Interprofessional Approach to Promote Patient Safety is Essential Christina Davidson MD Maternal Fetal Medicine Baylor College of Medicine Vice Chair of Quality amp Patient Safety Department of Obstetrics and Gynecology Baylor College of Medicine ID: 1039781
Download Presentation The PPT/PDF document "Obstetric Morbidity and Mortality: Why ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Obstetric Morbidity and Mortality: Why an Interprofessional Approach to Promote Patient Safety is EssentialChristina Davidson, MDMaternal Fetal Medicine, Baylor College of MedicineVice Chair of Quality & Patient Safety | Department of Obstetrics and Gynecology | Baylor College of MedicineChief Quality Officer, Obstetrics & Gynecology | Texas Children’s HospitalKristin Thorp BSN, RNC-OBAssistant Clinical Director Labor & Delivery & Women’s Assessment Center, Texas Children’s Pavilion for Women
2. ObjectivesReview most common causes of maternal mortality and morbidity in TexasReview interprofessional statewide initiatives to reduce maternal mortality/morbidityTexas Perinatal Quality CollaborativeAlliance for Innovation in Maternal Health (AIM)Levels of Maternal CareDiscuss interprofessional approaches to improve patient outcomesMaternal Early Warning System (MEWS)Safety huddlesInterprofessional debriefs
3. 3MATERNAL MORTALITYSEVERE MATERNAL MORBIDITY
4. MATERNAL MORTALITY AND SEVERE MORBIDITYUS maternal mortality: 21.1 deaths/100,000 live births (2014)US rate is increasing as every other developed country decreasesTexas maternal mortality: 34 deaths/100,000 live births (2014)79% increase in maternal mortality rate between 2010 and 2014Black women are 3–4 times more likely to die a pregnancy-related death as compared with white womenFor every 1 death there are 100 cases of severe maternal morbidity (SMM)
5. Acute myocardial infarctionAcute renal failureAdult respiratory distress syndromeAmniotic fluid embolismAneurysmCardiac arrest/ventricular fibrillationDisseminated intravascular coagulationEclampsiaHeart failure/arrest during procedure or surgeryPuerperal cerebrovascular disordersAcute Heart Failure/Pulmonary edemaSevere anesthesia complicationsSepsisShockSickle cell disease with crisisThrombotic embolismBlood transfusionConversion of cardiac rhythmHysterectomyTemporary tracheostomyVentilationWhat is Severe maternal morbidity?
6.
7.
8.
9. Top Causes of Maternal Death: During Pregnancy & Within 7 Days Postpartum9Slides from Dr. Lisa Hollier
10.
11. CALIFORNIA PREGNANCY-ASSOCIATED MORTALITY REVIEW Main E, et al. Obstet Gynecol 2015;125:938–47
12. Main et al. Pregnancy-related mortality in California. Obstet Gynecol 2015
13.
14. Interprofessional Statewide Initiatives to Reduce Maternal Mortality/Morbidity
15.
16. AIM MATERNAL SAFETY BUNDLE COMPONENTS: THE “4 R’S”Readiness – every unitIs your team ready for an emergency?Recognition – every patientHow does your team recognize patients at risk or experiencing deterioration?Response – every emergencyWhat is your team’s response to an emergency?Reporting – every unitHow does your team improve and learn?
17.
18. “The goal of regionalized maternal care is for pregnant women at high risk to receive care in facilities that are prepared to provide the required level of specialized care, thereby reduce maternal morbidity and mortality in the US.”
19. All levels required to have written guidelines or protocols for conditions that place pregnant/postpartum patient at risk for morbidity and/or mortality, including promoting prevention, early identification, early diagnosis, therapy, stabilization, and transfer. The guidelines or protocols must address a minimum of: Massive hemorrhage and transfusionObstetrical hemorrhageHypertensive disorders in pregnancySepsis and/or systemic infectionVenous thromboembolismShoulder dystociaBehavioral health disordersMaternal Levels of Care
20. Interprofessional Approaches to Improve Patient Outcomes
21. Maternal Early Warning SystemsSystem of escalation based on maternal vital signsDeveloped to facilitate timely recognition, diagnosis, and treatment for women developing critical illnessResults in bedside evaluation and communication between physician and nurse21
22.
23. Abnormal ParameterCreate multidisciplinary task force with physician and nurse champions to outline MEWS criteriaIdentify trigger(s) that will warrant responseValidate abnormal vital signsA single abnormal vital sign can reflect measurement artifactMEWS trigger should prompt immediate actionCreate multidisciplinary task force with physician and nurse champions to outline MEWS criteriaIdentify trigger(s) that will warrant responseMEWS trigger should prompt immediate actionMaternal Early WarningAbnormal parameter = prompt reporting to clinician
24. Effective Escalation Policy24
25. Effective Escalation Policy25Each organization may have different implementation plan according to hospital resources, availability of MEWS respondersSimplicity is key to success:Identify one responder roleIdentify consistent method of contactIf MEWS responder unavailable, establish backup responderSBAR, closed-loop communication for MEWS notification
26. MEWS at TCH Pavilion for WomenMEWS Trigger Criteria Systolic BP < 90 or > 160 Diastolic BP > 110 Heart Rate < 50 or > 120 Respiratory Rate < 10 or > 30 O2 Sat % on RA < 95Oliguria < 35 mL/hr for ≥ 2 hrsMaternal agitation, confusion or unresponsivenessPatient with preeclampsia reporting a non-remitting headache or shortness of breathAbnormal MEWS criteria vital sign (in red box) obtained by PCA or RNPCA immediately notifies RNVital sign repeated and verified by RNWithin 5 minutes of identifying MEWS trigger, using SBAR communication, RN notifies designated provider:L&D PGY 3 via MEWS Voalte Role for all units excluding WACWAC hospitalist via WAC MEWS Voalte Role for WACIf no answer from designated provider within 5 minutes, call another resident, Ob attending, or WAC HospitalistDesignated provider will evaluate patient at the bedside within 15 minutes of notificationDesignated provider will:Assume patient care responsibility until issue is resolved or patient is handed off to another providerReport findings to patient’s OB attendingDiscuss plan of care and additional orders with RNDifferential diagnosisPlanned frequency of monitoring & re-evaluationDiagnostic or therapeutic interventions (e.g., labs, imaging)
27. MEWS Key Points Delays in diagnosis contribute to a large portion of preventable maternal deaths and severe maternal morbidityKey components to Maternal Early Warning SystemsEarly Warning Criteria (Recognition)Bedside evaluation (Response)Prompt reporting (Reporting/Systems Learning)Local implementationIdentify triggers and debriefOutline who to notify, how to notify themInstitute back-up systems/chain of command to ensure timely evaluation27
28. Interprofessional Safety HuddlesRegularly scheduled huddles attended by Nurses and PhysiciansDiscussion can include:Patient overview“Watcher” patients, concernsMEWS callsThroughput issuesStaffing concernsDischarge barriers
29. Debriefs after Adverse EventsCases resulting in severe maternal morbidity and/or unexpected outcomes undergo debrief around time of event:Transfusion >4 units PRBCs or initiation of massive transfusion protocol (MTP)Shoulder dystociaStat cesarean Maternal or neonatl codeNeonatal total body coolingEclamptic seizureUnanticipated peripartum hysterectomyDebrief participants include all staff and providers involved in patient's care Purpose: identify improvement opportunities related to policies, processes, knowledge or systems in a non-punitive environmentGoal: uncover areas that, if addressed, could improve care or prevent adverse outcomes for future patients in a similar situation; highlight best practices
30.
31. Thank You!