FUTURE TMMC HOSPITAL2015

Improving Perinatal CareTorrance Memorial Medical Center

TMMC

Community Hospital in South Bay 401 total beds3200 annual deliveriesPrivate OB/GYN physiciansPerinatology consultantsLevel 3 NICU, 25 beds24 hour in house neonatologist24 hour in house anesthesiologist

TMMC IHI/BETA Team Members

Larisa Bargman, RNColleen Champlin, RNMonika Chudoba, RNDebbie Ernst, RNMaria Hovsepian, RNCarol Kretsch, RNTina Susatio, RNDonna Yukihiro, RN, CNSMaria Koegel, L&D Manager

Diane Galati, Dir. MCHS

Kenneth Chan, MDAlbert Chen, MDEsther Schmuel, MDRuth Idah, Clin.Qual.Analyst

Heather Shay, Dir. of Quality

Linda Dobie, VP Risk Manage.

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

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%)

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

Vaginal Exam (VE) & Oxytocin Audit Tool

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 chartsand review results

Manager to follow up with staff

Tachysystole Algorithm

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