Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Mahoney,
RN
BSN
Senior
Director,
ACOG
Director,
AIM
Project
Elliott
Main,
MD
Medical
Director,
CMQCC
Implementation
Director,
AIM
Project
US
Maternal
Mortality
Rates
Using
Death
Certificates
(NCHS)
or
using
Case
Reviews
by
CDC
PMSS
20
Mortality
Rate
(per
100,000
Live
births)
19
18
17
16 16
15
14
14.5
12
11.5 11.5
10
9
8 8
7.5
6
4
1987-1990 1991-1997 1998-2005 2006-2010 2011-2013
MMR
(NCHS
Death
Certificate) MMR
(CDC
PMSS)
The US has the
highest Maternal
Mortality rate of
any high resource
country and the
only country
outside of
Afghanistan and
Sudan where the
rate is rising.
Propublica
The
Last
Person
Youd
Expect
to
Die
in Childbirth
Lauren
Bloomstein,
a
neonatal
nurse,
died
from
preeclampsia
in
the
hospital
where
she
worked,
and
illustrates
the
need
for
focus.
By:
Promoting
safe
maternal
care
for
every
US
birth.
Engaging
multidisciplinary
partners
at
the
national,
state
and
hospital
levels.
Developing
and
implementing
evidence-based
maternal
safety
bundles.
Utilizing
data-driven
quality
improvement
strategies.
Aligning
existing
safety
efforts
and
developing/collecting
resources.
Funded
through
HRSA
(federal)
Maternal
and
Child
Health
Bureau
with
a
cooperative
agreement
Such
an
effort
requires
National
Mobilization!
AIM
Naitional Partners:
Professional
Organizations Public
Health
Organizations
Am.
Academy
of
Family
Physicians
Assoc.
Maternal
and
Child
Health
(AAFP) Programs
(AMCHP)
Am.
College
of
Nurse
Midwives
Assoc.
of
State
and
Territorial Health
(ACNM) Officers
(ASTHO)
Am. College
of
Obstetricians
and
Maternal
and
Child
Health
Gynecologists
(ACOG) Bureau/HRSA
(MCHB)
Assoc.
of
Womens
Health,
Centers
for
Disease
Control
and
Obstetric,
&
Neonatal
Nurses
Prevention
(CDC)
(AWHONN)
Nurse
Practitioners
in
Womens
City
MatCH
Health (NPWH)
Society
for
Maternal/Fetal
Centers
for
Medicare
and
Medicaid
Medicine
(SMFM) Innovation
Society
for
Obstetric
Anesthesia
National
Healthy Start
Association
and
Perinatology (SOAP)
AIM
Partners
(cont):
Other
Quality
Improvement
Organizations
Am.
Society
of
Health
Risk
Management
(ASHRM)
California
Maternal
Quality
Care
Collaborative
(CMQCC)
HealthStream
Preeclampsia Foundation
Premier, Inc.
The
Joint
Commission (TJC)
Trinity
Health Care
Examples
of
AIM
National
Partners
Contributions
ACOG Hosts
national
staff
and
meetings,
Highlighted
at
national
and
district
meetings,
MD
leadership
for
every
state,
national
education
and
lobbying
efforts
AWHONN Postpartum
discharge
teaching;
AIM
highlighted
throughout
Annual
Meeting;
monthly
calls
with
state
nursing
leaders.
ACNM Birthtools web
info,
Leadership
on
Supporting
Intended
Vaginal
Birth
bundle;
AIM
at
annual
meeting.
AMCHP Maternal
mortality
review
web
tools;
AIM
breakout
at
annual
meeting.
Engage
and
support
state
MCH
sections
ASTHO Engages
state
health
officers
to
provide
support.
AIM
discussed
at
bi-monthly
calls.
AAFP Content
on
bundle
work
groups
and
consultation
for
rural
state
issues.
ABOG Maintenance
of
Certification
credit
for
MDs
working
on
AIM
SOAP Consultation
on
bundle
implementation
and
disparities
SMFM M
in
MFM
annual
meeting;
leadership
and
mentorship
on
state
teams.
Annual
sessions
on
OB
QI
and
populaiton health
AIM
Works
at
National,
State,
and
Facility
Levels
State
to
State
Hospital
to
Hospital
Best
Practices
Implementation
Tools
Strategies
for
Overcoming
Barriers
AIM
Participation:
July
2017
AIM
Impact
Annual
Births:
1,520,000+
(11+)
Maternal
Early
Warning
For Reducing
Postpartum
Care
Safety
Criteria Every Disparities
in
Basics
Maternity
Care
Tools SMM
Case
Mother
Review
Forms Interconception
Maternal
Mental
Care
Patient,
Family
Health
Coming
Soon
and
Staff
Support
16
www.safehealthcareforeverywoman.org
Creating
multi-disciplinary
national
consensus
Safety
Bundles
is
actually
the
easy
part
Cross-Bundle Help
Bundle
Specific
Obstet
Gynecol.
2015
126:155
AIM
eModules
Thank
You!
Jeanne
Mahoney,
RN
AIM
Program
Director
Email:
jmahoney@acog.org
Elliott
Main,
MD
AIM
Implementation
Director
Email:
emain@stanford.edu
Obstetric Safety 101:
Implementing the
Hemorrhage Bundle
Elliott
K.
