Team based strategy to improve compliance with national safety & practice guidelines
Abstract Number: S-11
Abstract Type: Original Research
Objective: Although Joint Commission and The American Congress of Obstetrics & Gynecology (ACOG) have published numerous practice guidelines geared to improving safety as well as maternal & perinatal outcomes, compliance remains a significant challenge. We sought to develop a multi-disciplinary team-based perinatal strategy though education, monitoring and implementation of tools geared to improving compliance.
Materials and Methods:
A multi-disciplinary team consisting of Anethesia and Obstetrical attendings, residents and nursing was established to improve and monitor compliance with Joint Commission and ACOG perinatal safety and practice guidelines. These guidelines include eliminating elective delivery before 39 weeks; administering correct pre-operative antibiotic and DVT prophylaxis; appropriate use of antenatal steroids, and performing an pre-induction/augmentation checklist (evaluation of fetal heart rate, Bishop score, pelvic adequacy, uterine contraction pattern and estimated fetal weight) to ensure safe utilization of these techniques. A strategy was developed to include educating physicians and nurses regarding these professional practice guidelines, monitor compliance monthly, review non-compliant cases, change order sets to include mandatory prompts for antibiotics/DVT prophylaxis, require Maternal-Fetal-Medicine clearance for deliveries prior to 39 weeks and re-educate staff regarding areas of non-compliance.
Results: A total of 2792 deliveries were evaluated and reviewed from August 2010 to June 2011. Over the time period, elective deliveries without a medical indication dropped from 3.1% to 0. The percent of patients receiving antibiotic prophylaxis prior to cesarean increased from 94% to 99%. DVT prophylaxis improved from 2.7% to 87.3%. The percent of physicians performing all the required elements of the pre-induction/augmentation checklist before utilizing these management techniques rose from 34% to 92.5%. Documentation regarding pelvic adequacy and estimated fetal weight had the most opportunity for improvement (69% and 53% compliance respectively). Although all pre-term patients received antenatal steroids, the percent of patients with appropriate documentation improved but fluctuated from 53% to 93%. In addition, surgical site infections dropped from 1% to 0.63% with a direct cost savings of approximately $4100 over the time period.
Conclusions: Implementation of a multi-disciplinary team approach including residents, Anesthesia and Obstetrical attendings and nurses can be utilized successfully to develop, implement and monitor a perinatal safety strategy geared towards improving compliance with Joint Commission and ACOG practice guidelines.