Patients and FamiliesThe Center of CareSue Gullo, RN, MSManaging Director, IHI

History of the Perinatal Improvement ProjectNov 2004 Feb 2005 Phase I Premier launches Perinatal innovation Community with IHI Ten teams PIMS and Informatics customers March Premier and Ascension team merge

Oct 2005 Launce Phase II

Jun 2006 End Phase II

Apr 2006 IHI launches Perinatal IMPACT Comm. 50 Teams join

Fall 2006 Premier holds Advisor Live call over 2,300 call in IHI Web and Action 180 teams learn bundle implementation

Ascension Healthcare starts their effort with IHI - eight teams

Focus: Reliability and Bundle concept Simulation drills

Final Deliverables Beginnings Of a Change Concept Package for OB

PHASE I Seton Healthcare takes the lead

PHASE II

Community size increases to 26 teams

White Paper/ various articles about the project

High Reliability Team Training Primary focus is bundle compliance for the augmentation and induction bundles Managing first stage of labor Common language and communication skills

High Reliability Teams Focus on bundle compliance for the augmentation and induction bundles; introduction of a second stage of labor bundle Managing second stage of labor Teamwork and communication Measuring harm reduction

HI Perinatal Community Draft 6.12.09 Reduce harm to 5 or less per 100 live births Improve reliability of documentation to 100% Measure and Improve Patient Centered Care by 25%

Primary Drivers

Secondary Drivers1. 2. 3. 4. 1. Leadership-help establish aim & goals Senior Administration-support, sponsor Physical plant and supplies Competent trained available staff Implement the (2) oxytocin bundles and vacuum bundle. 2. Use ACOG/AWHONN guidelines for documentation. 3. Standardize administration of high alert medications- oxytocin, magnesium sulfate, epidurals. 4. Design care process improvements based on trigger tool analysis, event detection, sentinel event 1. Effective communication- SBAR, 2. Common language such as adopting NICHD criteria for fetal monitoring 3. Establish reliable techniques for handoffs 4. High risk identification and management-such as multidisciplinary huddles 5. Standardize Team Response-drills, 1.simulations Engage patients & families as partners just culture. 6. Establish a in care 2. Study patients/families preferences such as Patient/Family Focus Groups. 3. Transparent care with timely communication respectful of patients preferences 4. Include patients and families on improvement teams

Leadership/Sponsor

Reliable design Reduce variation

Effective Teamwork

Patient/family Centered care

Second Stage Safety

Consistent Patients on (across disciplines) Improvement Vacuum Bundle Credentialing Teams Standards

Collaborative And Supportive Culture

12-24 months

3 months to 36 months

Engage Patients and Families

Establish a multidisciplinary team training program

Establish Huddles, Care is transparent Multi-disciplinary rounds

9-12 monthsCommon EFM Language and Training Reduce VariationMeds, Emergencies Implement Techniques for Effective Communication Design Interventions From Trigger Tool findings

6-9 months Effective Team with Active Oxytocin Sponsor Deep DiveSenior Admin Pre-work and Board Level 1-3 months Support

Perinatal Oxytocin Bundles

Perinatal Trigger Tool 3-6 months

Two Tips Start before you are ready. When your family or friend is admitted to your facility, do you ask for care that is different (such as continuous presence of a family member at the bedside) or is it aligned with patient/family care?

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Tool- IHI Improvement Maphttp://www.ihi.org/IHI/Programs/ImprovementMap

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Builds on the great work of participants in the 100,000 Lives Campaign and the 5 Million Lives Campaign. Help us make sense of the many complex and competing demands we face. Brings together the best knowledge available on the key process improvements that will lead to exceptional hospital care. Helps hospital leaders set change agendas, establish priorities, organize work, and optimize resources. An open resource, available free of charge to anyone, anywhere. Scheduled for full launch in September 2009.

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Organizational ExamplesElliot Hospital, Manchester NH Baptist DeSoto, Southhaven MS11

We plan to change our team to an OB Patient Care Council by adding. Postpartum Unit Representative NBN Unit Representative Unit PI Representative Patient Centered Care Council Representative

Our aim and goals are: Change team to Patient Care Council by 2nd quarter of FY09 and continue meeting bi-monthly Continue to have Mock Drills quarterly and review with staff at quarterly staff meetings Implement Pro-Scheduler for all OB scheduled services by 1st quarter FY09 Develop and implement Gestational Diabetes Community Service Classes by 2nd quarter of FY09

Our plan to sequence next steps Change the meeting to Patient Care Council Improve physician participation on Patient Care Council Implement Pro-Scheduler Develop Community Service GD Class Continue to work on: documentation, handoffs, team work, pt flow, and mock drills

2009 Aim Statement Maintain our 95% or greater compliance with the Augmentation and Elective Induction bundles Maintain use of Trigger tool to identify areas of improvement and maintain perinatal harm below benchmarks we set of less than 15% (or half our starting point) Initiate Instrumented Delivery Bundle and achieve 95% compliance. We (will) need multidisciplinary training on second stage management Introduce Bundle components to staff and providers establish tools and process for tracking bundle compliance Achieve over 90% multidisciplinary compliance with completion of EFM education and formalize process to assure new staff are given this opportunity for training. Implement plan for incorporating TeamSTEPPS objectives into routine practice.

Develop and implement a plan for including a patient representative on the Exceptional Beginnings workgroup.

Exceptional BeginningsSix Goals for The Maternity Center Administration, care givers and staff will fully understand and support the Maternity Center mission, vision, and goals. The focus of Maternity Center work will be to improve the experience of the patient and her family. The Maternity Center will use evidence-based practices that ensure the highest standards of care are delivered, with a focus on patient safety and improved outcomes. The Maternity Center will implement communication methods that ensure safe, effective care and improve patient satisfaction. The Maternity Center will become regarded as the most satisfactory professional opportunity for care givers and all other team members in the region. The Maternity Center will measure and communicate its progress to administration, care givers, staff and the community.

The focus of Maternity Center work will be to improve the experience of the patient and her family Use of Coping Algorithm Partnering with the patient to assure that her plan is followed by improving hand offs. Room Service meals for Mom and Dad Post Partum Mood Disorder Program Patient on our Exceptional Beginnings Taskforce so the patient view is always present in decision making Using the New Moms group as an advisory group for decision making Continued evaluation of Press Ganey Leadership rounding on patients daily

Inspiration Sharing stories: overcoming our challenges and service excellence When our patient representative used the word We instead of You in offering her thoughts on a subject Sharing with staff when they are acknowledged by a peer or patient Hearing staff and providers say TeamSTEPPS has made a huge difference in my work/job

Contact:Deborah Bell-Polson MSN, RNC-OB Clinical Nurse Manager Maternity Services Elliot Hospital Manchester, NH 03103 office 603-663-4396 pager 564-2089

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Thank you so much for your time!For more information go to www.IHI.org

sgullo@ihi.orgDo not go where the path may lead; go instead where there is no path and leave a trail. ~ Ralph Waldo Emerson