11/16/2011

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THE GESTATION AND BIRTH OF A

PROVINCIAL LABOUR PARTOGRAM

Partnering for Change

PEI Reproductive Care Program

Partners

Leeanne Lauzon

Perinatal Nurse Consultant

Reproductive Care Program of Nova Scotia

Lily Lee

Provincial Lead, Surveillance

Perinatal Services BC

Diane Boswall

Clinical Specialist – Public Health Nursing

Health PEI

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• Descr ibe advantages to shar ing ideas , s t ra teg ies , and

processes (e .g . use o f na t iona l fo rum – Canad ian

Per inata l Programs Coal i t i on)

• Compare exper iences o f p rov inc ia l p rogram

representa t i ves

• Developing, trialing, implementing revised labour partogram

• Descr ibe respec t ive cha l lenges faced & lessons learned

Objectives

Canadian

Perinatal

Programs

Coalition

CPPC

A national organisation of perinatal/reproductive care programs and associations

Committed to fostering and supporting optimal care of childbearing families to facilitate the best possible outcomes for all mothers and babies.

Informal meeting in Nov/1988

Formal meetings since Nov/1989

„National Regionalization Group‟ & „Canadian Perinatal Database Committee‟ formed

1990 – „Canadian Perinatal Regionalization Coalition‟(CPRC)

2000 – „Canadian Perinatal Programs Coalition‟ (CPPC)

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CPPC

Voluntary participation

Multidisciplinary

Vehicle for HCPs involved in provincial/regional

reproductive care programs/associations to exchange

ideas and share information:

Database management – health status and performance

measurement (e.g. perinatal audit, benchmarking projects)

Evidence-based practice/policy guidelines

Interdisciplinary professional development

IT accessibility – web-based linkages

Lily’s

experience

•44,000 births per

year

• 50+ sites with

maternity care

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Lily’s

experience

The beginning is important

• Setting the stage

• Clarify objectives for the project

• Identify assumptions and expectations

• Review key project deliverables

• Regional representation and champions

Lily’s

experience

A giant leap!

Begin where you intend to go….

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Guiding Principles

Apply to all provincial sites

Incorporate evidence-based care for labour & birth

FHS guidelines

Core competencies and DSTs (CRNBC)

Support normal birth

Adapt to variance charting

Reduce duplication

Enhance early recognition, timely communication and

interventions for changing conditions

Articulate seamlessly with other provincial records

Facilitate data collection and electronic records

Bundle admission and labour charting

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Pilot for success Provide tools for learners

Engage the users

Challenges

Context of practice is important

Provincial standardization vs. locally developed forms

Institutional culture and leadership

Feedback from different end users

sometime conflicts

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Leeanne’s

experience

9,500 births per

year

10 sites, 3 levels

NS Hospitals where Maternity Care is provided

Leeanne’s

experience

Organization of program:

• clinical

• data collection and management

Focus – work directly with health care

facilities and hospital and community-based

health professionals to promote excellence

in the provision of reproductive care.

Mandatory participation?

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Leeanne’s

experience

October 2008 Revisions needed!

Last revision 2000

New evidence for BF and FHS

IWK partogram adapted/adopted by others across province

SCIL elements

Support RNs to narrative charting

Efficient, consistent, legal

Minor revisions made to IWK partogram – beta testing Spring 2009

content

format

Leeanne’s

experience

June 2009

CPPC Halifax

Draft BC partogram shared by Lily

RCP partogram revised over summer

Sept 2009

Beta testing Sept

Format completely changed

Use of abbreviations (pt. safety)

3 month trial at 4 sites

July 2010 – final version

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OCTOBER 2011

Feedback one year later…

Leeanne‟s experience

Diane’s

experience

PEI Reproductive Care Program

Prince Edward Island

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PEI

PEI Reproductive Care Program

1,400 – 1,500 births per year

2 hospitals where births take place

Births are attended by obstetricians

High risk pregnancies and preterm

babies (< 32 weeks gestation or

requiring complex care) are transferred

to Halifax, NS or Moncton, NB

PEI

PEI Reproductive Care Program

Membership in the Canadian

Perinatal Program Partnership has

been invaluable

“Maternal Database Labour Graphic”

in use since 1996

SOGC‟s Fetal Health Surveillance

(FHS) Guidelines 2007

FHS workshop May 2008

FHS workshop April 2009

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PEI

PEI Reproductive Care Program

BC had made many of the edits being

requested by PEI nurses

Supporting document “A Guide to

Completion of the British Columbia

Labour Partogram”

BC developing a Postpartum Clinical

Path and a Newborn Clinical Path –

continuum…

Met with Lily at CPPC meeting

Back to the hospitals

PEI

PEI Reproductive Care Program

Another pilot test

Both hospitals are now using an

adopted, with permission, version of

the February 2010 - British Columbia

Labour Partogram

Moving toward implementation of the

Postpartum Clinical Path and a

Newborn Clinical Path

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PEI

PEI Reproductive Care Program

Change is a process & takes time

Be clear: why is change is needed?

More than one change was being

implemented

Engaging staff –finding the

„Champions‟

Adapting if & when possible and

having an „acceptable‟ explanation

when „staying the course‟

Some challenges …

Challenges faced Lessons learned

Getting meaningful, timely

feedback

Consensus is elusive

Outright rejection

Tools may reflect practice

changes/terminology not

yet embraced

Consult, consult, consult,

but place limits on

revisions

Documentation tools

should not take time away

from care provision

Appreciate change theory

Don’t overlook ‘good’ in

the pursuit of ‘perfect’

Post - Partogram Reflections

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Thank you!