ACOG SMI Implementation Visit to South Nassau Communities Hospital

Transcription

1 ACOG SMI Implementation Visit to South Nassau Communities Hospital Janet Shelters, RN, BS, CEN Nurse Manager, Labor and Delivery Alyson Ornstein, RN, BSN, CBC Nurse Manager, NICU/Maternity

2 Hospital Description South Nassau Communities Hospital is a 435 bed hospital located in Oceanside, New York on the south shore of Nassau County. We are committed to providing quality, comprehensive, personalized and easily accessible health care services, to all residents of the south shore communities, in a manner which reflects innovation and a cultural of excellence. Level II NICU Complete OB services: MFM consultative services available Approximately 180 births monthly In-patient Pediatric Services Family Medicine Clinic Pediatric emergency and urgent care services Home care services for ante/post partum and well newborn

3 SNCH Multidisciplinary Obstetric Team Alan Garely, MD, Chairman Department of Obstetrics and Gynecology Edmund Tomlinson, MD Vice-Chair Department of Obstetrics Clara Mayoral, MD Chairman Department of Pediatrics Paul Jean-Charles, MD, Chief of Neonatology Jonathan Singer, MD, Chairman Department of Anesthesiology Susan Wu, MD, Chairman Laboratory Services Gayle Somerstein, RN, MPH, MBA Director of Nursing Alyson Ornstein, RN, BSN, CBC Nurse Manger Maternity/NICU Janet Shelters, RN, BS, CEN Nurse Manager Labor and Delivery Cecilia Carey, RN, C-NIC BSN Assist. Nurse Manager MCH Services Camille D Amato, RNC-OB, MSN Assistant Director, Performance Improvement Madeline Cozzi-Gotlieb, MSN, FNP-C, RNC-OB Nursing Education MCH services Opal McPartlin RN, MSN Clinical informatics Marianne Sarli, Administrative Director, Laboratory

4 MATERNAL HEMMORHAGE

5 Key Elements of SMI bundle: obstetric hemorrhage RECOGNITION & PREVENTION (every patient) Risk assessment Universal active management of 3rd stage of labor READINESS (every unit) Blood bank (massive transfusion protocol) Blood Refrigerator located on unit Cart & medication kit Hemorrhage team with education & drills for all stakeholders RESPONSE (every hemorrhage) Checklist (code H form) Support for patients/families/staff for all significant hemorrhages REPORTING / SYSTEMS LEARNING (every unit) Culture of huddles & debrief Multidisciplinary review of serious hemorrhages Monitor outcomes & processes metrics

6 ALERT vs ACTIVATION Alert Actions Nursing Driven Form lists risk factors as triggers and transcends to EMR Alert Steps outlined and used as guide READY SET- ACTION!!!! Code H Activation Who are the players? What are the roles? Where and How is our patient??????

7 EMR DOCUMENTATION Maternal Hemorrhage risk assessment

8

9 MATERNAL HYPERTENSION

10 Key Elements of SMI bundle: hypertension in pregnancy Risk Assessment & Prevention Diagnostic Criteria (risk assessment) When to Treat (incorporated into EMR order set) Agents to Use (incorporated into EMR order set) Monitoring Readiness & Response Identify Complications and Escalation Process Further Evaluation by MD Change of Status Postpartum surveillance, patient education and Nurse-generated home care referrals

11 Maternal Pre-eclampsia Process Measure (Patient Education)

12 EMR DOCUMENTATION Maternal Pre-eclampsia discharge instructions

13 How did we achieve a successful roll out Communication is the key.

14 Team STEPPS implementation First department to train and go-live with TeamStepps implementation TeamStepps Master training completed for Chair of Anesthesia, DON, NM and Nurse Educator April 2013 Classes for Attending OB s, Residents, Anesthesia personnel and all MCH RN staff conducted during May, June & July 2013 Briefs, Huddles and Debriefs rolled out during July/August 2013.

15 Interdisciplinary team successes! Administrative support Clinical medical leadership support Nursing Leadership: Nurse Managers and ANM cross cover all areas of service-line Collaborative/effective-multidisciplinary team communication based upon TeamSTEPPS principles Daily Briefs, Debriefs and huddles conducted with entire team

16 Interdisciplinary team successes! MCH staff nurses cross-trained to all areas of service-line Dedicated maternal-child staff educator Dedicated performance improvement team Unit based Nurse Practice Council: decision making team, producing positive patient outcomes and experiences Parent/caregiver education: continuity in education from admission through discharge

17 Maternal Child Service Journey of Excellence Award Many of us are more capable than some of us. but none of us is more capable than all of us Muhatma Ghandi

18 Questions? Thank you