Using the Strength of a System to Reduce Deliveries Prior to 39 Weeks Gestation
Version of Record 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 S88, June 2012
How to Cite
Kathman, J. K., Hansell, K. and Pyron, M. (2012), Using the Strength of a System to Reduce Deliveries Prior to 39 Weeks Gestation. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S88. doi: 10.1111/j.1552-6909.2012.01361_49.x
- Issue online: 14 JUN 2012
- Version of Record online: 14 JUN 2012
- elective deliveries prior to 39 weeks;
- collaborative network;
- evidence-based practice
Purpose for the Program
The purpose of the program was to dramatically reduce elective deliveries prior to 39 weeks gestation across a health care system of nine hospitals in the Midwest.
The proposed change was a systematic, evidence-based, reliable approach to assess and adhere to rationale for elective deliveries consistent with medical necessity. The proposed change would unfreeze the status quo, which would prepare physicians and nurses to reliably provide safe, evidence-based maternal care.
Implementation, Outcomes, and Evaluation
The change process was led by the system-wide Obstetric Practice Committee, including facility-based nurses, physicians, and system level nursing representation. Adoption potential for the change process was systematically evaluated at each facility. Strategies were designed to respect the voice of each facility while being mindful about fail-proofing the process. The existing shared governance structure was effectively used as the horizontal and vertical communication vehicle ensuring representation from the bedside to the boardroom. Early adopters shared barriers and successes to facilitate universal adoption. Inclusion of outpatient clinics and providers was essential in garnering support for this initiative.
The Obstetric Practice Committee began policy development with a draft presented in January 2010. After conferencing, audit, and feedback at the individual unit-based level, the policy was finalized in March 2010. Implementation at each hospital was championed by a core group but varied in timing because of unit-based readiness. Evidence-based practice guidelines were not negotiated, but specific implementation processes were facility-specific based on the cultural characteristics of the health care team. All hospitals achieved policy implementation, which utilized purposeful diffusion by May 2010. Initial outcomes of this system-wide practice change included dramatic drops in the number of elective deliveries prior to 39 weeks of gestation, but assessment of the extent of adoption and barriers continue. A system scorecard with sensitive, timely indicators identified through gap assessment provides ongoing opportunities to evaluate the use of the evidence-based practice policies.
Implications for Nursing Practice
Utilizing evidence-based practice guidelines decreases point of care disagreements regarding the appropriate timing of any individual delivery. This initiative prevents avoidable morbidity and mortality of mothers and infants. Purposeful development and integration techniques, communication, feedback, and policy development of the committee provide a framework for sustaining this change. This shared governance model has created a loop of accountability from bedside provider to system level leaders.