1. 1 © Sisters of Charity of Leavenworth Health System, Inc. All rights reserved. Montana Perinatal Quality Collaborative Alison Rentz, MD April 29, 2016

2. 2 I have nothing to disclose Objectives –1. Describe the formation of the Montana Perinatal Quality Collaborative –2. Discuss the goals of the collaborative –3. Examples of how it may be used –4. Next Steps

3. 3 State Perinatal Quality Collaboratives - CDC Networks of perinatal care providers and public health professionals working to improve pregnancy outcomes for women and newborns by advancing evidence- based clinical practices and processes through continuous quality improvement Identify processes that need to be improved and use the best available methods to make changes and improve outcomes State PQCs include key leaders in private, public, and academic health care settings with expertise in evidence-based obstetric and neonatal care and quality improvement

4. 4 CDC Map of Perinatal Collaboratives

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6. 6 Steps in creating a PQC Identify and Engage Key Players Ensure Buy-In Establish Identity Secure Funding Launch Initiatives Establishing Data Sources and Collection Developing Quality Improvement Models Dissemination Sustainability

7. 7 Why a Montana State Perinatal Collaborative? Modeled after other states’ collaborative development –Vermont Oxford Network provides framework for data collection, collaboration and continuous quality improvement work

8. 8 First Steps in creating a Montana PQC Identify and Engage Key Players Ensure Buy-In Establish Identity

9. 9 Montana Perinatal Collaborative (MPC) Chico Meeting 2014 –Share ideas and best practices, network –Improve quality at a state level by increasing the power of our individual data through transparency –Standardize care of neonates across the state –Advocacy Purpose –To improve the quality of care and the outcomes for pregnant women, newborns, and children as a collaborative of small centers in a large region

10. 10 MPC Membership –Begin with regional perinatal centers St. Vincent Healthcare Benefis Health System Kalispell Medical Center Community Medical Center Billings Clinic –Over time move to all delivery hospitals in the state Consider including Idaho, Wyoming, North Dakota

11. 11 Next Steps in creating a Montana PQC Establishing Data Sources and Collection Developing Quality Improvement Models

12. 12 Data Infrastructure View aggregated data –Vital Statistics (birth certificates) Share site specific data –VON Montana Group Report – formed in 2014, 2 years of data

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16. 16 Keys To Success Measure, measure, measure Increase numbers of patients in data Transparency Share ideas Keep it simple and sensible Aim high

17. 17 Current Steps in creating a Montana PQC Dissemination

18. 18 Examples of Our Work Sharing protocols around NAS care, ELBW feeding and CPAP use QI initiatives in individual units based on state collaboration –QI work presented at the VON quality congress (St. Vincent Healthcare, Benefis) Grant for development of training for Finnegan scoring and inter-rater reliability (Kalispell) Sharing of data and transparency to gain knowledge on best practices

