Journey to Zero Birth Injury: Improving Outcomes, Sustaining Gains
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, page S14, June 2012
How to Cite
Sommerness, S. A. and Gams, B. (2012), Journey to Zero Birth Injury: Improving Outcomes, Sustaining Gains. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S14. doi: 10.1111/j.1552-6909.2012.01359_12.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- birth trauma;
- birth injury;
- perinatal bundle;
- team building;
- high reliability team;
- in situ simulation;
- perinatal safety;
- multidisciplinary team
Purpose for the Program
Adverse outcomes in perinatal settings are a relatively rare occurrence but may have devastating consequences. To mitigate adverse outcomes, key strategies generally include standardization of care, communication and teamwork, physician engagement on multidisciplinary teams, and metrics. Initiatives incorporating bundle science to standardize daily operations have been successful in reducing birth trauma.
Key nursing and medical leadership proposed a system-wide multidisciplinary strategy to change the culture of safety by incorporating the Institute for Healthcare Improvement (IHI) perinatal bundles at all six hospitals in the health care system. Advanced practice nurse leaders directed the process of standardizing evidence-based practices related to induction and augmentation of labor and the use of the vacuum extractor, including order sets, policies, criteria for induction of labor, management of oxytocin, and patient education. A sustainable infrastructure set the teams on a trajectory for further initiatives, including the Management of Second Stage of Labor Guideline and the Management of Diabetes in Pregnancy and Postpartum Consensus Guideline.
Implementation, Outcomes, and Evaluation
Physician and nursing engagement is supported by leadership, which affirms the importance of partnerships in dialogue and decision making, professional autonomy and accountability for improving outcomes, and commitment to continued learning. Data are collected monthly to measure process compliance with all three IHI perinatal bundles. Clinical outcomes are measured quarterly by the perinatal adverse outcome index. Overall, all six hospitals are experiencing an annual decrease in the adverse outcome index since the implementation of standardized practices in 2009. The Zero Birth Injury multidisciplinary team engages in transparency by sharing their experiences from in situ simulation training debriefs or adverse events.
Data are shared with all disciplines and are posted on the hospital web site. Action plans to address upward trending, in particular adverse outcomes, are developed and implemented.
Implications for Nursing Practice
Birth injury, though infrequent, is traumatic for the family and the health care team. Nurses are often at the forefront of safety initiatives and are often the last defense to prevent harm to the patient. However, changing organizational culture to focus on patient safety is difficult without a multidisciplinary team approach. At any level, nurses incorporating evidence-based care, standardized communication, and teamwork concepts are integral to high reliability teams and reap the rewards of improved outcomes.