- Email: [email protected]
Maternity Preadmission Program
Cavin-Wainscott, L. R. and Nigro, S. R.
INNOVATIVE PROGRAMS Proceedings of the 2010 AWHONN Annual Convention
Nancy Hamilton, BSN, Perinatal, University of California, Irvine, Medical Center,
and symptoms, distraction was noted to have one of the best evidences of e⁄cacy (Morgan & Jorm, 2008).
Austin, M., Tully, L., & Parker, G. (2007). Examining the relationship between antenatal anxiety and postnatal depression. Journal of A¡ective Disorders, 101(1-3), 169-174.
Orange, CA
Childbearing
REFERENCES
The response style theory of reaction to negative life events (Nolen-Hoeksema, 1991) predicts that those who ‘‘ruminate’’ on their depressed mood will amplify depressed feelings. Those who use distraction in response to their depressed mood will attenuate these feelings. Our goal is to assist our patients to avoid a ruminative reaction to their problem pregnancy and to provide them with meaningful distraction tools. We have designed a three-prong approach. ‘‘Wini’’ provides Internet access, ‘‘Wally’’ is a cart designed to play downloadable audible library books (the local library has over 2,000 titles), and ‘‘Wanda’’ is a wandering cart loaded with books, movies, and crafts.
Brandon, A.,Trivedi, M., Hynan, L., Miltenberger, P., Labat, D., Rifkin, J., et al. (2008). Prenatal depression in women hospitalized for obstetric risk. Journal of Clinical Psychiatry, 69(4), 635-643. Dennis, C., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123(4), e736-e751. Field, T., Diego, M., & Hernandez-Reif, M. (2006). Prenatal depression effects on the fetus and newborn: A review. Infant Behavior and Development, 29(3), 445-455. Lee, A., Lam, S., Sze Mun Lau, S., Chong, C., Chui, H., & Fong, D. (2007). Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology, 110(5),1102-1112. Marcus, S. (2009). Depression during pregnancy: Rates, risks and consequencesçMotherisk Update 2008. Canadian Journal Clinical Pharmacology, 16(1), e15-e22. Morgan, A., & Jorm, A. (2008). Self-help interventions for depressive disorders and depressive symptoms: A systematic review. Annals General Psychiatry, 7, 13.
We plan to evaluate our program in two ways: by our Intelligent Survey scores and by evaluating our patients’ response to questionnaires speci¢cally designed for this purpose.
Nolen-Hoeksema, S. (1991). Responses to depression and their e¡ects on the duration of depressive episodes. Journal Abnormal Psychology, 100(4), 569-582.
Maternity Preadmission Program Poster Presentation Lisa Renee Cavin-Wainscott, RNC, MSN, ARNP, CPST, The Birth Place and Women’s Health, Olathe Medical Center, Olathe, KS
Susan Renee Nigro, RNC, BSN, The Birth Place and Women’s Health, Olathe Medical Center, Olathe, KS
ive obstetricians and nine family practice physicians average 130 deliveries monthly in our 29-bed labor/delivery/recovery/postpartum (LDRP) unit. Pediatricians and family practitioners expressed frustration with the large number of patients consistently assigned to them during their on-call rotations. We had also experienced repeated problems in receipt/storage of prenatal records from delivering physicians. Unit leadership had already been considering a preadmission program. Hospital administrators willingly endorsed such a program to help combat both of these physician-related issues.
F
Childbearing Structure for the program was ¢rst established, and basic components included a physical space to conduct the visits, a job description and budgeted position, a dedicated phone line, and computer access to electronic patient records. Logistic components included a method of identifying patients at de¢ned gestations, transfer of prenatal records to the preadmission coordinator, a written process of scheduling appointments, conducting
JOGNN 2010; Vol. 39, Supplement 1
and documenting visits, and performance improvement tracking and evaluation. A chart form was created to document educational items addressed in the visit. An accompanying teaching guideline was developed as an orientation tool for the newly created position. The job description required that the candidate be an obstetric nurse or a certi¢ed childbirth instructor so she would be able to address most concerns about the delivery experience. A prenatal breastfeeding assessment tool was also developed to help identify patients that could bene¢t from advice or intervention from a lactation consultant prior to hospitalization. Multiple resource lists and pamphlets were collated and updated to be readily available during visits for patients with special concerns such as adoption, paternity assignment, multiple gestations, or other discharge planning needs. Hospital consents and other forms were identi¢ed for completion during preadmission visits and listed for reference and creation of preadmission packets. The Public Relations Department helped create a £yer for patient distribution in physician o⁄ces.
