Because content in this area is still being developed, it is posted in "document" form — and these documents will be updated as the innovation work progresses.
The aim of the IHI Improving Perinatal Care Collaborative is to create a perinatal unit that reliably delivers care as determined by sound science, with a goal of zero preventable injury. To improve safety and reliability, what we do and how we do it must come together as the way we provide effective perinatal care. The scope of this project begins with the presentation of the woman and family to the Labor and Delivery Unit and ends with the handover to the postpartum period of care.
There are currently more than 60 teams participating in the Collaborative. The work that is being done by these teams will be shared by IHI. The current work is represented by the Perinatal Driver Diagram and is grouped into four primary drivers: leadership, reliable design and reduce variation, effective teamwork and communication, and patient- and family-centered care.
IHI has developed three care bundles that are actively being tested: the Elective Induction Bundle, the Augmentation Bundle, and the Vacuum Bundle. Core to understanding the bundles and achieving success is the reliability of the system that delivers the care and effective teamwork and communication of the front-line team. The "all or nothing" strategy — that is, teams must comply with all components of the bundle, unless medically contraindicated — is also a patient-centered measure. For example, if the bundle includes four components that are recognized as the standard for care, the patient should receive all four elements, every time (again, unless medically contraindicated). Data collection and measurement tools for the bundles are posted in the Tools section below.
A prepared and activated team is essential to improve care. Teamwork and communication training prepares team members to communicate better and work together towards a common goal. A publicly available program to support teamwork and communication is TeamSTEPPS. Additionally, participants are trained in the principles of appropriate assertion and conflict resolution, and the use of SBAR (Situation-Assessment-Background-Recommendation), a technique to improve care team communication and teamwork, particularly in critical situations. Case scenarios are used to develop SBAR scripts and practiced by nurses and physicians to train and test competence in the use of this method. This learning is core to the use of drills and simulations to prepare and be ready for obstetrical emergencies that may occur infrequently, but are high risk to the patient. In particular, shoulder dystocia training has been supported by published research.
Goals for this work include:
- Compliance with bundles at 95 percent
- Reduction of perinatal harm by 50 percent
- Culture survey score increase of 30 percent or more
- Reliable documentation of care of 95 percent or greater
Content in the Patient Safety Topic area may also be informative and useful to your perinatal care improvement efforts.
