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Implementation of a Standardized, Evidence-Based Protocol to Triage Women in Preterm Labor
INNOVATIVE PROGRAMS Proceedings of the 2017 AWHONN Convention
Promoting the Progress of Labor With the Peanut Ball Yolanda Alvarado, BA, RNC- Purpose for the Program OB, Kaiser Panorama City and o implement a health promotion program to California State University use the Peanut Ball to facilitate the progress Dominguez Hills, Chatsworth, of labor. CA
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Proposed Change Hospital birth has restrictions that may impede progress of labor. To counteract the effects of inactivity and horizontal birth positions and achieve health benefits for the mother and fetus, we Angelica Menchaca, BSN, RN, recommend use of the Peanut Ball. Lauren Outland, DrPH, MSN, CNM, California State University Dominguez Hills, Carson, CA Kaiser Panorama City and Chamberlain College of Nursing, Downers Grove, IL
Niki Strong, BSN, RNC-ON, Kaiser Panorama City and Chamberlain College of Nursing, Downers Grove, IL
Implementation, Outcomes and Evaluation All women in labor who meet the inclusion critical are offered the opportunity to use the Peanut Ball,
which is a 45 80 cm ball, shaped like a peanut. The ball is placed between the woman’s legs to increase the width of the pelvic diameter. Nurses promote women’s self-efficacy through demonstration. Monthly assessment of cesarean rates and length of second stage of labor after adoption show a decrease in the length of labor at this stage of data collection. Implications for Nursing Practice The Peanut Ball is an inexpensive and effective way to potentially reduce the rate of cesarean birth. Sharing our experience with others may help to disseminate this innovation.
Keywords Peanut Ball labor cesarean health promotion
Obstetric Poster Presentation
Implementation of a Standardized, Evidence-Based Protocol to Triage Women in Preterm Labor Mandi Roos, BSN, Northern Michigan University, Marquette, MI
Purpose for the Program o improve health care outcomes by standardizing care for women in preterm labor.
Erika Osier, BSN, RNC-OB, C-EFM, Upper Peninsula Health Systems Marquette, Marquette, MI
Proposed Change To implement a standardized care model to reduce transfers from outlying facilities, increase cost savings, and improve patient outcomes for the studied region.
Keywords evidence-based standardized protocol preterm birth quality improvement
Obstetric Poster Presentation
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Implementation, Outcomes and Evaluation At a Midwestern, level III hospital with a regional NICU and 700 annual births, a preterm labor (PTL) assessment toolkit was implemented and data were collected before and after the implementation. The toolkit contains a health care provider algorithm and order set for triage of women in preterm labor. A chart audit was completed from a convenience sample of 91 women who were at 24–34 weeks gestation and coded as threatened PTL patients. Initial postimplementation data were then collected
JOGNN 2017; Vol. 46, Supplement 3S
after 6 months from 37 patients using the same criteria. Key measures were outlined. In comparison to preimplementation results, postimplementation findings showed increased numbers of sterile vaginal and speculum examinations, doubled fetal fibronectin collection, and increased cervical length measurements. The disposition to decision time decreased from nearly 13 hours to 3 hours, and a decrease in steroid and tocolysis therapy was noted. Implications for Nursing Practice Standardized PTL assessment protocols have been found to reduce preterm birth rates, decrease costs, and are supported by the American College of Obstetricians and Gynecologists. Furthermore, these protocols have been found to result in a more timely diagnosis and prevent the overtreatment of pregnant women who are not in true PTL.
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Promoting the Progress of Labor With the Peanut Ball Yolanda Alvarado, BA, RNC- Purpose for the Program OB, Kaiser Panorama City and o implement a health promotion program to California State University use the Peanut Ball to facilitate the progress Dominguez Hills, Chatsworth, of labor. CA
T
Proposed Change Hospital birth has restrictions that may impede progress of labor. To counteract the effects of inactivity and horizontal birth positions and achieve health benefits for the mother and fetus, we Angelica Menchaca, BSN, RN, recommend use of the Peanut Ball. Lauren Outland, DrPH, MSN, CNM, California State University Dominguez Hills, Carson, CA Kaiser Panorama City and Chamberlain College of Nursing, Downers Grove, IL
Niki Strong, BSN, RNC-ON, Kaiser Panorama City and Chamberlain College of Nursing, Downers Grove, IL
Implementation, Outcomes and Evaluation All women in labor who meet the inclusion critical are offered the opportunity to use the Peanut Ball,
which is a 45 80 cm ball, shaped like a peanut. The ball is placed between the woman’s legs to increase the width of the pelvic diameter. Nurses promote women’s self-efficacy through demonstration. Monthly assessment of cesarean rates and length of second stage of labor after adoption show a decrease in the length of labor at this stage of data collection. Implications for Nursing Practice The Peanut Ball is an inexpensive and effective way to potentially reduce the rate of cesarean birth. Sharing our experience with others may help to disseminate this innovation.
Keywords Peanut Ball labor cesarean health promotion
Obstetric Poster Presentation
Implementation of a Standardized, Evidence-Based Protocol to Triage Women in Preterm Labor Mandi Roos, BSN, Northern Michigan University, Marquette, MI
Purpose for the Program o improve health care outcomes by standardizing care for women in preterm labor.
Erika Osier, BSN, RNC-OB, C-EFM, Upper Peninsula Health Systems Marquette, Marquette, MI
Proposed Change To implement a standardized care model to reduce transfers from outlying facilities, increase cost savings, and improve patient outcomes for the studied region.
Keywords evidence-based standardized protocol preterm birth quality improvement
Obstetric Poster Presentation
T
Implementation, Outcomes and Evaluation At a Midwestern, level III hospital with a regional NICU and 700 annual births, a preterm labor (PTL) assessment toolkit was implemented and data were collected before and after the implementation. The toolkit contains a health care provider algorithm and order set for triage of women in preterm labor. A chart audit was completed from a convenience sample of 91 women who were at 24–34 weeks gestation and coded as threatened PTL patients. Initial postimplementation data were then collected
JOGNN 2017; Vol. 46, Supplement 3S
after 6 months from 37 patients using the same criteria. Key measures were outlined. In comparison to preimplementation results, postimplementation findings showed increased numbers of sterile vaginal and speculum examinations, doubled fetal fibronectin collection, and increased cervical length measurements. The disposition to decision time decreased from nearly 13 hours to 3 hours, and a decrease in steroid and tocolysis therapy was noted. Implications for Nursing Practice Standardized PTL assessment protocols have been found to reduce preterm birth rates, decrease costs, and are supported by the American College of Obstetricians and Gynecologists. Furthermore, these protocols have been found to result in a more timely diagnosis and prevent the overtreatment of pregnant women who are not in true PTL.
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