OPQC OB ACTION PERIOD

CALL

July 26, 2012

2:00-3:00 PM ET

Welcome

Please don’t put us on HOLD

• If you need to step away

– Use the MUTE button on your phone or

– You can use *6 to place the call on MUTE and

*6 to come off of MUTE

2:00

Welcome and Roll Call Sandy Fuller

2:05 Data for Improvement Drs. Jay Iams

2:15 “Mind the Gap” Dr. Jay Iams

2:25 Monthly Progress Report and

PDSA’s

Sandy Fuller

2:35 Lessons learned from the 39

week Dissemination and Spread

initiative

Carole Lannon

Beth White and Susan Ford

2:50 Preparing for ANCS

Dissemination

Dr. Heather Kaplan

2:55

Next Steps Sandy Fuller

Agenda

SMART AIM

To increase the

percentage of infants

born in Ohio at 24 0/7

to 33 6/7 weeks’

gestation who receive

pre-delivery ANCS to

> 90%, by June 2013

Global Aim: Assure that all infants born between 24 0/7

and 33 6/7 weeks’ gestation receive appropriate

antenatal corticosteroid treatment to reduce perinatal

morbidity and mortality.

Key Drivers

Documentation System

Identification of Appropriate

Time for ANCS Administration

Optimal and Efficient

Administration of ANCS

Awareness of Benefits and

Risks

Interventions

Identification of Appropriate

ANCS Candidate

• Promote public awareness of benefits of ANCS

• Education of parents & non-perinatal providers

• Link to maternal transfer & tocolysis

• General risks and benefits

• Promote consistent use of common algorithm of

ANCS administration for Betamethasone &

Dexamethasone

• Practitioners

• Prescribing

• Care Giving / Administering

• Hospitals

• Link to maternal transfer & tocolysis

• Pharmacies

• Distributors

• Pharmaceutical Manufacturers

• CHOOSE an ANCS Strategy or Guideline for your

site

• Create an integrated system of recording ANCS

administration among prenatal care sites and

delivery sites encompassing all levels and acuity

of care.

• Standardize birth certificate documentation of

ANCS administration

Aggregate Report

OPQC Obstetric Collaborative to Improve the Use of

Antenatal Corticosteroids

Monthly Progress Report – What have we

Learned?

• Many teams are working on accurately entering administration of

ANCS into the birth certificate system (documentation completeness)

• 2 teams are working with OBTV to help staff enter data into the

system accurately and pull the data out of the system

• 2 teams discovered that the reasons why ANCS was not given was a

systems failure

• Many reported the reasons for not receiving ANCS is because of

“Short interval from Presentation to Delivery; Interval <2 hours”

• Barriers – Having more than one person responsible for data

collection

What are teams working on? • Merging BC data with clinical data

• Next PDSA - ANCS Card

• Increasing communication between data collectors

and monitor information entered into OPQC database

• Improving ANCS documentation of transferred

patients

• Compare nurse collected data with nurse charted

data in OBTV – computer generated data

• Steroid sign in the triage room

• Analyzing all 24-34 week patients for full course of

ANCS

• Complete documentation by nurses so Medical

Records can input the data

Goals for the ANCS Project

> 90% Aggregate ANCS Rx @ 24-34 Wks

Reduce Variation Across the State

Eliminate ANCS System Failures

Maximize the # and % Rx’d in “Sweet Spot”

– 2 to 14 Days Before Preterm Birth 24-34 wks

– Who Is Doing It Best?

• High % Rx’d AND High % In The Sweet Spot

– How Are They Doing It?

– How Can We Spread It to All Sites?

Poll

Help us rename the “Root Cause Analysis”

activity!

•CSI – Corticosteroid Investigation

•MOp – Missed Opportunity

•MSI – Missed Steroid Investigation

•MOA – Missed Opportunity Analysis

39 week Dissemination and

Spread • Spread what we learned from the great work of the

original 20 teams!

• January 2012, in partnership with Ohio Department

of Health Office of Vital Statistics

– 15 hospitals recruited to participate in a pilot learning

collaborative

– Teams consist of Clinical and Data Abstraction staff

– Birth Certificate data used to guide improvement efforts

Bailit, JL. for Ohio Perinatal Quality Collaborative. “Rates of labor induction without

medical indication are overestimated when derived from birth certificate data.”

American Journal of Obstetrics & Gynecology203.3 (Sept 2010): 269.e1-269.e3.

Kamath B, E Donovan, R Christopher, et al. “Using Improvement Science to Increase

Accuracy and Reliability of Gestational Age Documentation.” American Journal of

Perinatology, in press

The Ohio Perinatal Quality

Collaborative

Ohio Department of Health

Office of Vital Statistics

39-Week Scheduled Delivery

Dissemination Project

“The focus of healthcare for

women and infants over the

next century depends on the

quality of the data collected by

those who fill out the birth

certificates”.

Bill Callaghan, MD MPH

Centers for Disease Control and Prevention

December 1, 2011

39-week Project

1. 39-week scheduled delivery clinical project

2. Improving accuracy of birth data entry

** guiding principle:

Importance of regular connection and

communication between clinical and birth data

staff

Top 5 “A-ha Moments” learned

on site visits: 5. Medical terminology can be interpreted in different ways by

different people.

4. Prenatal visits are inconsistently captured after 36 weeks.

3. Breast feeding is being captured as intent, not if it is being

done at discharge.

2. When the value of the birth certificate is known, accuracy of

documentation increases.

Top 5 “A-ha Moments” learned

on site visits:

The number ONE “A-ha Moment” IS….

#1. The source of “obstetrical estimate of

gestation” is often inconsistently and

incorrectly recorded in IPHIS.

Does your site have regular

communication between

clinical and birth data staff?

Hot Off the Press!

Changes in the Indications for Scheduled Births

to Reduce Nonmedically Indicated Deliveries

Occurring Before 39 Weeks of

Gestation

Jennifer L. Bailit, MD, MPH, Jay Iams, MD, Angela Silber, MD, Michael

Krew, MD,

David McKenna, MD, Michael Marcotte, MD, and Edward Donovan,

MD, for the Ohio Perinatal

Quality Collaborative

OBSTETRICS & GYNECOLOGY

VOL. 120, NO. 2, PART 1, AUGUST 2012

ANCS: Thinking about dissemination

from the beginning….

SITE VISITS

St. Elizabeth’s Hospital

Good Samaritan Hospital—Cincinnati

Ohio State University Wexner Medical

Center

Aultman Hospital

University Hospital-Case Western Reserve

St. Elizabeth’s Hospital—Youngstown

Promedica Toledo

Good Samaritan

Hospital

IRB Documentation

• We’ve received documentation from 2

hospitals

• Please send a copy of your IRB # and

expiration date or determination that it was

exempt to:

OPQC@cchmc.org

Next Steps • Continue to collect data and submit July data –

due August 5, 2012

• Complete your Monthly Progress Report (MPR) by

August 5, 2012

• Continue to submit your “ “ for all patients

who have not received ANCS

• Keep testing changes – PDSA’s

• Join the August Action Period Call – August

30th from 2-3

• Mark your calendars! All AP calls from July-Dec

will be on the last Thursday of the month from 2-3

Thank you for joining the call and being

willing to share your great work!