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Integration of a Mental Health Professional in a Multidisciplinary Team Caring for the Pregnant Woman after Diagnosis of Fetal Anomaly
I N N O VAT I V E P R O G R A M P O S T E R S Proceedings of the 2015 AWHONN Convention
How Our Hospital Successfully Reduced Cesarean Rates Purpose for the Program o demonstrate how one Washington state hospital reduced its cesarean delivery rate dramatically by implementing a Centers for Medicare & Medicaid Services (CMS)-funded project called Leading Edge Advanced Practice Topics (LEAPT) as part of a larger project to help reduce cesarean births regionally and nationally.
T
Proposed Change To decrease the rate of cesarean births, the project, which occurred from December 2013 to December 2014, involved labor and induction management tools/bundles and patient education.
Implementation, Outcomes, and Evaluation The tools were piloted, revised, and implemented with great success. Sustained improvement occurred, and cesarean and induction rates dramatically decreased over the course of the project. An unexpected outcome was improvement in collaborative practice, registered nurse (RN) to provider communication, and better patient education around term gestation and nonmedical inductions.
Trish L. Nilsen, BSN, RNC-OB, Whidbey General Hospital/Whidbey Family Birthplace, Coupeville, WA
Implications for Nursing Practice RNs play a pivotal role in changing practice in a clinical care setting involving other providers who share management of the patient. Success celebrated by the care team can stimulate further growth and practices can then become the new norm.
Childbearing Poster Presentation
Keywords cesarean delivery reduction nonmedical induction of labor patient education interdisciplinary management of labor
Integration of a Mental Health Professional in a Multidisciplinary Team Caring for the Pregnant Woman after Diagnosis of Fetal Anomaly Purpose for the Program regnancy is a time of psychologic change for women and their families. Even women with uncomplicated pregnancies report increased rates of depression, stress, and anxiety during the perinatal period. In addition, maternal mental health conditions may complicate 13% to 25% of all healthy pregnancies. The prenatal diagnosis of a fetal structural or genetic abnormality may further compound the psychologic effect on the pregnant woman. The Center for Fetal Diagnosis and Treatment and the Garbose Family Special Delivery Unit are outpatient and inpatient programs dedicated to caring for women experiencing pregnancies complicated by fetal anomalies. With increasing evidence that prenatal stress, anxiety, and preexisting mental health conditions may have long-term sequelae for the pregnant woman, her fetus, and the family, it was imperative that these concerns be addressed.
P
Proposed Change To add a mental health professional to our multidisciplinary team. Philanthropic funding was generated and a clinical psychologist with perinatal experience was hired in 2012. This embedded provider partners with nursing staff and is in the unique position to offer assessment and immediate intervention to support women and families
S18
during the prenatal course, into intrapartum care, and throughout the postpartum period while their newborns are in the neonatal intensive care unit (NICU). Implementation, Outcomes, and Evaluation To better understand the base rate of maternal mental health risks, the psychologist initiated a standardized screening tool to identify those expectant mothers and fathers at greatest risk of psychologic distress in response to the diagnosis of fetal abnormality. The goal of screening is to provide prenatal intervention at the earliest possible point in care to reduce symptoms in the postpartum period. Patients demonstrating risks of depression, anxiety, or traumatic stress are connected to therapeutic services offered in the same location as prenatal care. Nursing staff continue to evaluate patient well-being during routine prenatal care and can make direct referrals to the psychologist as needed. Implications for Nursing Practice Nurses are ideally situated to provide familycentered obstetric care for these women and their families. A woman’s preexisting mental health diagnosis or an acute psychologic challenge related to the fetal anomaly may entail a higher level of psychosocial intervention than nurses are trained
JOGNN, 44, S6-S40; 2015. DOI: 10.1111/1552-6909.12664
Susan R. Miesnik, MSN, RNC-OB, CRNP, The Children’s Hospital of Philadelphia, Philadelphia, PA Joanna CM Cole, PhD, CD (DONA), The Children’s Hospital of Philadelphia, Philadelphia, PA Tyra Jones, RNC-OB, MSN, CRNP, The Children’s Hospital of Philadelphia, Philadelphia, PA Keywords perinatal mood disorders fetal anomalies perinatal psychology maternal mental health psychosocial nursing
Childbearing Poster Presentation
http://jognn.awhonn.org
Miesnik, S. R., Cole, J. C. M., and Jones, T.