S21
INNOVATIVE PROGRAMS Proceedings of the 2010 AWHONN Annual Convention
The new Preadmission Coordinator, the Director, and the Clinical Nurse Specialist of the Maternity Department met with physician o⁄ce managers individually to establish a plan for identifying patients and to explain the goals of the program. We began the program with patients from the physician group with the highest number of deliveries and added other o⁄ces in phases over a period of 6 months. Prior to the program’s inception, the rate of infants assigned to the pediatrician on call was 30%. After 6 months of a part-time program, the pediatrician on-call rate decreased to 15%. One year after im-
plementing the program and 6 months following the inclusion of all delivering physicians, the on-call rate dropped to 11%. Complaints about missing prenatal records are now few and far between. Approximately 65% of all delivering patients are now attending a preadmission appointment. The position has been increased from a part- to full-time. Appointment scheduling transferred from the Preadmission Coordinator to a centralized scheduling department. The major value of this program is documented in the highly positive evaluations from participants. Patients and nurses appreciate the expedience of completing necessary paperwork upon admission.
Prenatal Care: The Beginning of a Lifetime Poster Presentation nfant mortality has long been an indicator of overall community health. Currently, the United States ranks 31st of developed nations in infant mortality, falling behind South Korea, Cuba, Czech Republic, and many others. Although infant mortality is a very complex problem, prenatal care is one variable that can in£uence the health of moms and babies and therefore improve infant mortality.
I
The current health care delivery system challenges providers of prenatal care. Providers are expected to do more with less: see more patients despite their greater needs. Evidenced-based care is critical to deliver in all disciplines of medicine, and the American College of Obstetricians and Gynecologists (ACOG) has recommended prenatal care guidelines that are the standard of care. Even so, many standards of prenatal care are omitted due to not enough time, not enough people/resources, lack of patient understanding, ine⁄ciency of o⁄ce practice, and accidental mistakes. Omission of any aspect of care can be costly, whether because of patient dissatisfaction, poor maternal or fetal outcome, and/or a lawsuit. Standardized prenatal care is essentially a protocol for the interdisciplinary team of prenatal care health care workers to ‘‘hardwire’’ into practice. The goal is to improve quality of care and perinatal outcomes by reducing errors and allowing for succinct,
S22
e⁄cient delivery of prenatal care. Prenatal Care: The Beginning of a Lifetime was a pilot program designed to integrate a standardized template of prenatal care into everyday practice at three di¡erent practice sites. When nurses and doctors were approached about the program, they felt that this was already the care that they were delivering. However, chart reviews revealed that none of the charts met criteria for the standardized model. Taking into account the obstacles providers face with time, personnel, and ¢nances, the goal was to implement standardized prenatal care as e⁄ciently and cost-e¡ectively as possible. One hundred and ¢fty patients were enrolled in the program in three di¡erent groups varying with the level of involvement of the coordinator. The coordinator met with each participant to explain the pilot program and discuss a notebook of information about pregnancy. The coordinator was available to assist providers with whatever care needs presented, including referral to appropriate community resources of all participants. Clinic sta¡ and providers were surveyed to assess their knowledge about and satisfaction with the intervention.
Kelly Herger Dixon, MSN, WHNP, Improving Prenatal Care Grant, Moses Cone Health System, Greensboro, NC
Lynne Porter Lewallen, PhD, RN, CNE, School of Nursing, Parent-Child Department, The University of North Carolina at Greensboro, Greensboro, NC
Childbearing
A program such as Prenatal Care: The Beginning of a Lifetime is a culture change, and nurses are key to coordinating this e¡ort for the patients and the providers. This article discusses the implementation of the program and o¡er suggestions to nurses in outpatient clinics on ways to implement standardized prenatal care in institutions.
