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Improving Perinatal Care Torrance Memorial Medical Center

Improving Perinatal Care Torrance Memorial Medical Center

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Improving Perinatal Care Torrance Memorial Medical Center

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  1. Improving Perinatal CareTorrance Memorial Medical Center Future tmmc hospital 2015

  2. 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

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

  4. Oxytocin Deep Dive • References • JCAHO Standard MM.7.10 The organization develops processes for managing high- risk 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

  5. Oxytocin Deep Dive • Chart audit occurred June 8, 9, & 10, 2010 • 124 charts pulled (deliveries occurring April 18th-30th) • 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%)

  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

  7. Vaginal Exam (VE) & Oxytocin Audit Tool

  8. 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: 100% • Plan: Continue to audit charts and review results Manager to follow up with staff

  9. Tachysystole Algorithm

  10. 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