19. 19 SMART Aim Mechanisms/Drivers of Change Data  A Breastmilk use guideline was developed in 2014 and with this we had a 50% increase in breast milk use.  In 2014, of the 4 babies that were strictly formula fed, 3 of the 4 were not candidates for breast feeding per the guideline.  In 2015, of the 3 that were strictly formula fed, 2 were not candidates per the guideline. Overall, our use of MBM in infants with NAS has increased dramatically.  A Breastmilk use guideline was developed in 2014 and with this we had a 50% increase in breast milk use.  In 2014, of the 4 babies that were strictly formula fed, 3 of the 4 were not candidates for breast feeding per the guideline.  In 2015, of the 3 that were strictly formula fed, 2 were not candidates per the guideline. Overall, our use of MBM in infants with NAS has increased dramatically.  Decrease length of stay for babies with Neonatal Abstinence Syndrome at St. Vincent Healthcare. We will decrease LOS by 10% (from 17.5 days to 15.75 days) by June 2015. SECONDARY AIMS: Improve identification and treatment of infants exposed to narcotics Improve education to parents and staff on scoring and non-pharmacologic treatment Encourage a family centered approach. Data was collected via chart audits and survey results. SVH NICU treated 17 babies diagnosed with NAS out of 585 NICU admits between Jan. 2013 and Aug 2015.  Primary Measure: Average length of hospital stay in days for babies admitted to NICU with the diagnosis of NAS that received pharmacologic treatment. This measure was assessed every 6 months.  Secondary Measures:  Percentage of babies that received breast milk  Inter-rater reliability in Finnegan NAS scoring  ability of nursing staff to treat the narcotic exposed mother/baby dyad and to provide effective non- pharmacologic interventions  Increased level of parental education after prenatal consults In 2013, a multidisciplinary team was assembled and felt standardization of pharmacologic treatment, use of breast milk, standardized scoring and improving family centered care would decrease LOS and improve quality. In June 2014 this team began taking steps towards improvement by using distinct PDSA cycles related to specific drivers of improving our NAS care. SETTING: St. Vincent Healthcare NICU is a 22 bed, level 3B unit in a regional hospital serving Billings, Eastern Montana, Northern Wyoming, and Western North Dakota and is a part of a women and children service line that delivers 1500 babies/year with 200 NICU admits (80% inborn). While we have seen an increase in the number of narcotic exposed infants within the population that we serve, we have a low volume of infants/year that require pharmacologic treatment for NAS (5-10/year). SETTING: St. Vincent Healthcare NICU is a 22 bed, level 3B unit in a regional hospital serving Billings, Eastern Montana, Northern Wyoming, and Western North Dakota and is a part of a women and children service line that delivers 1500 babies/year with 200 NICU admits (80% inborn). While we have seen an increase in the number of narcotic exposed infants within the population that we serve, we have a low volume of infants/year that require pharmacologic treatment for NAS (5-10/year). Reducing Length of Stay and Improving Family Centered Care for Narcotic Exposed Infants St. Vincent Healthcare, Billings, MT, USA Lacey Koenig RN, Dianne Kimm RN, Sammy Twito RN, Vicki Birkeland RN, Alison Rentz MD Reducing Length of Stay and Improving Family Centered Care for Narcotic Exposed Infants St. Vincent Healthcare, Billings, MT, USA Lacey Koenig RN, Dianne Kimm RN, Sammy Twito RN, Vicki Birkeland RN, Alison Rentz MD People Healing People. Develop a breast milk use policy that outlines safe use of breast milk in narcotic exposed mother/baby dyads In the first 6 months of 2015 the average LOS at SVH for a baby with NAS was 14.2 days. Even in a center with low NAS volumes, SVH has demonstrated an improvement in the care of infants with NAS through standardization based on potentially better practices. Our NAS QI initiative has decreased our LOS by 18.9%. Variability in LOS has decreased and the recognition of NAS is increasing over time. We have successfully increased the number of babies that receive breast milk during their hospitalization. NAS education among staff is ongoing. We hope to be designated as a Center of Excellence in NAS treatment by the end of October 2015 with the completion of the VON NAS universal training, improve prenatal diagnosis and consultation, and provide outreach education to our regional hospitals. Lacey Koenig RNC St. Vincent Healthcare 1233 N. 30 th Street, Billings MT 59101 (406)-237-7076 Lacey.Koenig@sclhs.net SECONDARY DATA:  2014 scoring training: achieved a 93% inter-rater reliability among nursing staff  2015 staff survey: 90.4% of nurses feel more able to provide effective non- pharmacologic treatment for NAS and 87.7% of nurses feel they are better prepared to provide quality family centered care after the education they have received. Measures Discussion LOS in 2013 was 17.5 days.

20. Improving Nutrition & Minimizing Necrotizing Enterocolitis (NEC) Through Standardization of Feeding Practices Benefis NICU Great Falls, MT – United States Vermont Oxford NICQNEXT Beckett S. Perkins ARNP, MS, NNP, Sarah Kenney MD, Caroline McConville RN MBA, Staci Griffin RNC, Cheryl Menghini RN and Carlene Turner RNC

21. 21 Next Steps Review the CDC guidelines for creating a PQC Establish our identity –Clearly state mission –Identify focus and goals –Branding/online presence Funding Recruit stakeholders/identify champions for projects Launching initiatives Leadership in quality improvement models Communication

22. 22 WE NEED YOU!!! Questions?