Main,
MD
Medical
Director,
CMQCC
Objectives
Infection 10% 5% 5%
19.3
United States Rate 16.9
18.0 16.6 19.9
15.5 16.9
15.1
14.6
15.0 13.1 14.0
12.7
10.9 11.6
12.0 10.0 13.3
9.9 9.9 12.1
11.8 11.7 9.2
11.1
9.0 9.8 9.7 7.4
8.9 7.3
6.0 7.7
6.2
0.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, 1999-2013. Maternal mortality for
California (deaths 42 days postpartum) was calculated using ICD-10 cause of death classification (codes A34, O00-O95,O98-O99). United States data
and HP2020 Objective use the same codes. U.S. maternal mortality data is published by the National Center for Health Statistics (NCHS) through 2007
only. U.S. maternal mortality rates from 2008 through-2013 were calculated using CDC Wonder Online Database, accessed at http://wonder.cdc.govon
March 11, 2015. Produced by California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, March,
2015.
Obstetric Hemorrhage and
Preeclampsia: Overview
n Most common preventable causes of
maternal mortality (70-90%)
n Far and away the most common causes of
Severe Maternal Morbidity (80%)
n High rates of provider quality improvement
opportunities (90%)
Obstet Gynecol. 2015 Jul;126(1):155-62
First Bundle:
July 2015
26
J Midwifery Womens Health. 2015 Jul;60(4):458-64.
OB HEM
Bundle
Approved by Council
on Patient Safety and
posted on website.
Publication:
July 2015
Creating a
bundle is the
easy part
safehealthcareforeverywoman.org 27
Every
unit
OB
Hemorrhage
- Readiness
q Hemorrhage
cart
with
supplies,
checklist,
instruction
cards
and
posters
q Immediate
access
to
hemorrhage
medications
q Establish
a
response
team
who
to
call
when
help
is
needed
q Establish
massive
and
emergency
release
transfusion
protocol/policies
q Unit
education
on
processes,
unit-based
drills
(with
debriefs)
Just
in
Time
Education
32
B-Lynch Compression Suture
Belt and Suspenders
33
Patient
Level
Readiness
Some units have found it easier, cost-effective and time saving to Type and
Screen everyone (cross match the highest risk as above).
www.CMQCC.org
CMQCC OB Hemorrhage
Care Guidelines
44
Importance of Protocols and Checklists creating
standardized approaches esp. for Emergencies
Link on ACOG
home page, or:
www.safehealthcareforeverywoman.org
52
Every
unit
OB
Hemorrhage
Reporting/Systems
Learning
q Establish
a
culture
of
huddles
for
high
risk
patients
and
post-event
debriefs
to
identify
successes
and
opportunities
q Multidisciplinary
review
of
significant
hemorrhages
for
systems
issues
q Monitor
outcomes
and
process
metrics
in
perinatal
quality
improvement
committee
q Celebrate
Great
Team
Responses!!
California
Partnership
for
Maternal
Safety 53
How to Avoid the Twin Traps
1. Early wins
2. Biggest
impacts
3. Not all can be
done quickly
Bundle elements
may need to be
adapted to fit
your resources
Localize
Creating a Team For All Seasons
19.3
United States Rate 16.9
18.0 16.6 19.9
15.5 16.9
15.1
14.6
15.0 13.1 14.0
12.7
10.9 11.6
12.0 10.0 13.3
9.9 9.9 12.1
11.8 11.7 9.2
11.1
9.0 9.8 9.7 7.4
8.9 7.3
6.0 7.7
6.2
0.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, 1999-2013. Maternal mortality for
California (deaths 42 days postpartum) was calculated using ICD-10 cause of death classification (codes A34, O00-O95,O98-O99). United States data
and HP2020 Objective use the same codes. U.S. maternal mortality data is published by the National Center for Health Statistics (NCHS) through 2007
only. U.S. maternal mortality rates from 2008 through-2013 were calculated using CDC Wonder Online Database, accessed at http://wonder.cdc.govon
March 11, 2015. Produced by California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, March,
2015.
Maternal Mortality Rate,
California and United States; 1999-2013
24.0
California Rate 22.0
21.0
Maternal Deaths per 100,000 Live Births
19.3
United States Rate 16.9
18.0 16.6 19.9
15.5 16.9
15.1
14.6
15.0 13.1 14.0
12.7
10.9 11.6
12.0 10.0 13.3
9.9 9.9 12.1
11.8 11.7 9.2
11.1
9.0 9.8 9.7 7.4
8.9 7.3
6.0 7.7
6.2
0.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, 1999-2013. Maternal mortality for
California (deaths 42 days postpartum) was calculated using ICD-10 cause of death classification (codes A34, O00-O95,O98-O99). United States data
and HP2020 Objective use the same codes. U.S. maternal mortality data is published by the National Center for Health Statistics (NCHS) through 2007
only. U.S. maternal mortality rates from 2008 through-2013 were calculated using CDC Wonder Online Database, accessed at http://wonder.cdc.govon
March 11, 2015. Produced by California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, March,
2015.
Improving
Maternity
Outcomes
Through
Collaboration
Implementation
Package
Cross-Bundle Help
Bundle
Specific
Obstet
Gynecol.
2015
126:155
AIM
eModules
Hemorrhage
Toolkits
265pp
25pp 60pp