Patient safety resources to improve outcomes

Dr. Sandra KochSandra Koch, MD, ACOG Committee on Patient Safety and Quality Improvement vice chair

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) fetal monitoring guidelines have been out since 2008. While most registered nurses are trained and recertified regularly, many clinicians have never been certified. As we’ve seen in so many areas of health care, standardization improves patient outcomes. It does this by advancing communication and simplifying decision-making. The NICHD guidelines provide a decision tree for clinicians to improve complicated decision-making. How many times have you watched a tracing that created anxiety? Get certified today!

Is your birth center having a difficult time complying with the guideline to not deliver infants electively before 39 weeks’ gestation? Are you looking for guidelines to help determine which infants need to be delivered early? There are many tools that can be useful. The ACOG Committee Opinion “Nonmedically Indicated Early-Term Deliveries” provides an excellent summary of the data available and the current ACOG recommendations for elective inductions. To create a hard stop, there are some important steps to take. Many centers have found the following steps helpful:

  1. Make all staff aware of the existence of the guideline and the reason it’s in place
  2. Appoint physician champions who are willing to coach practitioners who attempt to avoid compliance
  3. Use scheduling forms or checklists for all elective deliveries. Documentation makes the process of reviewing all cases for inappropriate early delivery much easier
  4. Require patients to sign a consent form that lists the benefits and risks associated with induction. Women should understand the pros and cons of intervention
  5. Review every case that fails to meet the guideline. By reviewing these cases, you can address the factors that are preventing your hard stop from being effective

The ACOG Committee Opinion “Medically Indicated Late-Preterm and Early-Term Deliveries” is a wonderful resource for discussions around which patients need to be delivered early. It lists common maternal and fetal conditions that require late-preterm and early-term delivery.

American Congress of Obstetricians and Gynecologists
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