Proposed Change

Our facility desired to respond to the needs of our

community and create an atmosphere and initiatives

to ensure that the women could obtain the delivery

they desired within the hospital setting. Our facility

chose to meet this need by partnering with doulas.

Barriers to our success were going to be ouranesthe-

sia team and nursing sta¡ both of which preferred the

popular epidural management of labor. Another bar-

rier was lack of available monitoring equipment

allowing women to move about freely during labor

and free community education. One way we over-

came these barriers was by having all health care

providers attend workshops with the doulas to

enhance their knowledge. Through the quarterly

workshops with the doulas the sta¡ was able to stay

up to date on the changing needs of this population.

We also added new free prenatal classes open to

anyone in the community on how to plan a natural

childbirth.We already o¡ered Lamaze andamodi¢ed

Bradley class with contracted instructors with a fee for

attendance. To facilitate patient mobility in labor, the

unit purchased remote fetal monitors.

Implementation, Outcomes, and Evaluation

Since implementation of our initiatives in January 2010,

wehave seenamodest increase in unmedicated deliv-

ery.We expect to see this number rise as we continue

to enhance our environment and build relationships

with the community doulas, physicians, and patients.

Patients as well as doulas who have delivered or as-

sisted with deliveries at our facility have found that our

new initiatives have accomplished our goals and that

the environment provides them the support they want.

Implications for Nursing Practice

The labor and delivery sta¡ nurses have become

more con¢dent in caring for an unmedicated labor-

ing patient. You cannot fail to press forward with

such an initiative just because you have sta¡ push

back or lack of knowledge. The knowledge de¢cit

within the sta¡ can be overcome with continued

education and support.

Lights Out—It’s Quiet Time

Poster Presentation

Purpose for the Program

Adesignated quiet time was implemented on the

maternal infant services unit at Sharp Mary

Birch Hospital for Women & Newborns to address

patients’ feedback about their di⁄culty in getting

enough rest during their stays, especially in the ¢rst

24 hours after delivery. In addition, providing new

mothers with uninterrupted time was expected to

promote exclusive breastfeeding.

Proposed Change

To provide a designated time period during which

visits from hospital sta¡ were limited to medically

necessary visits (e.g., for pain medication) and vis-

its requested by patients. In addition, visitors would

be alerted about quiet time, lights would be

dimmed, the noise level in the hallways and at the

nursing stations would be kept down. Participating

in quiet time would be optional ; however, patients

would be encouraged to have visitors come before

or after quiet time so that they could rest.

Implementation, Outcomes, and Evaluation

An interdisciplinary task force planned the imple-

mentation of quiet time. Patient and sta¡ surveys

were completed, indicating that both groups were

in favor of trialing a designated quiet time. Quiet

time was o¡ered for an hour and a half each day

for a month-long trial. At the end of the trial, patients

and sta¡ completed follow-up surveys. Eighty-¢ve

percent of patients surveyed rated quiet time posi-

tively. Seventy-seven percent of sta¡ members

surveyed, including all disciplines providing care to

patients, recommended that quiet time be contin-

ued. After the trial, quiet time was shortened to 1

hour daily to allow ancillary departments more time

to complete their work. Although the original intent

was to o¡er quiet time in the afternoon only, a night

shift quiet time was established, beginning at the

end of visiting hours through shift change in the

morning. Lamps were placed by computer stations

to provide more light for sta¡ charting.

The exclusive breastfeeding rate when quiet time was

implemented in September 2009 was 66.4% and in-

creased to 70.4% in July 2010. Before implementing

quiet time, the Press Ganey patient satisfaction ques-

tion rating ‘‘Noise level in andaround the room’’ was at

the 55th percentile and increased to the 65th percen-

tile after quiet time implementation.

