Purpose for the Program
Coordination of care for high-risk obstetric patients and their infants is vital to promoting optimal outcomes. When an obstetric patient receives a diagnosis of some form of fetal anomaly, she begins to receive close follow-up care and supervision. The patient also needs to obtain additional information about the fetal diagnosis and have questions answered. Information can be provided by prenatal consults with a neonatologist or other pediatric specialists that will be involved with the infant's care after delivery and by other personnel, such as nurses, social workers, and hospital chaplains. A coordinated plan of care promotes the exchange of information between physicians and all other healthcare professionals involved in care of the mother and infant.
To develop a comprehensive plan of care for both mother and infant. Under the direction of an obstetric geneticist at the Oklahoma University Medical Center, an interdisciplinary team was developed. All staff that might be involved with planning and coordination of care were invited to the initial meeting. A discussion was held to review the basic format of the proposed monthly meeting. All in attendance agreed to the model.
Implementation, Outcomes, and Evaluation
A spreadsheet was developed to enter each month's new patients. The data in the spreadsheet included basic demographic information, expected date of delivery, parity, fetal diagnosis, maternal issues, and the suggested plan of care. At each monthly meeting, each patient that was new to the system was discussed and ultrasound images were provided for review. Furthermore, the upcoming planned deliveries for the month were also discussed. This provided time for the multidiscipline professionals to come together and review complex cases to plan for the most comprehensive care.
The monthly meeting has now been in place for 3 years and continues to evolve. It has been very successful in providing a venue for multidisciplined healthcare professionals to be informed of the patients and provide their input into the plan of care.
Implications for Nursing Practice
Nursing leadership for women's services and the neonatal intensive care unit (NICU) attend the meetings. A weekly updated case list is used to inform of patient delivery plans and potential admissions to the NICU. This knowledge can be communicated to staff as needed and used in considering availability of beds, staffing needs, and needs for specialized staff availability for certain deliveries.