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Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control.

Abstract：

BACKGROUND:A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%. METHODS:The change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a 'delivery bundle', an 'oxytocin bundle' and a 'vacuum extraction bundle'; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming's system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar <7 after 5 min or pH <7) were analysed using statistical process control. RESULTS:Compliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH <7 and Apgar <7 after 5 min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions. CONCLUSION:This QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.

journal_name

BMJ Qual Saf

journal_title

BMJ quality & safety

authors

Hollesen RVB,Johansen RLR,Rørbye C,Munk L,Barker P,Kjaerbye-Thygesen A

doi

10.1136/bmjqs-2017-006599

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

633-642

issue

eissn

2044-5415

issn

2044-5423

pii

bmjqs-2017-006599

journal_volume

pub_type

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Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control.