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Emerging Content Emerging Content

Perinatal Care: General

Because content in this area is still being developed, it is posted in "document" form — and these documents will be updated as the innovation work progresses.

 

The aim of IHI's IMPACT Learning and Innovation Community on Improving Perinatal Care is to create a perinatal unit that reliably delivers care as determined by sound science, with a goal of zero preventable injury. To improve safety and reliability, what we do and how we do it must come together as the way we provide effective perinatal care. The scope of this project begins with the presentation of the woman and family to the Labor and Delivery Unit and ends with the handover to the postpartum period of care.

 

There are currently 40+ teams participating in the Learning and Innovation Community through IHI's IMPACT network. The work that is being done by these teams will be shared by IHI.

 

Teams are testing the implementation of two "bundles": the Elective Induction Bundle and the Augmentation Bundle. Successful implementation of the bundles is based on the “all or nothing” strategy, that is, teams must comply with all components of the bundle, unless medically contraindicated.

 

A prepared and activated team is essential to improve care. Teamwork and communication training prepares team members to communicate better and work together towards a common goal. Participants are trained in the principles of appropriate assertion and conflict resolution, and the use of SBAR. Case scenarios are used to develop SBAR scripts and practiced by nurses and physicians to train and test competence in the use of this method.

 

Design targets for this work include:

  • Compliance with bundles
  • Reduction of perinatal harm
  • Culture survey score
  • Improved defensibility of claims
  • Harm measurement will be based on the use of an OB Trigger Tool, currently in testing with the teams

 

Teams will also develop and test interventions to improve the management of second stage labor. Teams will continue to test the impact of the bundles and interventions as well as incorporate the use of simulation and drills.

 

Content in the Patient Safety Topic area may also be informative and useful to your perinatal care improvement efforts.
How to Improve
Measures
Changes
Tools
Literature
Other

How to Improve

Idealized Design of Perinatal Care Model
The Idealized Design of Perinatal Care Model that is currently being tested represents IHI's theory about how perinatal care could be the safest and most reliable care system.


Measures

Improving Perinatal Care Measurement Strategy
These documents reflect IHI's evolving strategy for measuring the safety of perinatal care.


Changes

Improving Perinatal Care Change Concepts and Testable Ideas
Teams participating in IHI's IMPACT Learning and Innovation Community on Improving Perinatal Care are testing these change concepts and ideas. Teams are also using these measures to track progress towards their desired aims.


Elective Induction and Augmentation Bundles
Applying the principles of reliability science as developed by IHI, teams are testing the implementation of two bundles: the Elective Induction Bundle and the Augmentation Bundle.


Tools

Algorithms for Hyperstimulation
These example hyperstimulation algorithms were developed to reliably improve the delivery of oxytocin and decrease interruptions in care.


Consent Forms for Augmentation and Induction of Labor Using Oxytocin
Incorporating the patient and family in consents for the administration of the high-alert medication oxytocin ensures that clinicians and patients are engaged in collaborative care.


Elective Labor Induction: Intermountain Healthcare Patient Information and Provider Pamphlet
Resources from Intermountain Healthcare (Salt Lake City, Utah), including guidelines for providers on elective labor induction and a patient information sheet with answers to common questions.


Augmentation Bundle Data Collection Tool
Use this data collection tool when implementing the Augmentation Bundle to measure Augmentation Bundle Compliance.


Elective Induction Bundle Data Collection Tool
Use this data collection tool when implementing the Elective Induction Bundle to measure Elective Induction Bundle Compliance.


Perinatal SBAR Tools
The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. These SBAR tools have been adapted for use in labor and delivery.


Perinatal Trigger Tool (IHI Tool)
The Perinatal Trigger Tool provides instructions for conducting a retrospective review of patient records using triggers to identify possible adverse events causing any physical harm to the infant or mother.


SBAR Technique for Communication
Teams in the Idealized Design of Perinatal Care innovation work are testing use of the SBAR (Situation-Background-Assessment-Recommendation) technique to improve their teamwork and communication.


Literature

AHRQ Fact Book: Hospitalization in the US, 2002
This fact book contains information about the incidence of neonates being in the top 10 category risk for hospitalization.


Other

Storyboard: Improving Reliability and Outcomes in the OB Suite
The storyboard, presented at the June 2006 AWHONN National Meeting, represents the collaborative work between the Institute for Healthcare Improvement, Ascension Health, and Premier, Inc., to improve perinatal care.


NIH State-of-the-Science Statement: Cesarean Delivery on Maternal Request
In March 2006, the National Institutes of Health (NIH) convened a panel of health professionals and public representatives to evaluate the available scientific evidence relative to trends in cesarean deliveries, benefits and harms, and the necessary research for making appropriate decisions.


Idealized Design of Perinatal Care Innovation Work: Q&A Document
This document was designed to explain the Idealized Design process and answer questions about the innovation work for teams participating in IHI's Idealized Design of Perinatal Care.




Related Information
Develop a Culture of Safety
Improving the Reliability of Health Care
Literature

What's New

Perinatal Trigger Tool

 

The Perinatal Trigger Tool provides instructions for conducting a retrospective review of patient records using triggers to identify possible adverse events causing any physical harm to the infant or mother.

 

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IHI Innovation Series White Paper:

Idealized Design of Perinatal Care

 

This white paper provides detail about the Idealized Design process and examines some of the initial work completed by teams in the innovation project.

 

Idealized Design of Perinatal Care white paper
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