Maryland Patient Safety Center

3Rs: Risks, Referrals and

Readmissions

Maternal and Newborn Risks

Risks are predictors of post partum adjustments for both mothers and newborns. The MPSC

Perinatal & Neonatal Learning Networks developed maternal and newborn risk

assessment tools to assist the healthcare provider in screening for these risks/predictors

prior to discharge.

Maternal and Newborn Risks

Maternal Risks•Prescribed high risk medications

•Medical Risks•Pregnancy Related Risks

Maternal and Newborn Risks

Newborn Risks• Apgar scores <4 at 5 min

• Birth defect/Genetic syndrome• <1500 gm

• Congenital Infection• Late Preterm 34-36 6/7 weeks• Prematurity <34 weeks• Hearing risk/failed hearing

• Medical condition

Maternal and Newborn Risks

Newborn Risks (cont.)• Neurological condition• Metabolic disorder• Positive toxicology

• Weight loss >10% at discharge• ROP, IVH/PVL

• Gastroesophageal Reflux• Failed CCHD Screen without confirmatory echo

• Hyberbilirubinemia• Feeding Problems

• History of psychosocial stressors• Hospital Stay <5 days

Maternal and Newborn Referrals

Maternal•OB/GYN-early post-discharge evaluation

•PMD•Appropriate Outpatient Follow-Up

•Home visits•WIC

•Local Health Department

Maternal and Newborn Referrals

Newborn

•Pediatrician/HCP-early post-discharge evaluation•Appropriate Outpatient Follow-Up

•Home visits•WIC

•Local Health Department

Maternal and Newborn Referrals

A special word about Local Health Department Referrals

http://phpa.dhmh.maryland.gov/mch/SitePages/postpartum-referral.aspx

GuidelinesLow birth weight birth ( <1500 gm)

NICU admissionTeen mother

No prenatal careMaternal substance abuse

Previous infant deathAny other circumstance deemed to be a risk for mother or infant

Maternal and Newborn Readmissions <30 Days

CMS Hospital Readmission Reduction Program

Penalizes hospitals for “greater than expected” readmission rates.

Maternal and Newborn Readmissions <30 Days

Nationally (AHRQ 2011)Maternal- 4%Newborns- 5%

http://www.medicaiddirectors.org/sites/medicaiddirectors.org/files/public/clinical_policy_1.pdf

QUESTIONS?

See your Perinatal or Neonatal Team Lead

ORContact Bonnie DiPietro, RN, MS, Director of Operations, MPSC at:

bdipietro@marylandpatientsafety.org 410-540-5095