Perinatal Safety Intervention Program (PSIP): Design and Development

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Slide 1

Perinatal Safety Intervention Program (PSIP): Design and Development

Nancy Lenfestey, MHA,¹ Nancy Chescheir, MD,²
Margot Schwartz, MPH,¹ Celeste Mayer, PhD, RN², Douglas Kamerow, MD, MPH,¹

AHRQ Annual Meeting
September 10, 2012

¹ RTI International
² University of North Carolina (UNC) Health Care

Image: The PSIP program "pinwheel" logo is shown.

Slide 2

Overview

• Why focus on perinatal safety?
• PSIP pinwheel.
• Audience.
• Toolkit background, goals, objectives.
• Toolkit development and structure.
• PSIP phases and toolkit testing.
• Current status and plans.

Slide 3

Why Focus on Perinatal Safety?

• Birth-associated adverse outcomes: 2-10% (80-400,000 annually), half of which are preventable.
  

  (Forster et al., 2006, Leape, 2008)

• 30-40% of "near misses" and severe maternal morbidities may be preventable through changes in patient, health care provider, and system factors.
  

  (Geller, 2007)

Slide 4

Financial Consequences

• Approximately 50 percent of hospital risk management budgets are allocated for obstetric events, and birth-related events account for more than 75 percent of claims paid in amounts over $1 million.

  (Pettker, 2001)

• Prevention or minimization of harm through adherence to evidence-based practice guidelines is the best defense against patient harm and malpractice claims.

  (Cherouny et al., 2005)

Slide 5

PSIP "Pinwheel"

Image: The PSIP "pinwheel" has "Perinatal Safety Intervention Program" and an icon of a woman cradling an infant at its center and five fins of different colors extending outward. The fins are labeled:

• Quality Improvement.
• Communication.
• Best Practices.
• Pateint & Family Involvement.
• Team-Based Care .

Slide 6

Toolkit: Target Audience

• Geared towards perinatal health care teams in the areas of obstetrics, neonatology, and anesthesiology.
• Intended for use by perinatal teams across all hospital types, geographic location, and staffing and resource levels.
• Toolkit can assist leaders in prioritizing perinatal quality and safety improvement efforts and resource allocation decisions.

Slide 7

Toolkit: Background

• Developed under an AHRQ contract that also includes development of a literature review, interviews with providers, and development of a course design guide.
• Provides a clinical basis for integrating CUSP and TeamSTEPPS concepts and methodology with current clinical evidence in a high-risk setting.
• Customizable to meet organizations’ individual clinical needs and level of staffing and resources available.

Slide 8

Toolkit: Goals and Objectives

1. Increase standardization of practices and more consistent use of best practices.
2. Enhance teamwork, communication, and efficiency of perinatal teams, thereby improving perinatal safety outcomes.
3. Provide tools and resources that will facilitate greater involvement of patients and families in the care process to foster patient-centered care.

Slide 9

Toolkit: Development Process

• Bi-weekly in-person UNC-RTI meetings:
  • UNC develops clinical content.
  • RTI has taken the lead in developing the overall PSIP framework and converting the clinical content into toolkit modules complete with guidance and tools.
• Integrate feedback from 2 Technical Expert Panel Meetings.
• Integrate feedback from AHRQ.
• Integrate feedback from field testing .

Slide 10

Toolkit: Structure

• 7 clinical modules:
  • Postpartum hemorrhage.
  • Umbilical cord prolapse.
  • Safe performance of Cesarean-section.
  • Shoulder dystocia.
  • Induction of labor/augmentation of delivery.
  • The seizing patient.
  • Identification of the hypoxic fetus.
• 3 non-clinical:
  • Implementation Basics.
  • TeamSTEPPS.
  • Rapid Response Team.

Slide 11

Module Contents

• Goals and objectives.
• Information about epidemiology, risk factors, clinical presentations, potential harms, and clinical interventions.
• Pre- and post-test questions.
• Simulations.
• Process and outcome measures.
• Tools and references (located in the Appendices for each module).

Slide 12

PSIP User Phases

• Phase I:
  • Assessment and Planning.
• Phase II:
  • Implementation.
• Phase III:
  • Evaluation and Sustainment.

Slide 13

Module Topics

• 5 modules completed, sent to AHRQ and ready for field testing:
  • Implementation Basics.
  • Postpartum Hemorrhage (PPH).
  • Umbilical Cord Prolapse.
  • TeamSTEPPS.
  • Obstetric Rapid Response Teams.
• Remaining Modules:
  • Shoulder dystocia.
  • Induction of labor/augmentation of delivery.
  • The seizing patient.
  • Safe performance of C-section.
  • Identification of hypoxic fetus.

Slide 14

Field Testing

• To obtain feedback on the toolkit’s feasibility in civilian and military hospitals.
• UNC Health Care and Womack Army Medical Center.
• Field testing topics:
  • Overall impressions.
  • Feasibility and appropriateness.
  • Changes needed?

Slide 15

Additional Activity

• HRET CUSP videos:
  • PSIP team is working with HRET to produce videos for cord prolapse and PPH.
  • Videos integrate CUSP with PSIP.
  • September 30th completion date .