State-wide QI initiatives seek to improve outcomes of maternal, child care

Maternal/child nurses are at the forefront of efforts to design and implement effective quality improvement (QI) programs to improve care for mothers and infants throughout labor and delivery, according to the special September/October issue of MCN: The American Journal of Maternal/Child Nursing. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The current MCN is a special issue highlighting new reports of large-scale projects to improve the quality and safety of maternal/child care. "The special issue includes six full-length articles, each of which details large system-wide or state-wide programs that have been incredibly successful in producing positive change in perinatal outcomes," comments MCN Editor Margaret Comerford Freda, Ed.D., R.N., of Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, N.Y.

The new papers draw attention to the use of large-scale QI initiatives to achieve meaningful improvements in the quality and safety of care for mothers and infants. While the programs address differing objectives, a common theme is multidisciplinary involvement of maternal/child nurses, obstetrician/gynecologists, and all professionals involved in labor and delivery care.

The guest editor of the special issue is Kathleen Rice Simpson, Ph.D., R.N.C., of St. John's Mercy Medical Center St. Louis. The QI interventions highlighted include:

•A standard policy on induced labor, with the goal of avoiding elective delivery before 40 weeks' completed gestation. Standardizing the wide range of procedures for labor induction has the potential to improve care while reducing risks.
•A "rigorous process" for eliminating sponges left behind after childbirth—a so-called "never event" that can lead to serious complications. The experience shows that changing established policy is difficult but possible, even across multiple hospitals in different states.
•Implementation of a statewide process in California to reduce bleeding after childbirth: a leading cause of maternal complications and death. The experience highlights the critical role of maternal/child nurses in leadership and participation.
•An intervention that successfully increased the rate of skin-to-skin contact between mothers and newborns after cesarean section. As more infants received skin-to-skin contact with their mothers in the hours after birth, rates of successful breast-feeding increased significantly.
•An effort to improve the obstetric triage process to ensure that women in labor are seen within the time frame appropriate for their condition. The new obstetric triage tool gives nurses the ability to prioritize and evaluate women in a timely manner and to improve patient flow.
•Development of a new nursing role—the perinatal safety nurse—to promote the safety of mothers and infants. The new role is part of a successful effort to reduce the rate of adverse events during labor and delivery.

The six new articles highlight the growing trend toward following standardized approaches, based on the best available evidence, to optimizing patient care while minimizing preventable complications. Dr. Freda notes that all of the regular MCN columnists have also focused on the QI theme, making the special issue "a complete package." She adds, "We think it's a really exciting issue that will be helpful for nurses and administrators everywhere."