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Habersham Medical Center focuses on improving maternal and infant health by prohibiting elective deliveries before 39 weeks gestation. This initiative aligns with ACOG guidelines, emphasizing the importance of full-term delivery for optimal fetal development. The hospital has revamped its policies and processes, including improved documentation and community education, to ensure compliance. Initiatives like the March of Dimes commercial emphasize the necessity of full-term pregnancies. The objective is to eliminate non-medically indicated deliveries before 39 weeks, ensuring the well-being of mothers and their babies.
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Eliminating Elective Deliveries < 39 Weeks Habersham Medical Center Kelly J. Allen, RN, BSN, RNC
Habersham Medical Center • Acute Care Hospital Licensed for 53 Bed • Average Daily Census 24 • Family Birthing Center • Annual Census 450/yr. • Level II Nursery • Community Wellness Program • Long Term Care for 84 Residents • HCMC Home Health Agency • Six Physician Practice Offices
Mission Statement • Habersham Medical Center’s mission is to provide high quality, caring in a compassionate, professional and economical manner to all persons in Habersham County and adjacent areas.
Established • How to determine “due date” • Brain development between 36-40 weeks. • Why it is important to wait 39 weeks to deliver • Organ growth • Vision and hearing impairment • Weight/warmth • Suck and swallow
In the beginning… • 2006 HMC Blue Cross Blue Shield Quality Initiative for Perinatal Care (Joined 6 months into the active year)
Perinatal Care 1 • - Does your hospital have a policy in place prohibiting elective deliveries prior to 39 weeks gestation? • (including elective C-Sections)
Perinatal Care 2 • - Does your hospital have a policy in place requiring the use of ACOG recommended DVT/VTE prophylaxis for patients undergoing cesarean section delivery?
Perinatal Care 3 • Does your hospital have a policy in place adopting ACOG recommendations for the appropriate use of corticosteroids for patients experiencing labor/birth prior to 34 weeks gestation?
Perinatal Care 4 • - Does your hospital have a policy in place that requires bilirubin level screening of all infants prior to post-delivery discharge?
POLICY • 2006-2012 • HMC identified our policy stated we did not perform elective deliveries <39 weeks but did not allow for the outliers related to best practice/ ACOG standards.
Step Four • DO: • Describe what actually happened when you ran the test of change. • Found our documentation did not meet the expectation of our policy. • Found no screening tool available at the time the elective delivery was being scheduled.
Step Five • STUDY: • Describe the measured results and how they compare to the predicted results. • After the implementation of the scheduling procedure, it brought a more focus on the policy. • Documentation improvement noted after revision of the policy and scheduling procedure.
Step Six • ACT- • Describe what changes to the plan will be made for the next cycle from what you learned • All inductions are required to sign an Induction Instructions Form explaining the potential risks and benefits of Labor Induction. • Hardwiring the process into our education program would sustain the progress. • Including the monitoring of deliveries to the Credentialing and Privileging process. • 100% <39 week deliveries are reviewed.
Community Education • Commercial • Supporting March of Dimes (making a change in national perception) • March of Dimes commercial educates the public the need to let the baby fully grow up to 39 weeks. • HMC Instruction Sheet supports the March of Dimes public commercial.
Education • Incorporate standards into Family Birthing Center’s initial orientation and annual orientation. • Review 100% <39 week delivery for appropriateness of care and medical indications for delivery. • Provide staff feedback.
Administrative Involvement • Send CEO, CFO, and Sr. VP Patient Care Treatment Services OB Adverse Event Data via email. • Place on Administration’s Communication Board. • Place on Family Birthing Center’s Communication Board. • Manage up the Family Birthing Center’s good work in meetings with leadership.
“Objective” • Eliminate all non-medically indicated deliveries less than 39 weeks by January 1st, 2013.
In conclusion… • Zero elective deliveries < 39 weeks gestation x 6 months. • Average APGAR at the 5 minute post birth check = 9 • 2012 HMC has had 7 transports to higher level of care: • 29 week with No Prenatal Care • 35.4 LUGR • 37.3 Labor-gastroschisis • 28.6 NRFHT’s • 36 & 38 week PIH • 38.2 Active Labor • HMC continues to improved outcomes save lives!