JOGNN, 39, S19-S41; 2010. DOI: 10.1111/j.1552-6909.2010.01119.x
http://jognn.awhonn.org
INNOVATIVE PROGRAMS Proceedings of the 2010 AWHONN Annual Convention
Nancy Hamilton, BSN, Perinatal, University of California, Irvine, Medical Center,
and symptoms, distraction was noted to have one of the best evidences of e⁄cacy (Morgan & Jorm, 2008).
Austin, M., Tully, L., & Parker, G. (2007). Examining the relationship between antenatal anxiety and postnatal depression. Journal of A¡ective Disorders, 101(1-3), 169-174.
Orange, CA
Childbearing
REFERENCES
The response style theory of reaction to negative life events (Nolen-Hoeksema, 1991) predicts that those who ‘‘ruminate’’ on their depressed mood will amplify depressed feelings. Those who use distraction in response to their depressed mood will attenuate these feelings. Our goal is to assist our patients to avoid a ruminative reaction to their problem pregnancy and to provide them with meaningful distraction tools. We have designed a three-prong approach. ‘‘Wini’’ provides Internet access, ‘‘Wally’’ is a cart designed to play downloadable audible library books (the local library has over 2,000 titles), and ‘‘Wanda’’ is a wandering cart loaded with books, movies, and crafts.
Brandon, A.,Trivedi, M., Hynan, L., Miltenberger, P., Labat, D., Rifkin, J., et al. (2008). Prenatal depression in women hospitalized for obstetric risk. Journal of Clinical Psychiatry, 69(4), 635-643. Dennis, C., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123(4), e736-e751. Field, T., Diego, M., & Hernandez-Reif, M. (2006). Prenatal depression effects on the fetus and newborn: A review. Infant Behavior and Development, 29(3), 445-455. Lee, A., Lam, S., Sze Mun Lau, S., Chong, C., Chui, H., & Fong, D. (2007). Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology, 110(5),1102-1112. Marcus, S. (2009). Depression during pregnancy: Rates, risks and consequencesçMotherisk Update 2008. Canadian Journal Clinical Pharmacology, 16(1), e15-e22. Morgan, A., & Jorm, A. (2008). Self-help interventions for depressive disorders and depressive symptoms: A systematic review. Annals General Psychiatry, 7, 13.
We plan to evaluate our program in two ways: by our Intelligent Survey scores and by evaluating our patients’ response to questionnaires speci¢cally designed for this purpose.
Nolen-Hoeksema, S. (1991). Responses to depression and their e¡ects on the duration of depressive episodes. Journal Abnormal Psychology, 100(4), 569-582.
Maternity Preadmission Program Poster Presentation Lisa Renee Cavin-Wainscott, RNC, MSN, ARNP, CPST, The Birth Place and Women’s Health, Olathe Medical Center, Olathe, KS
Susan Renee Nigro, RNC, BSN, The Birth Place and Women’s Health, Olathe Medical Center, Olathe, KS
ive obstetricians and nine family practice physicians average 130 deliveries monthly in our 29-bed labor/delivery/recovery/postpartum (LDRP) unit. Pediatricians and family practitioners expressed frustration with the large number of patients consistently assigned to them during their on-call rotations. We had also experienced repeated problems in receipt/storage of prenatal records from delivering physicians. Unit leadership had already been considering a preadmission program. Hospital administrators willingly endorsed such a program to help combat both of these physician-related issues.
F
Childbearing Structure for the program was ¢rst established, and basic components included a physical space to conduct the visits, a job description and budgeted position, a dedicated phone line, and computer access to electronic patient records. Logistic components included a method of identifying patients at de¢ned gestations, transfer of prenatal records to the preadmission coordinator, a written process of scheduling appointments, conducting
JOGNN 2010; Vol. 39, Supplement 1
and documenting visits, and performance improvement tracking and evaluation. A chart form was created to document educational items addressed in the visit. An accompanying teaching guideline was developed as an orientation tool for the newly created position. The job description required that the candidate be an obstetric nurse or a certi¢ed childbirth instructor so she would be able to address most concerns about the delivery experience. A prenatal breastfeeding assessment tool was also developed to help identify patients that could bene¢t from advice or intervention from a lactation consultant prior to hospitalization. Multiple resource lists and pamphlets were collated and updated to be readily available during visits for patients with special concerns such as adoption, paternity assignment, multiple gestations, or other discharge planning needs. Hospital consents and other forms were identi¢ed for completion during preadmission visits and listed for reference and creation of preadmission packets. The Public Relations Department helped create a £yer for patient distribution in physician o⁄ces.
