Nulliparous, Term, Singleton, Vertex Cesarean, Oh My! Deciphering the Perinatal Core Measures
Article first published online: 11 JUN 2013
© 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2013 Convention Proceedings
Volume 42, Issue s1, pages S54–S55, June 2013
How to Cite
Orlosky-Novack, J. A. and Kline, S. M. (2013), Nulliparous, Term, Singleton, Vertex Cesarean, Oh My! Deciphering the Perinatal Core Measures. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42: S54–S55. doi: 10.1111/1552-6909.12130
- Issue published online: 11 JUN 2013
- Article first published online: 11 JUN 2013
- core measures;
- elective deliveries;
- cesarean deliveries;
- antenatal steroids;
- exclusive breastfeeding
Purpose for the Program
In late 2009, the Joint Commission introduced the Perinatal Care Core Measure Set as a way for hospitals to use evidence-based practice to assess quality in perinatal care. By reviewing data collected and proposing changes to the current state of care, patient safety and quality are improved. Our Women's and Children's Services department started collecting data as a way to make staff aware of how we compare nationally and to identify areas that need improvement. Performance improvement (PI) was introduced to the staff.
Data collection began using the Perinatal Core Measures as a guide. Those data were graphed, analyzed, and communicated to physicians and nurses. The goals were to decrease the rate of elective deliveries, give antenatal steroids as required, and decrease the cesarean delivery rate.
Implementation, Outcomes, and Evaluation
Data collection began in late 2011. A scheduling form for labor inductions and cesareans was developed to capture reasons for elective deliveries and cesareans and as a tracking mechanism for assistance with data collection. Triage data were used to collect antenatal steroid usage. Exclusive breastfeeding rates have also become very important in the hospital's move toward Baby Friendly designation. A staff report card was developed to see how well each person was doing to support exclusive breastfeeding. Data collection for PI was introduced to staff in a nonthreatening, simplified way.
There is a greater awareness of elective inductions among staff nurses and physicians and a better understanding of the importance of PI data collection. A preterm labor order set was developed to help remind staff about ordering and administering antenatal steroids. The elective delivery rate is decreasing since putting the scheduling criteria in place. The exclusive breastfeeding rates are increasing as all staff compete to score 100% on their breastfeeding report card.
Because we strive to have zero elective deliveries, there is still work to be done to continue to improve elective delivery rates. Educating the staff and community will help with exclusive breastfeeding rates. The core measures are a springboard from which change comes. More nurses are becoming involved in PI at the unit level.
Implications for Nursing Practice
The use of the Joint Commission Perinatal Care Core Measures helped improve communication with the staff nurses and physicians. Staff nurses learned that PI does not have to be incomprehensible. PI helps nurses keep patients safe!