Purpose for the Program
Caring for complex obstetric patients presents many challenges to obstetric nurses. Current evidence indicates that maternal mortality rates and near misses are increasing. According to the Centers for Disease Control and Prevention, chronic health conditions, such as hypertension, diabetes, and obesity are increasing and place women at higher risk of complications or adverse outcomes during pregnancy and delivery. Research has shown that approaches to reduce risk involve identifying those at high risk and using multidisciplinary care planning to optimize outcomes. Limited communication between nurses and obstetricians regarding high-risk patients leads to nurses feeling frustrated and ill prepared. A proactive versus reactive approach to managing these patients is needed.
To create a mechanism to facilitate interdisciplinary communication and develop an individualized plan of care to promote patient safety, and improve patient and nurse satisfaction. A multidisciplinary High-Risk Obstetrics Committee (HROC) was formed to facilitate interdisciplinary communication and collaboration. High-risk patients were identified before admission and an individual plan of care was developed that was aimed at promoting patient safety.
Implementation, Outcomes, and Evaluation
The Labor & Delivery Shared Decision Making Council recognized the need for identifying and planning care for high-risk patients. The Iowa Model for Evidence-Based Practice guided implementation. HROC membership included nurses, obstetricians, perinatologists, neonatologists, anesthesiologists, management, and other specialties. Meetings were held monthly to plan care of future patients and evaluate outcomes of delivered patients. Set criteria helped identify cases for referral, such as maternal cardiac conditions or neonatal fetal anomalies that require special needs postdelivery. Referrals came from physicians and nurses during antepartum checks. New cases were presented, discussed, and recommendations from various disciplines were used to develop an optimal plan of care, which was shared with appropriate staff. Postdelivery cases also were reviewed to evaluate outcomes and determine opportunities for improvement. Since July 2009, 140 patients have been referred. Feedback from staff has been positive regarding the following: improved communication and coordination of care, increased nurse confidence, ability to research rare conditions before patient arrival, include patients in multidisciplinary care conferences, and offer NICU tours. Policy changes, which also have been recommended, have led to system improvements.
Implications for Nursing Practice
Planning care for patients with known high-risk conditions can prevent near misses and decrease morbidity and mortality for the mother and infant. Communication is key in providing quality patient care and creating a culture of safety.