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November 19, 2013 > ÔQuest for ZeroÕ Program Improves Care at Birthing Center

ÔQuest for ZeroÕ Program Improves Care at Birthing Center

Since 2012, the Washington Hospital Birthing CenterÕs team of physicians and nurses has been working in partnership with BETA Healthcare Group to improve patient care for both mothers and infants during labor and delivery. The Quest for Zero obstetrical safety initiative is focused on eliminating preventable errors, improving reliability and reducing risk.

ÒThrough our work in the Quest for Zero program, we have reduced the rates of injury and complications for mothers and infants at the Birthing Center,Ó says Carmen Williams, RNC-OB, BSN, Manager of Maternal and Child Health at Washington Hospital. ÒThe program also has increased the sense of team collegiality and cooperation among our obstetricians and nurses.Ó

Other Quest for Zero Project Team members include Siobhan Calhoun, M.D., Chair of the Washington Hospital OB/GYN Department; Tina Sloan, RNC-OB BSN, Project Manager and Maternal Child Health Staff Nurse IV, and Yvonne Dobbenga-Rhodes, MS, RNC-OB, CNS, CNS-BC, Clinical Nurse Specialist.

BETA Healthcare Group is a provider of the hospitalÕs professional liability insurance coverage. Facilities participating in Quest for Zero are rewarded with liability insurance premium reductions if they comply with the initiativeÕs criteria.

ÒSince adopting the Quest for Zero program, our liability insurance premiums for obstetrics have been reduced by approximately 9 percent, recognizing the high level of compliance with the programÕs criteria,Ó Williams notes.

ÒOne of our first Quest for Zero projects was to have all our obstetricians and nurses take online courses in perinatal safety,Ó says Dr. Calhoun. ÒNext, we implemented the use of standardized, measurable medical terms to describe the ÔtracingsÕ Ð or recordings Ð for electronic fetal monitoring.Ó

Obstetricians are required to use electronic fetal monitoring while a pregnant patient is in labor. The monitor measures the babyÕs ÒbaselineÓ heart rate and evaluates how it changes over time, including during contractions. Standardized terminology for describing events shown on the monitor ÒtracingsÓ were adopted by the National Institute of Child Health and Human Development in 1998. This standardized terminology also was endorsed in 2008 by the American College of Obstetrics and Gynecology and the Association of WomenÕs Heath, Obstetric and Neonatal Nurses.

ÒWhen you speak the same language to describe events tracked by the fetal monitor, you are able to communicate the babyÕs status better and make decisions more quickly,Ó says Dr. Calhoun. ÒItÕs like using the same recipe every time.Ó

The criteria for complying with the electronic fetal monitoring terminology project included:
* Educating all nursing and medical staff members on the changes in terminology.

* Drafting and approving a Policy and Procedure requiring obstetricians and nurses utilize the current accepted terminology.

* Ensuring all electronic and paper medical record documentation reflects the changes in terminology.

* Establishing criteria for physician privileging and nurse hiring requiring successful completion of an endorsed course that includes the changes in terminology.

Another major Quest for Zero project involved developing and implementing a ÒbundleÓ of interventions to be completed during a ÒvacuumÓ delivery. In this type of delivery, a vacuum device is attached to the babyÕs head to assist in delivering the baby when the second stage of labor has not progressed adequately. This is an alternative to a forceps delivery or a cesarean section. The use of a vacuum device is generally safe, but it can occasionally have negative effects on either the mother or the child.

ÒThe bundle of interventions is essentially a group of best practices to follow during a vacuum delivery,Ó says Dobbenga-Rhodes, ÒWe also have the delivering physician document these practices, using electronic medical records.Ó

The various elements that needed to be included in the vacuum delivery bundle included:
* Alternative labor strategy considered Ð the physician has to discuss all the alternatives with the mother.

* Preparing the patient Ð discussing the risks and benefits associated with each labor and delivery option.

* High probability of success Ð providing information about the general success rate of vacuum delivery and the patientÕs specific circumstances.

* Maximum application time Ð determining how long the vacuum device can remain on the babyÕs head, which can vary from baby to baby.

* Exit strategy Ð what is the alternative delivery plan if the doctor realizes the vacuum delivery is not going to be successful.

ÒWe also have to show evidence that the procedure is done by the obstetrician (OB) and the OB is present,Ó says Dobbenga-Rhodes. ÒWe also need to show evidence the Special Care Nursery staff are notified and/or the neonatal nurse is present at delivery.Ó

The BETA Healthcare Group team conducted a site visit in May 2013 and found the Washington Hospital Birthing Center 100 percent compliant with all the criteria for both the electronic fetal monitoring terminology and the vacuum delivery bundle projects. The hospitalÕs Quest for Zero team and other Birthing Center staff members attended BETA Healthcare GroupÕs Risk Symposium in September in San Diego, where they were awarded a beautiful blue glass sculpture in recognition of their accomplishments.

ÒOur next steps in our Quest for Zero include continued compliance with both the electronic fetal monitoring terminology and vacuum delivery bundle projects,Ó Dr. Calhoun notes. ÒWe also will have another project for interdisciplinary evaluations of fetal monitor tracings, with doctors and nurses working together.Ó

In addition, the Birthing Center will be launching a Quest for Zero interactive learning program called GNOSIS Ð which is the Greek word for Òknowledge.Ó

ÒThe GNOSIS program will involve an initial test for each nurse and obstetrician that determines areas where they need improvement,Ó Dr. Calhoun explains. ÒThe test is completely objective, so it rules out any personal bias in evaluating staff. Based on the test results, the program will map out a personalized learning path for each nurse and obstetrician. WeÕre eager to continue seeing positive results in our Quest for Zero.Ó

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Tri-City Voice article re: Quest for Zero

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