healthy birth initiative reducing primary cesareans collaborative
DESCRIPTION
Agenda for Reducing Primary Cesareans Webinar Jan 8 th :30 p.m. Eastern (12 Central, 11 Mountain, 10 Pacific) Intro2 Bundle Implementation Process10 Unwarranted variation/drivers20 Discussion10 Data collection process 20 Questions15 Reflections on barriers/facilitators5 Wrap up2TRANSCRIPT
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Healthy Birth Initiative
Reducing Primary Cesareans Collaborative
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Our Team for Jan. 8th Webinar
Elliot Main Leslie Cragin Cathy Emeis Ana Delgado Kate Chenok
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Agenda for Reducing Primary Cesareans Webinar
Jan 8th 20161-2:30 p.m. Eastern (12 Central, 11 Mountain, 10 Pacific)
Intro 2Bundle Implementation Process 10Unwarranted variation/drivers 20Discussion 10Data collection process 20Questions 15Reflections on barriers/facilitators 5Wrap up 2
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Objectives for Call
• Understand the overall process of implementing a bundle
• Discuss unwarranted variation in the drivers of NTSV Cesarean Birth
• Review the variables and process for collecting QI data
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BUNDLE IMPLEMENTATION PROCESS
Leslie Cragin
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Plan- Big PictureWhat are you trying to accomplish? Reduce NTSV
cesarean section rate– What is your target amount and time frame (1 year?)
Team: content experts, leaders• Predictions: what drives your NTSV cesarean birth
rate? What decrease do you want to seeData: what and how are you going to measure?
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Initial Work
Identify your patient/target population
Analyze your drivers and contributing factors for the NTSV rate
Choose your bundle
Become familiar with what will be measured and how, including outcomes and processes
Develop a preliminary picture about how all the elements work together to get the desired result, and note the most important elements (could be a driver diagram or other visual tool)
Describe an ideal system: How will care be delivered? Identify major gaps between this and the current system.
Tackle an “easy” part of the system first.
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Structure and Process
MAP-IT• Mobilize people and resources• Assess• Implement• Track
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Two hospitals (data from RPC member institutions)
• University Affiliated Medical Center (UAMC)
• 4800 births annually• 38% Primary CesareanBarrier• Lack of consensus among
care providers that C/S rate needs to be decreased
• Community Hospital (CH)
• 1250 births annually • 31% Primary Cesarean
Barrier• RN staffing models that make
bundle implementation difficult
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Planning- AssessUAMC StrengthsInstitutional commitment to lowering the C/S rateCommitment to evidence based practiceUAMC BarrierLack of consensus among care providers that C/S rate needs to be decreased
CH Strengths• Culture of change in our
workplace• Commitment to evidence-based
practiceCH Barrier• RN staffing models that make
bundle implementation difficult
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Other AssessmentsDeliverables• Drivers
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Key bundle elements• Develop guidelines and policies in support of
change• Training for everyone who is part of the care
team• All needed resources are reliably available • Shared decision making is a part each
conversation about an intervention or procedure• Data is gathered to support the QI process
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UAMC Bundle interestPromoting spontaneous progress in labor
CH Bundle interest• Promoting comfort in
labor• Promoting spontaneous
progress in labor
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Rapid cycle improvementsUAMC
• Goal: All providers educated about importance of reducing NTSV– Champions for reduction of
rate mobilized, – Grand Rounds “debate” held– Existing policies reviewed for
consistency with the evidence
CH• Goal: All women who
desire an unmedicated birth will have access to comfort measures– Inventory of current
supplies– Lunch time trainings in
care practices
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Study • Data analysis• Compare results to predictions• What was learned?
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Act• How can you get closer to your goal?• What changes can you make to be more
successful?
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• Jan – Logistics, Train in data collection, and Implement– Assess drivers and select bundle
• Feb– Begin first PDSA cycle
• March– First cycle completed?
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NTSV: UNWARRANTED VARIATION AND DRIVERS
Dr. Elliot Main
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METRICSCathy Emeis
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Metrics
• Outcome Measure: NTSV cesarean rate• Balancing Measure: Apgars less than 7 at 5 min.• Variables for all NTSV patients: 13• Variables per bundle: 4-7
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Before Data Collection Begins:
Before data collection begins, have an Information Technology Specialist at your hospital ensure :1. the monthly data collection spreadsheet is located
in a secure location on your network, accessible to all the individuals who will be using it.
2. a current version of Microsoft Excel is installed at the workstations that will be used to input the data.
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Step 1: Determine if the patient case was NTSV:
1. Nulliparous (no prior pregnancies beyond 20 weeks)2. Term (37+0 weeks gestational age)3. Singleton4. Vertex presentation
After Every Delivery:
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Step 2 Open the spreadsheet
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Step 3: Answer using drop down• Answer all the questions from left to right
using the available drop-down options. Please DO NOT populate any of the questions with manually typed responses.
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PLANNING DATA Ana Delgado
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Planning Survey: Top Ranked AssetsResponses % Who Ranked in Top 3
Commitment to evidence-based practice 95%
Institutional commitment to lowering the C/S rate 67%
Front-line staff commitment to lowering the C/S rate
67%
Significant in-house QI expertise 42%
Culture of change in our workplace 35%
Consumer interest in lowering the C/S rate 29%
Adequate funding to procure needed supplies and equipment
21%
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Planning Survey: Top Ranked BarriersResponses % Who Ranked in Top 3
Lack of consensus among care providers that C/S rate needs to be decreased
62%
Skepticism about specific bundle items 54%
RN staffing models that make bundle implementation difficult
43%
Lack of funding for necessary staff time. supplies or equipment
32%
Overly bureaucratic processes that make change very slow 32%
Workplace culture is not receptive to change 30%
Technical difficulties related to data collection 25%
Resistance to protocol or bundle-driven care 24%
Lack of staff champions 20%
Problems with collecting the raw data 13%
Lack of shared decision-making between providers and patients
4%
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Planning Survey: Priorities for Jan. 28 Meeting
Topics % who ranked as priority (top 5)
Review of the evidence behind each bundle 84%
More information about the structure and timeline of the collaborative itself
60%
Specific QI techniques (fishbone diagrams, rapid cycle PDSA, etc)
56%
How to facilitate difficult conversations 56%
Tips for creating a culture of change 48%
Support for leadership development for my collaborative team
48%
Hands-on data collection tech support 44%
How to identify and cultivate stakeholders 36%
Opportunity for making peer/regional connections 20%