Improving Perinatal Care Torrance Memorial Medical Center FUTURE

Improving Perinatal Care Torrance Memorial Medical Center FUTURE TMMC HOSPITAL 2015

TMMC §Community Hospital in South Bay § 401 total beds § 3200 annual deliveries §Private OB/GYN physicians §Perinatology consultants §Level 3 NICU, 25 beds § 24 hour in house neonatologist § 24 hour in house anesthesiologist

TMMC IHI/BETA Team Members Larisa Bargman, RN Kenneth Chan, MD Colleen Champlin, RN Albert Chen, MD Monika Chudoba, RN Esther Schmuel, MD Debbie Ernst, RN Ruth Idah, Clin. Qual. Analyst Maria Hovsepian, RN Heather Shay, Dir. of Quality Carol Kretsch, RN Linda Dobie, Tina Susatio, RN Donna Yukihiro, RN, CNS Maria Koegel, L&D Manager Diane Galati, Dir. MCHS VP Risk Manage.

Oxytocin Deep Dive References JCAHO Standard MM. 7. 10 The organization develops processes for managing highrisk or high-alert medications ISMP alert, August 9, 2007 Simpson, Kathleen Rice. Measuring Perinatal Patient Safety: Review of Current Methods. JOGNN. 35, 432 -442. 2006

Oxytocin Deep Dive Chart audit occurred June 8, 9, & 10, 2010 124 charts pulled (deliveries occurring April 18 th-30 th) 64 charts audited (oxytocin used) Results – Positive Careful Monitoring (98%) Results – Improvement needed Documentation of oxytocin dose & pattern during handoff (2%) Tachysystole with normal fetal heart rate identified/managed (3%) Discontinued oxytocin if labor progressing (5%) Oxytocin ↓ or discontinued due to tachysystole with significant fetal heart rate decelerations (6%)

Oxytocin Deep Dive Results – Surprises Vaginal exam not done consistently prior to initial oxytocin administration Order to discontinue oxytocin (12 AM) & to restart (6 AM) even with patients with ruptured membranes Inconsistent notification of MD in change of oxytocin dose

Vaginal Exam (VE) & Oxytocin Audit Tool

VE & Oxytocin Results 25 charts audited (August) No vaginal exams prior to initiation of oxytocin (5) Vaginal exams done prior to initial oxytocin dose (20) VE done prior to initiation of oxytocin (80%) Goal: Plan: 100% Continue to audit charts and review results Manager to follow up with staff

Tachysystole Algorithm

Tachysystole Algorithm Tachysystole with normal fetal heart rate identified/ managed (3%) Goal Nurses will identify, manage & document tachysystole Plan Nurses & physicians will be inserviced Tachysystole algorithm implemented Chart audit