Implementing a Best Practice Bundle in the Class III Morbidly Obese Intrapartum Patient

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Implementing a Best Practice Bundle in the Class III Morbidly Obese Intrapartum Patient

Hensley, Patricia - Dissertation

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title: Implementing a Best Practice Bundle in the Class III Morbidly Obese Intrapartum Patient

creator: Hensley, Patricia

subject: Dissertations, Academic.

description: Background: Obesity in pregnancy is associated with obstetrical morbidity and poormaternal and neonatal outcomes including co-morbidities such as hypertension,preeclampsia, and diabetes, and outcomes such as stillbirth, postpartum hemorrhage, andfetal hypoxemia (Edwards, 2016). Obesity increases the likelihood of labor induction andsubsequent intrapartum cesarean delivery, which is increases risk to mother and fetus(Machado, 2012).Purpose: The purpose of this process improvement project was to standardize the caredelivered to Class III morbidly obese intrapartum patients in a community hospital byutilizing a best practice bundle to provide evidence-based care for this at-risk population.Methods: This process improvement project involved the development and implementationof a best-practice bundle for Class III morbidly obese (BMI > 40 kg/m²) patients to providestandardized, safe intrapartum care. The BMI bundle interventions were separated into fivecategories; (1) adjusted medication doses; (2) infection prevention; (3) bariatric equipment;(4) resource utilization; and (5) intra-operative care. The measure of compliance to each ofthe five categories of the bundle was performed using an all-or-nothing approach with creditgiven to a category only when all applicable interventions for that category wereimplemented (Resar, Griffin, Haraden & Nolan, 2012). Nine individual interventions fromthe bundle were assessed pre and post-implementation.Results: The goal for this project was to provide standardized care to all patients with a BMI> 40 kg/m² admitted to this labor and delivery unit by utilizing this bundle. The bundle wasutilized 48.84% of the time. The compliance rate of utilizing all interventions in each of thefive categories ranged from 6.90% to 59.52%. Nine specific interventions were comparedpre- and post-implementation. Improvement was found in all nine categories of interventionsranging from 10.65% to 39.50%.Conclusion: Implementation of the Class III Intrapartum/Cesarean Section Best-PracticeBundle demonstrated improved use of evidence-based practice in the care of this populationby chart audit. The low utilization rate and compliance in the five categories suggested that aPDSA cycle was indicated.

publisher: Simmons College (Boston, Mass.)

contributor:

date: 2018

type: Text

format: 1 PDF (76 Pages)

identifier: td_np_2017_ph

source:

language: English

relation:

coverage:

rights: Material from the Simmons University Archives collections are made available for study purposes only. For more information, or to request rights to reproduce or reuse any material, contact the University Archives at archives@simmons.edu.

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