm Creation of PPH kit Quantification of blood loss Delayed Cord Clamping Created algorithm for providers and nursing
The work of the IPPC Infant weight loss related to maternal intrapartum fluid intake Breastfeeding and marijuana Consistent planning and education Hypertension in pregnancy
Hardwired into Practice Nursing reports improved communication at the bedside now feels empowered to be part of the changes in practice on the unit Providers using order sets, and following policies and algorithms created by the IPPC Members of IPPC communicate collaboratively outside of the committee
Sustainability Culture of Safety IPPC viewed as the format to discuss and vet practice changes Created an environment that strives to decrease risk to patients with increased collaboration and communication
Next steps Bringing the IPPC to the system level System-side interdisciplinary round table
Our mission The Interdisciplinary Perinatal Practice Committee (IPPC) will be an interdisciplinary committee that will examine scientific literature and evidence based guidelines about a particular topic. Recent literature, practice guidelines from ACOG, AWHONN, AAP, etc as well as current Kent practice will be reviewed during the meetings. By examining the most scientific, peer reviewed literature and professional organization standards, we will be focusing on patient safety, risk reduction, and best practice at the bedside. Collaborative discussion will be held around the selected topic to obtain nursing and medical staff input into suggested practice changes. Practice guidelines/proposals may be developed based on the discussions of the meetings.
Thank you jsalera@carene.org
References Lyndon, A., & Kennedy, H. P. (2010). Perinatal Safety: From concept to nursing practice. The Journal of Perinatal and Neonatal Nursing, 24(1), 22-31. Miller, L. (2005). Patient safety and teamwork in perinatal care: Resources for clinicians. The Journal of Perinatal and Neonatal Nursing, 19(l), 46-51. Simpson, K. R. (2011). Perinatal patient safety and quality. The Journal of Perinatal and Neonatal Nursing, 25(2), 103-107. Simpson, K. R., & Lyndon, A. (2009). Clinical disagreements during labor and birth: How does real life compare to best practice? The American Journal of Maternal Child Nursing, 34(1), 31-39. Simpson, K. R., James, D. C., & Knox, G. E. (2006). Nurse-physician communication during labor and birth: Implications for patient safety. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35(4), 547-556. Simpson, K. R., Kortz, C. C., & Knox, G. E. (2009). A comprehensive perinatal patient safety program to reduce preventable adverse outcomes and costs of liability claims. The Joint Commission Journal on Quality and Patient Safety, 35(11), 565-574.