Committing to Excellence in Antenatal Steroid Administration: Applying the Plan-Do-Check-Act Continuous Performance Improvement Model


Poster Presentation

Purpose for the Program

To ignite a passion in nurses to actively engage and participate in performance improvement initiatives that advance evidence-based practices.

Proposed Change

Nurses will commit to participate in ongoing performance improvement initiatives with renewed confidence from gained knowledge.

Implementation, Outcomes, and Evaluation

In 2006, concern was raised by our neonatology department that all women at risk of preterm delivery were not receiving antenatal steroids. A team of nurses, physicians, and system analysts routinely met to evaluate performance and assess for improvement opportunities. Since 2005, findings from our neonatal information system showed that 77.8% of the women who gave birth between 24 and 32 weeks gestation received at least one dose of antenatal steroids. Staff was educated and protocols established with some improvement realized (83.9% in the year 2008). Efforts to develop a key performance indicator to facilitate concurrent review of missed opportunities were initiated. In 2009, the National Quality Forum released the Perinatal Consensus Standard (PC03) supporting the National Institutes of Health recommendations to give a full course of corticosteroids to all expectant women between 24 and 32 weeks gestation. On further evaluation, numerous challenges surfaced, including the collection and accurate reporting of data (due to definitional issues of successful treatment), identification of barriers to treatment, and the need to clarify reporting parameters.

The need to refine the definition of success to accurately measure quality within the constraints of controllable variables also was identified. In October 2010, the key performance indicator was operationalized, facilitating concurrent review of identified cases of failed treatment. Staff education and awareness of the need for timely administration (within 2 hours of admission/order) was established. Utilizing the Plan-Do-Check-Act continuous performance improvement model, the percentage of mothers receiving antenatal steroids prior to giving birth to a premature newborn improved 19%, from 78% to 93% between 2005 and 2010 (per the neonatal information system data base). Additional improvements were realized with the use of the key performance indicator, correcting and supplementing the system's reporting capabilities specific to the National Quality Forum definition (successful treatment defined as administration of both doses). Monthly rates improved from 61.5% in October 2010 to 100% in July 2011 representing a 38.5% increase.

Implications for Nursing Practice

It is essential to set clear expectations and involve front line staff in promoting evidence-based practices. Plan-Do-Check-Act is a valuable tool to guide and sustain quality improvement endeavors.