I N N O VAT I V E P R O G R A M P O S T E R S Proceedings of the 2015 AWHONN Convention
to provide. Close collaboration between the nurse and the mental health professional ensures that
obstetric management will be coordinated with psychologic care to optimize outcomes for the woman and her family.
Reducing Infection Rates after Cesarean Birth Cindra S. Holland, DNP, Purpose for the Program RNC-OB, ACNS-BC, Kettering he purpose of this innovative educational proMedical Center, Kettering, OH gram was to implement changes to reduce the and Wright State University, rate of infection after cesarean at a Midwestern reDayton, OH
T
gional health care facility. From 2011 to 2013, this rate ranged from 0.62% to 1.23%. Clearly, there is Katie Adkins, BSN, RNC-MNN, Kettering Medical an upward trend in the rate of infection that needs to be managed to decrease postoperative infecCenter, Kettering, OH tions. Peggy Foster, MSN, RNC-OB, C-EFM, Kettering Medical Center, Kettering, OH Deborah Ulrich, PhD, RN, Wright State University, Dayton, OH Kim Job, BSN, cEFM, Kettering Medical Center, Kettering, OH Jessica Akemon, MS, RN, Kettering Medical Center, Kettering, OH
Proposed Change To implement standardized preoperative and postoperative education for all women who have cesarean births. Implementation, Outcomes, and Evaluation The interdisciplinary, evidence-based practice (EBP) project involved physicians, nurses, and staff in obstetric offices and nurses and educators in the labor and delivery and postpartum units. A retrospective chart review was conducted of women who experienced infections after cesarean for 99 variables. No common variables were iden-
tified regarding etiology of postcesarean delivery infections. A review of the literature was conducted, and patient education was identified as an intervention that affected infection rates. The interdisciplinary team created standardized preoperative instructions and standardized postoperative instructions that include an educational pamphlet and DVD. The projected program outcome is a decrease in the rate of infection after cesarean at the facility. Project outcomes will be measured by tracking infection rates quarterly and yearly. Preimplementation and postimplementation outcome data will be compared. Implications for Nursing Practice It is important that nurses are educated on how to identify best practices to provide consistent education to women from the time they decide on cesarean birth to discharge. It is imperative that nurses know how to implement best practices to improve patient outcomes. Reduced rates of infection will also reduce cost and morbidity associate with cesareans.
Keywords cesarean postoperative infection patient education
Childbearing Poster Presentation
Notification of Obstetric Emergency Nan Ybarra, MBA, BSN, RN, NEA-BC, Texas Children’s Hospital Pavilion for Women, Houston, TX Keywords OB emergency notification patient safety
Childbearing Poster Presentation
Purpose for the Program mergency activation models relied on the nurse pressing the nurse call button and requesting help, vocally calling out for help, and then relying on a person to notify each team member needed in the response effort. This meant that other staff had to be able to hear and respond to a nurse’s calls, and nonclinical personnel had to be available to relay medical information to physicians and other care team members. The response was unfocused and highly variable.
E
Proposed Change To implement swift notification of team response in obstetric (OB) emergencies using a cap code
JOGNN 2015; Vol. 44, Supplement 1
pager team and smart panel technology already available in every patient room and operating rooms. Response buttons were built for massive transfusion protocol (MTP) team response, emergency cesarean delivery (ECD) team response, and stat anesthesia team response. The team members on the response teams will vary slightly, but the recurring members on the MTP and ECD team include emergency response nursing staff from the labor and delivery unit. These nurses will carry pagers and phones that will alert them to the location of the patient and type of code response. Notification to all the various medical team members will mirror the same process, pager, and phone notification. The most vital change involves
S19
How Our Hospital Successfully Reduced Cesarean Rates Purpose for the Program o demonstrate how one Washington state hospital reduced its cesarean delivery rate dramatically by implementing a Centers for Medicare & Medicaid Services (CMS)-funded project called Leading Edge Advanced Practice Topics (LEAPT) as part of a larger project to help reduce cesarean births regionally and nationally.
