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IHI Idealized Design of Perinatal Care

IHI Idealized Design of Perinatal Care . IHI Innovation Series 2005 A Deliberate design methodology for Perinatal Care. Idealized Design Bundles. Experts identified processes that will decrease the risk of birth trauma and other adverse events.

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IHI Idealized Design of Perinatal Care

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  1. IHI Idealized Design of Perinatal Care IHI Innovation Series 2005 A Deliberate design methodology for Perinatal Care

  2. Idealized Design Bundles • Experts identified processes that will decrease the risk of birth trauma and other adverse events. • Two clinical processes identified for first round – to decrease the incidence of common problems (determined from evaluation of chart review and claims • Based on reliable science and provide common language for team members

  3. BUNDLES • A group of evidence based interventions related to a care process that when executed together result in better outcomes than when implemented individually. • Perinatal strategy based on proven success of the Ventilator Bundle to decrease incidence of VAP

  4. Elective Induction Bundle • Assessment of Gestational Age – ensuring gestational age > 39 wks • Reassuring Fetal Status – assess via NICHD criteria and document • Pelvic Examination – cervical exam, station, presenting part, cervical position and consistency, Bishop’s score, pelvimetry, and fetal presentation • Absence of Hyperstimulation (Tachysystole) during the induction process

  5. ACOG Criteria for Gestational Age Determination (>39 wks) • FHT documented for 20 wks (nonelectronic fetoscope) or 30 wks Doppler • 36 wks since + serum or urine HCG by a reliable lab • US measurement of C-R length (at 6-12wks) support GA of at least 36 wks • US obtained at 13 – 20 wks confirms GA of at least 39 wks determined by clinical hx and physical exam

  6. Augmentation Bundle • Estimated fetal weight – determine size to determine whether continued attempt at vag delivery appropriate • Reassuring fetal status • Pelvic Assessment • Monitoring and managing tachysystole

  7. Road to Success • Leadership – hospital and physician – support and expectations • Adoption of ALL elements of the bundles • All team members committed to follow bundle criteria • Good team work and communication • Standardization of management approaches (i.e. tachysystole)

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