S21
INNOVATIVE PROGRAMS Proceedings of the 2010 AWHONN Annual Convention
The new Preadmission Coordinator, the Director, and the Clinical Nurse Specialist of the Maternity Department met with physician o⁄ce managers individually to establish a plan for identifying patients and to explain the goals of the program. We began the program with patients from the physician group with the highest number of deliveries and added other o⁄ces in phases over a period of 6 months. Prior to the program’s inception, the rate of infants assigned to the pediatrician on call was 30%. After 6 months of a part-time program, the pediatrician on-call rate decreased to 15%. One year after im-
plementing the program and 6 months following the inclusion of all delivering physicians, the on-call rate dropped to 11%. Complaints about missing prenatal records are now few and far between. Approximately 65% of all delivering patients are now attending a preadmission appointment. The position has been increased from a part- to full-time. Appointment scheduling transferred from the Preadmission Coordinator to a centralized scheduling department. The major value of this program is documented in the highly positive evaluations from participants. Patients and nurses appreciate the expedience of completing necessary paperwork upon admission.
Prenatal Care: The Beginning of a Lifetime Poster Presentation nfant mortality has long been an indicator of overall community health. Currently, the United States ranks 31st of developed nations in infant mortality, falling behind South Korea, Cuba, Czech Republic, and many others. Although infant mortality is a very complex problem, prenatal care is one variable that can in£uence the health of moms and babies and therefore improve infant mortality.
I
The current health care delivery system challenges providers of prenatal care. Providers are expected to do more with less: see more patients despite their greater needs. Evidenced-based care is critical to deliver in all disciplines of medicine, and the American College of Obstetricians and Gynecologists (ACOG) has recommended prenatal care guidelines that are the standard of care. Even so, many standards of prenatal care are omitted due to not enough time, not enough people/resources, lack of patient understanding, ine⁄ciency of o⁄ce practice, and accidental mistakes. Omission of any aspect of care can be costly, whether because of patient dissatisfaction, poor maternal or fetal outcome, and/or a lawsuit. Standardized prenatal care is essentially a protocol for the interdisciplinary team of prenatal care health care workers to ‘‘hardwire’’ into practice. The goal is to improve quality of care and perinatal outcomes by reducing errors and allowing for succinct,
S22
e⁄cient delivery of prenatal care. Prenatal Care: The Beginning of a Lifetime was a pilot program designed to integrate a standardized template of prenatal care into everyday practice at three di¡erent practice sites. When nurses and doctors were approached about the program, they felt that this was already the care that they were delivering. However, chart reviews revealed that none of the charts met criteria for the standardized model. Taking into account the obstacles providers face with time, personnel, and ¢nances, the goal was to implement standardized prenatal care as e⁄ciently and cost-e¡ectively as possible. One hundred and ¢fty patients were enrolled in the program in three di¡erent groups varying with the level of involvement of the coordinator. The coordinator met with each participant to explain the pilot program and discuss a notebook of information about pregnancy. The coordinator was available to assist providers with whatever care needs presented, including referral to appropriate community resources of all participants. Clinic sta¡ and providers were surveyed to assess their knowledge about and satisfaction with the intervention.
Kelly Herger Dixon, MSN, WHNP, Improving Prenatal Care Grant, Moses Cone Health System, Greensboro, NC
Lynne Porter Lewallen, PhD, RN, CNE, School of Nursing, Parent-Child Department, The University of North Carolina at Greensboro, Greensboro, NC
Childbearing
A program such as Prenatal Care: The Beginning of a Lifetime is a culture change, and nurses are key to coordinating this e¡ort for the patients and the providers. This article discusses the implementation of the program and o¡er suggestions to nurses in outpatient clinics on ways to implement standardized prenatal care in institutions.
JOGNN, 39, S19-S41; 2010. DOI: 10.1111/j.1552-6909.2010.01119.x
http://jognn.awhonn.org