camp pendleton s optimal antepartum visit program n.
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Camp Pendleton’s Optimal Antepartum Visit Program. Cdr. Jack Klausen Cdr. John Holman. Antepartum Visits Goals. Education Evaluation Documentation Intervention. Three types of Antepartum Visits. Normal Falls with in accepted standards Complicated High Risk

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Presentation Transcript
antepartum visits goals
Antepartum Visits Goals
  • Education
  • Evaluation
  • Documentation
  • Intervention
three types of antepartum visits
Three types of Antepartum Visits
  • Normal
    • Falls with in accepted standards
  • Complicated
    • High Risk
    • Requires more time and effort
      • Teen Pregnancy
      • Singles Pregnancy
  • Educational
optimization of staff facilities
Optimization of Staff/Facilities
  • Fewer Visits at Strategic Times
    • Allows more Time for each visit
      • 20 vs 15 minutes (midwives)
      • 15 vs 10 minute (Physicians)
    • Each visit accomplishes a specific goal
optimization of patient s time
Optimization of Patient’s Time
  • Fewer Unnecessary trips to hospital
    • Parking
    • Waiting Rooms
    • Missed Work
    • Baby Sitting
    • Why did I come to just get measured and weighed?
why the nine visit protocol
Why the Nine Visit Protocol
  • Recommended in 1989 by Expert Panel on the Content of Prenatal Care.
  • Studied extensively
  • Rigidly structured as to content and goals
  • Supported by educational material designed for Normal Obstetrical Patients
  • Allowed more time for other than normal pregnancies
implementation
Implementation
  • Nine Visit Pathway Created
  • Normal Pregnancy defined using Kaiser Colorado Region criteria
  • Began Process at Pregnancy Registration
  • Booklet Given to all patients
    • New Installment for next visit given at each visit
visit schedule
Visit Schedule
  • See Handout of Nine Visit Pathway
  • Method for removing from Nine Visit to Complicated Obstetrics Clinic
educational
Educational
  • See Support Booklet
    • Soon Will Have in Spanish
  • See Web Page
  • Incorporated in our Classes
modification of our practice
Modification of our Practice
  • All patients receive an anatomical U.S. at 18 Weeks
historical precedence at camp pendleton
Historical Precedence at Camp Pendleton
  • All Pregnant Patients were seen on basically the same schedule
    • Averaged 15 Visits per Patient with no definable complication
  • No real structure as to when patient was seen in pregnancy only how far apart the visits were
  • No structures as to what was done and taught at each visit
historical precedence cont d
Historical Precedence Cont’d
  • Comments on Form 600 were about random findings
  • Patients complained that they were not getting the information they needed
  • Complicated Obstetrics was not handled in a structured manner
  • Different approaches to care between Family Practice and Obstetrical Clinics
under new system
Under New System
  • Each Visit is Structured as to content and education
  • Patient knows ahead of time what to expect from the visit
    • Can Formulate Questions from handout from previous visit
  • Corpsman and Nurses can participate in Education Process
new system continued
New System Continued
  • Allows better separation of Patients between MD and Nurse Providers
  • Allows Complicated Obstetrics to be seen in a formal context with cases discussed amongst providers
  • Soon will help integrate with our visiting MFM Staff
  • Assist resident Teaching
advantage to date
Advantage to date
  • We have adequate Obstetrical Appointments for both Complicated and Normal OB
  • Our Performance in the Navy Wide Patient satisfaction survey has improved.
  • The Provider Staff find the Normal Obstetrical Clinic Functions for more efficiently
further advantages
Further Advantages
  • Patient Satisfaction is improved as evidenced by survey and postpartum questions
  • Unnecessary Ultrasounds have been markedly reduced
    • Patient has fewer opportunities to request them
patient care
Patient Care
  • We have been doing the 9 visit protocol for 7 months and there has been no evidence of any adverse effects
    • This was also the case in the Kaiser Studies
  • Rarely a patient will state that she was used to more visits with previous pregnancies
    • Explain reasoning to patient
    • Allow them extra visits
plans
Plans
  • One Year Out to survey patients as their satisfaction
  • One Year Out to review our statistics for pregnancy complications to compare outcome
  • DEVELOP AN ANTEPARTUM DOCUMENTATION SHEET
    • Separate Normal and Complicated Patients