OB – April 2012
Category
Title
Source
Description
Iowa Statewide Guidelines for
Perinatal Services
http://www.idph.state.ia.us/hpcdp/common/pdf/8th_edi
tion_guidelines.pdf
This document serves as a guideline for perinatal services in
Iowa combining important information regarding Iowa’s
regionalized perinatal health system, guidelines for care,
quality improvement and Iowa Code impacting care of Iowa’s
moms and babies.
“OB Hemorrhage Toolkit”
(California Maternal Quality
Care Collaborative [CMQCC])
http://www.cmqcc.org/ob_hemorrhage
“OB Hemorrhage: Carts, Kits,
Trays” (CMQCC)
http://www.npic.org/Links/Postpartum_Hemorrhage_Cart.
pdf
A comprehensive toolkit from the California Maternal Quality
Care Collaborative (CMQCC) for health care providers to
improve readiness, recognition, response and reporting of
hemorrhage.
Equipment list for an OB hemorrhage “cart” designed to treat
vaginal/cervical lacerations and provide the instruments for
uterine tamponade and uterine/ovarian artery ligation.
Section 2: Induction and
Augmentation
“Elective Induction and
Augmentation Bundles”
(Institute for Healthcare
Improvement [IHI])
http://www.ihi.org/knowledge/Pages/Changes/ElectiveIndu
ctionandAugmentationBundles.aspx
A “bundle” is a group of evidence-based interventions related
to a disease process that, when executed together, result in
better outcomes than when implemented individually.
Successful implementation of the bundles is based on the “all
or nothing” strategy, under which teams must comply with all
components of the bundle unless medically contraindicated.
http://www.cmqcc.org/_39_week_toolkit
A Quality Improvement Toolkit, “Elimination of Non-medically
Indicated (Elective) Deliveries Before 39 Weeks Gestational
Age,” to decrease deliveries before 39 weeks and to help
determine and disseminate best practices for prevention of
early deliveries, and to outline the most effective strategies for
health care providers in implementing those practices.
Core
Section 1: OB Hemorrhage
Core
Supporting
Core
Section 3: Early Elective
Deliveries
“<39 Weeks Toolkit” (CMQCC)
Core
1
Category
Supporting
Supporting
Supporting
Supporting
Title
“Electronic Alerts, Patient
Education, and Performance
Reports Improve Adherence to
Guideline Designed to Reduce
Early Elective Inductions” (U.S.
Department of Health &
Human Services, Agency for
Healthcare Research and
Quality [AHRQ])
“Eliminating Elective
Deliveries Prior to 39(+0)
Weeks” (California Hospital
Patient Safety Organization)
“Safe Deliveries: Reducing
Elective Delivery Prior to 39
Weeks” (Washington State
Hospital Association)
“Measure Information Form”
(The Joint Commission)
Source
Description
http://www.innovations.ahrq.gov/content.aspx?id=3161
Intermountain Healthcare adapted an existing guideline and
developed associated care processes to ensure that pregnant
women undergo early elective inductions (defined as before
the baby reaching a gestational age of 39 weeks) only when
medically necessary.
http://www.chpso.org/perinatal/thecase.pdf
A presentation by the California Hospital Patient Safety
Organization outlining the evidence for eliminating this
practice.
http://www.wsha.org/0398.cfm
A description of the work of the Washington State Hospital
Association to reduce elective deliveries before 39 completed
weeks of gestation.
http://manual.jointcommission.org/releases/TJC2010A/MIF
0166.html
Specifications for The Joint Commission’s NQF-endorsed
measure for elective delivery.
http://shoulderdystociainfo.com/index.htm
A comprehensive Web site with an extensive bibliography on
shoulder dystocia.
http://www.nnepqin.org/site/page/vbac
The products of a collaborative process in Northern New
England to restore the practice of Vaginal Birth After C-Section
(VBAC) safely. This includes VBAC guidelines, consent for birth
after a C-section, and birth choices after a C-section.
http://www.nnepqin.org/site/page/emergency
A toolkit for hospitals to use to improve their local emergency
Caesarean delivery process.
ACOG Committee Opinion. Patient care emergencies may
periodically occur at any time in any setting, particularly the
inpatient setting. To respond to these emergencies, it is
important that obstetrician/gynecologists prepare themselves
Section 4: Shoulder Dystocia
Supporting
Enhanced
Core
Enhanced
“Shoulder Dystocia: Facts,
Evidence and Conclusions” (Dr.