T
Proposed Change To decrease the rate of cesarean births, the project, which occurred from December 2013 to December 2014, involved labor and induction management tools/bundles and patient education.
Implementation, Outcomes, and Evaluation The tools were piloted, revised, and implemented with great success. Sustained improvement occurred, and cesarean and induction rates dramatically decreased over the course of the project. An unexpected outcome was improvement in collaborative practice, registered nurse (RN) to provider communication, and better patient education around term gestation and nonmedical inductions.
Trish L. Nilsen, BSN, RNC-OB, Whidbey General Hospital/Whidbey Family Birthplace, Coupeville, WA
Implications for Nursing Practice RNs play a pivotal role in changing practice in a clinical care setting involving other providers who share management of the patient. Success celebrated by the care team can stimulate further growth and practices can then become the new norm.
Childbearing Poster Presentation
Keywords cesarean delivery reduction nonmedical induction of labor patient education interdisciplinary management of labor
Integration of a Mental Health Professional in a Multidisciplinary Team Caring for the Pregnant Woman after Diagnosis of Fetal Anomaly Purpose for the Program regnancy is a time of psychologic change for women and their families. Even women with uncomplicated pregnancies report increased rates of depression, stress, and anxiety during the perinatal period. In addition, maternal mental health conditions may complicate 13% to 25% of all healthy pregnancies. The prenatal diagnosis of a fetal structural or genetic abnormality may further compound the psychologic effect on the pregnant woman. The Center for Fetal Diagnosis and Treatment and the Garbose Family Special Delivery Unit are outpatient and inpatient programs dedicated to caring for women experiencing pregnancies complicated by fetal anomalies. With increasing evidence that prenatal stress, anxiety, and preexisting mental health conditions may have long-term sequelae for the pregnant woman, her fetus, and the family, it was imperative that these concerns be addressed.
P
Proposed Change To add a mental health professional to our multidisciplinary team. Philanthropic funding was generated and a clinical psychologist with perinatal experience was hired in 2012. This embedded provider partners with nursing staff and is in the unique position to offer assessment and immediate intervention to support women and families
S18
during the prenatal course, into intrapartum care, and throughout the postpartum period while their newborns are in the neonatal intensive care unit (NICU). Implementation, Outcomes, and Evaluation To better understand the base rate of maternal mental health risks, the psychologist initiated a standardized screening tool to identify those expectant mothers and fathers at greatest risk of psychologic distress in response to the diagnosis of fetal abnormality. The goal of screening is to provide prenatal intervention at the earliest possible point in care to reduce symptoms in the postpartum period. Patients demonstrating risks of depression, anxiety, or traumatic stress are connected to therapeutic services offered in the same location as prenatal care. Nursing staff continue to evaluate patient well-being during routine prenatal care and can make direct referrals to the psychologist as needed. Implications for Nursing Practice Nurses are ideally situated to provide familycentered obstetric care for these women and their families. A woman’s preexisting mental health diagnosis or an acute psychologic challenge related to the fetal anomaly may entail a higher level of psychosocial intervention than nurses are trained
JOGNN, 44, S6-S40; 2015. DOI: 10.1111/1552-6909.12664
Susan R. Miesnik, MSN, RNC-OB, CRNP, The Children’s Hospital of Philadelphia, Philadelphia, PA Joanna CM Cole, PhD, CD (DONA), The Children’s Hospital of Philadelphia, Philadelphia, PA Tyra Jones, RNC-OB, MSN, CRNP, The Children’s Hospital of Philadelphia, Philadelphia, PA Keywords perinatal mood disorders fetal anomalies perinatal psychology maternal mental health psychosocial nursing
Childbearing Poster Presentation
http://jognn.awhonn.org
Miesnik, S. R., Cole, J. C. M., and Jones, T.
