Tools to help improve outcomes in Obstetrics

Sharon Carpinello

Did you know that the latest pregnancy related mortality ratio is 16 deaths per 100,000 live births¹. I am not surprised that the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and The Joint Commission have begun to focus on this as a national health problem along with many hospitals across the country.

AWHONN recently published a research study on the “Development of an Obstetric Vital Sign Alert to Improve Outcomes in Acute Care Obstetrics” by Dianna J. Behling and Michelle Renaud ²    this article focused on the importance of early recognition and intervention are keys in the possible prevention of increased risk for morbidity or mortality.

The Joint Commission has focused on patient safety for many years.  The former patient safety goals 16 (recognize and respond to change in a patient’s condition) ³ and their latest Sentinal Event alert published on March 31, 2015 ties in the safe use of electronic documentation, recognizing that electronic documentation can play a role in patient safety and early detection.

In the AWHONN study they discussed the use of electronic configured checklists can help identify the triggers earlier which could result in decreased time to a needed intervention.   The Joint Commission also discusses the importance of built in safety checklists and other configuration within the EMR to maximize the electronic documentation features for overall patient safety guidelines.

I love to see hospitals take these types of research studies and look toward how they are using their electronic documentation and how it can possibly help them enhance patient care.   A hospital in TX configured the Modified Early Obstetric Warning System (MEOWS).  They literally took the paper scoring grid and configured it into their system.  She shared that it has assisted in conveying information concisely, accurately and efficiently, helped Increase communication and also now encourages initiation of the Chain of Command quicker.   Another hospital in TN discussed how standardization across their health systems has also helped improve communication among the care delivery team and improved overall documentation.  It is exciting to hear about customers utilizing Centricity Perinatal and having them see positive results.

It is up to us, as nurses, to continue to educate our hospitals on patient safety.  Yes, Labor and Delivery is typically a “happy” place but as we all know things can change in a “heartbeat”. Let’s face it, as one of my favorite customers says, “it is the only unit in the hospital that you enter as one patient and leave as two”!   Ask yourself how your electronic documentation system and internal protocols can help take that step in the right direction to give your best care to your moms and babies.


¹  Creanga, A. A.,Berg, C.J. Syverson, C., Seed, K.k Bruce, C., Callaghan, W.M. (2015)  Pregnancy-related mortality in the United States, 2006-2010.  Obstetrics & Gynecology, 125, 5-12.

² ˉ ³ Nursing for Women’s Health® April/May 2015 Vol. 19 Issue 2.   Development of an Obstetric Vital Sign Alert.  Pg 128-141.

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