Clinical Applications of the Four Perinatal Quality Initiaitves

The Institute for Healthcare Improvement’s Perinatal Improvement Community (IHIPIC) provides results-focused quality improvement support to hospital teams. Participants start with in-depth diagnostic and goal-setting processes to assess areas for improvement. The hospital then identified areas for improvement based on the clinical Microsystems assessment. The hospital targeted three areas for focused improvement: oxytocin, hemorrhage, and communication. Teams engaged in rapid testing of changes (Plan-Do-Study-Act cycle) that were shown to improve care, adapted them to their own settings, and then measured the outcomes.  Four improvement projects were identified: development of an oxytocin and hemorrhage protocols and implementation of Safety Rounds and Shift Huddle.

One of the improvement projects was to implement an Oxytocin Protocol including a revised Oxytocin Policy and Procedure and Pre-Use and In-Use Checklists. The Oxytocin Deep Dive was an in-depth chart review to obtain information on the current use of oxytocin in the institution. Using this information the institution developed and implemented the new Policy and Procedure and the Checklists. Preliminary results have shown a decrease in hours in labor for both primiparous and multiparous women, tachysystole and a slight decrease in the C/S rate. Hemorrhage Protocols and Algorithms have been well-researched and when implemented, clearly show an improvement in time to hemorrhage recognition and rescue improving maternal and neonatal outcomes as evidenced by a decrease in blood transfusions. Safety Rounds provides the opportunity for nurses, physicians and case managers to gather together and review patient data in order to develop multidisciplinary care plans for complex patients and improving communication and relationships between specialties. The Shift Huddles provide an opportunity for staff to hear report on each patient, improving care by imparting patient information to nursing staff. Staff members can ask questions about patients and offer suggestions to their colleagues related to patient care.