Implications for Nursing Practice

Patient satisfaction, recovery from the delivery pro-

cess, and successful breastfeeding are a¡ected by

Tracy M. Condra, RN, BSN,

Labor and Delivery, Norton

Suburban Hospital,

Louisville, KY

Lindsey Hafendorfer, RNC,

BSN, Labor and Delivery,

Norton Suburban Hospital,

Louisville, KY

Keywordsun-medicated childbirthprenatal educationnursing

Childbearing

Ellen Fleischman, MBA, RD,

RN, Maternal Infant Services,

Sharp Mary Birch Hospital for

Women & Newborns,

San Diego, CA

Monika Lanciers, BSN, RN,

Sharp Mary Birch Hospital

for Women & Newborns,

San Diego, CA

Keywordsexclusive breastfeedingquiet timepatient satisfaction

Childbearing

S6 JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x http://jognn.awhonn.org

I N N O V A T I V E P R O G R A M S

Proceedings of the 2011 AWHONN Convention

the mother’s ability to get adequate rest. Through

interdisciplinary collaboration, modifying work£ow

and providing a designated quiet time, patient

satisfaction improved, and the rate of exclusive

breastfeeding increased.

First Stop: Pre-Admission for Your Delivery

Poster Presentation

Purpose for the Program

Leadingand forging new directions in the care of

scheduled inductions and Cesarean births

leads to increased compliance to safety initiatives,

nurse satisfaction, physician satisfaction, patient

satisfaction, and safe, e⁄cient, quality care.

A multidisciplinary team at Baylor University Medical

Center identi¢ed the need to improve the admission

process for scheduled inductions and Cesarean

births. This multidisciplinary team identi¢ed patient

safety issues with the current admission process. To

improve patient safety, the following objectives were

their main focus: to improve the veri¢cation of patient

information on admission, timely administration of

medications and increased medication scanning

compliance, access to lab results before surgery and

reduction in stat lab orders, access to themost current

prenatal history on admission, and timely implemen-

tation of physician orders.

Proposed Change

In order to meet these objectives a comprehensive

pre-admission process was implemented.

Implementation, Outcomes, and Evaluation

This process required that all physicians schedul-

ing an induction or Cesarean submit orders and a

current prenatal record for their scheduled patient

within 2 to 14 days before admission. Labor and

delivery secretaries would then create a pre-admis-

sion account for the patients and assemble the

patient chart. Physician orders would be faxed to

the pharmacy the day before the scheduled case

to ensure pharmacy veri¢cation of all medications,

immediate availability of medications upon admis-

sion and thus increased scanning compliance to

ensure safe and timely delivery of ordered medica-

tions. In addition, any patient being admitted for a

Cesarean would present 2 to 14 days before her

scheduled date to have lab work completed to en-

sure results were known before surgery. This lab

initiative would also decrease the overuse of stat

lab orders.While obstacles were faced, many hospi-

tal departments came together to work through the

process and make it successful. A communication

tool originally devised for pharmacy enabled us to

track compliance for all components of the process.

Through implementation of this process we have

improved nurse satisfaction, physician satisfaction,

and patient satisfaction as there are no delays in

care. We have seen increased scanning compli-

ance for the safe delivery of medications and are

able to verify all lab results before surgery.

Implications for Nursing Practice

The pre-admission process has created a checklist-

type system that guarantees that all necessary

components are met before the patient arriving for

care, thus providing safe, e⁄cient, quality care.

Optimizing Care of the Bariatric Patient

Poster Presentation

Purpose for the Program

Obesity, de¢ned as body mass index (BMI)

equal to or greater than 30, is a rising concern

in all ¢elds of health care. The pregnant obese pop-

ulation presents unique challenges. These women

are at increased risk of hypertension, preeclampsia,

diabetes, deep vein thrombosis, labor dystocia,

shoulder dystocia, stillbirth, and postoperative

complications from Cesarean delivery. As the nurse

cares for both the mother and the fetus, she must

also be mindful of her own safety. Lifting, turning,

and repositioning heavier patients can predispose

nurses to injury which could result in long-term

implications for their own health.

Christine Fuhrmann, RNC-OB,

C-EFM, Labor and Delivery,

Baylor University Medical

Center, Dallas, TX

Keywordspre-admissioninductionCesareanchecklistscheduled birth

Childbearing

JOGNN 2011; Vol. 40, Supplement 1 S7

Fuhrmann, C. I N N O V A T I V E P R O G R A M S

Proceedings of the 2011 AWHONN Convention