Henry Lerner)
Section 5: VBACs
“VBAC Project” (Northern New
England Perinatal Quality
Improvement Network
[NNEPQIN])
Section 6: Simulation of OB
Emergencies
“Emergency C-Section Toolkit”
(NNEPQIN)
“Preparing for Clinical
Emergencies in Obstetrics and
Gynecology” (American
Congress of Obstetricians and
http://www.acog.org/Resources_And_Publications/Commit
tee_Opinions/Committee_on_Patient_Safety_and_Quality_
Improvement/Preparing_for_Clinical_Emergencies_in_Obst
etrics_and_Gynecology
2
Category
Title
Source
Description
Gynecologists [ACOG])
HPH
HPH
“Rehearsing Team Care for
Relatively Rare Obstetric
Emergencies Leads to
Improved Outcomes” (AHRQ)
“Crisis Management
Simulation Course Receives
Positive Reviews, Enhances
Communication and
Teamwork Among Labor and
Delivery Practitioners During
Crises” (AHRQ)
Section 7: Magnesium Sulfate
for Neuroprotection
“Magnesium Sulfate Before
Anticipated Preterm Birth for
Neuroprotection” (ACOG)
Core
Enhanced
Section 8: Improve Teamwork
& Communication
“TeamSTEPPS®: National
Implementation” (AHRQ)
http://www.innovations.ahrq.gov/content.aspx?id=2463
http://www.innovations.ahrq.gov/content.aspx?id=265
by assessing potential emergencies that might occur, creating
plans that include establishing early warning systems,
designating specialized first responders, conducting emergency
drills, and debriefing staff after actual events to identify
strengths and opportunities for improvement. Having such
systems in place may reduce or prevent the severity of medical
emergencies.
Multidisciplinary teams at the University of Kansas Hospital
seek to improve the handling of obstetric emergencies by
rehearsing team responses to emergency situations that can
occur during a delivery.
Labor and Delivery Crisis Resource Management courses are
two (introductory and advanced) seven-hour, simulation-based
teamwork classes for labor and delivery clinicians.
http://www.acog.org/Resources_And_Publications/Commit
tee_Opinions/Committee_on_Obstetric_Practice/Magnesiu
m_Sulfate_Before_Anticipated_Preterm_Birth_for_Neuropr
otection
ACOG Committee Opinion. Available evidence suggests that
magnesium sulfate given before anticipated early preterm birth
reduces the risk of cerebral palsy in surviving infants. Physicians
electing to use magnesium sulfate for fetal neuroprotection
should develop specific guidelines regarding inclusion criteria,
treatment regimens, concurrent tocolysis, and monitoring in
accordance with one of the larger trials.
http://teamstepps.ahrq.gov/
An evidence-based teamwork system to improve
communication and teamwork skills among health care
professionals.
Section 9: VTE in OB
3
Category
Title
Prevention and Treatment of
Venous Thromboembolism
(VTE) in Obstetrics (SOGC)
Source
Description
http://www.sogc.org/guidelines/public/95E-CPGSeptember2000.pdf
A 2000 clinical practice guideline reviewed and approved by the
Maternal Fetal Medicine Committee and the Council of the
Society of Obstetricians and Gynaecologists of Canada.
Identifies risk factors for venous thromboembolism
(VTE) in the peripartum period and provides guidelines for
risk assessment and thromboprophylactic measures for VTE in
pregnant women. Guidelines for diagnostic testing and for
acute and long-term treatment of VTE are also provided.
http://www.marchofdimes.com/TIOPIII_FinalManuscript.pd
f
A March of Dimes publication and “call to action” filled with
examples of promising and successful initiatives designed to
improve the quality of perinatal care at hospitals and
healthcare systems across the country.
http://www.ismp.org/tools/highalertmedications.pdf
A list of medications that bear a heightened risk of causing
significant patient harm when used in error, including
magnesium sulfate and oxytocin.
ACOG Committee Opinion. Since publication of the Institute of
Medicine’s landmark report “To Err is Human: Building a Safer
Health System,” emphasis on patient safety has steadily
increased. Obstetrician-gynecologists should continuously
incorporate elements of patient safety into their practices and
also encourage others to use these practices.
Home page of a comprehensive Web site for ACOG, a
membership organization for obstetricians and gynecologists.
Core
Supporting
Supporting
Section 10: OB Adverse Events
Toward Improving the
Outcome of Pregnancy III:
Enhancing Perinatal Health
through Quality, Safety and
Performance Initiatives (March
of Dimes)
“ISMP's List of High-Alert
Medications” (Institute for
Safe Medication Practices)
“Patient Safety in Obstetrics
and Gynecology” (ACOG)
Supporting
Supporting
Supporting
Supporting
“ACOG” (American College of
Obstetricians and
Gynecologists)
“AWHONN” (Association of
Women's Health, Obstetric
and Neonatal Nurses)
National Quality Forum,
“National Voluntary Consensus
Standards for Perinatal Care
2008”
http://www.acog.org/Resources_And_Publications/Commit
tee_Opinions/Committee_on_Patient_Safety_and_Quality_
Improvement/Patient_Safety_in_Obstetrics_and_Gynecolo
gy
http://www.acog.org/
http://www.awhonn.org/awhonn/
Home page of a comprehensive website for AWHONN, a
membership organization for obstetric and neonatal nurses.
http://www.qualityforum.org/Publications/2009/05/Nation
al_Voluntary_Consensus_Standards_for_Perinatal_Car
A National Quality Forum abridged consensus report on
perinatal standards. The full document is available for a fee.
e_2008.aspx
4