I N N O VAT I V E P R O G R A M P O S T E R S Proceedings of the 2015 AWHONN Convention
to provide. Close collaboration between the nurse and the mental health professional ensures that
obstetric management will be coordinated with psychologic care to optimize outcomes for the woman and her family.
Reducing Infection Rates after Cesarean Birth Cindra S. Holland, DNP, Purpose for the Program RNC-OB, ACNS-BC, Kettering he purpose of this innovative educational proMedical Center, Kettering, OH gram was to implement changes to reduce the and Wright State University, rate of infection after cesarean at a Midwestern reDayton, OH
T
gional health care facility. From 2011 to 2013, this rate ranged from 0.62% to 1.23%. Clearly, there is Katie Adkins, BSN, RNC-MNN, Kettering Medical an upward trend in the rate of infection that needs to be managed to decrease postoperative infecCenter, Kettering, OH tions. Peggy Foster, MSN, RNC-OB, C-EFM, Kettering Medical Center, Kettering, OH Deborah Ulrich, PhD, RN, Wright State University, Dayton, OH Kim Job, BSN, cEFM, Kettering Medical Center, Kettering, OH Jessica Akemon, MS, RN, Kettering Medical Center, Kettering, OH
Proposed Change To implement standardized preoperative and postoperative education for all women who have cesarean births. Implementation, Outcomes, and Evaluation The interdisciplinary, evidence-based practice (EBP) project involved physicians, nurses, and staff in obstetric offices and nurses and educators in the labor and delivery and postpartum units. A retrospective chart review was conducted of women who experienced infections after cesarean for 99 variables. No common variables were iden-
tified regarding etiology of postcesarean delivery infections. A review of the literature was conducted, and patient education was identified as an intervention that affected infection rates. The interdisciplinary team created standardized preoperative instructions and standardized postoperative instructions that include an educational pamphlet and DVD. The projected program outcome is a decrease in the rate of infection after cesarean at the facility. Project outcomes will be measured by tracking infection rates quarterly and yearly. Preimplementation and postimplementation outcome data will be compared. Implications for Nursing Practice It is important that nurses are educated on how to identify best practices to provide consistent education to women from the time they decide on cesarean birth to discharge. It is imperative that nurses know how to implement best practices to improve patient outcomes. Reduced rates of infection will also reduce cost and morbidity associate with cesareans.
Keywords cesarean postoperative infection patient education
Childbearing Poster Presentation
Notification of Obstetric Emergency Nan Ybarra, MBA, BSN, RN, NEA-BC, Texas Children’s Hospital Pavilion for Women, Houston, TX Keywords OB emergency notification patient safety
Childbearing Poster Presentation
Purpose for the Program mergency activation models relied on the nurse pressing the nurse call button and requesting help, vocally calling out for help, and then relying on a person to notify each team member needed in the response effort. This meant that other staff had to be able to hear and respond to a nurse’s calls, and nonclinical personnel had to be available to relay medical information to physicians and other care team members. The response was unfocused and highly variable.
E
Proposed Change To implement swift notification of team response in obstetric (OB) emergencies using a cap code
JOGNN 2015; Vol. 44, Supplement 1
pager team and smart panel technology already available in every patient room and operating rooms. Response buttons were built for massive transfusion protocol (MTP) team response, emergency cesarean delivery (ECD) team response, and stat anesthesia team response. The team members on the response teams will vary slightly, but the recurring members on the MTP and ECD team include emergency response nursing staff from the labor and delivery unit. These nurses will carry pagers and phones that will alert them to the location of the patient and type of code response. Notification to all the various medical team members will mirror the same process, pager, and phone notification. The most vital change involves
S19