1. AHRQ Annual Meeting Perinatal Safety Intervention Program (PSIP): Design and Development AHRQ Annual Meeting September 10, 2012 Nancy Lenfestey, MHA, 1 Nancy Chescheir, MD, 2 Margot Schwartz, MPH, 1 Celeste Mayer, PhD, RN 2, Douglas Kamerow, MD, MPH, 1 1.RTI International 2.University of North Carolina (UNC) Health Care

2. AHRQ Annual Meeting Overview Why focus on perinatal safety? PSIP pinwheel Audience Toolkit background, goals, objectives Toolkit development and structure PSIP phases and toolkit testing Current status and plans

3. AHRQ Annual Meeting Why Focus on Perinatal Safety? Birth-associated adverse outcomes: 2-10% (80- 400,000 annually), half of which are preventable (Forster et al., 2006, Leape, 2008) 30-40% of “near misses” and severe maternal morbidities may be preventable through changes in patient, health care provider, and system factors. (Geller, 2007)

4. AHRQ Annual Meeting Financial Consequences Approximately 50 percent of hospital risk management budgets are allocated for obstetric events, and birth-related events account for more than 75 percent of claims paid in amounts over $1 million. (Pettker, 2001) Prevention or minimization of harm through adherence to evidence-based practice guidelines is the best defense against patient harm and malpractice claims. (Cherouny et al., 2005)

5. AHRQ Annual Meeting PSIP “Pinwheel”

6. AHRQ Annual Meeting Toolkit: Target Audience Geared towards perinatal health care teams in the areas of obstetrics, neonatology, and anesthesiology. Intended for use by perinatal teams across all hospital types, geographic location, and staffing and resource levels. Toolkit can assist leaders in prioritizing perinatal quality and safety improvement efforts and resource allocation decisions.

7. AHRQ Annual Meeting Toolkit: Background Developed under an AHRQ contract that also includes development of a literature review, interviews with providers, and development of a course design guide. Provides a clinical basis for integrating CUSP and TeamSTEPPS concepts and methodology with current clinical evidence in a high-risk setting. Customizable to meet organizations’ individual clinical needs and level of staffing and resources available.

8. AHRQ Annual Meeting Toolkit: Goals and Objectives 1)Increase standardization of practices and more consistent use of best practices. 2)Enhance teamwork, communication, and efficiency of perinatal teams, thereby improving perinatal safety outcomes. 3)Provide tools and resources that will facilitate greater involvement of patients and families in the care process to foster patient-centered care.

9. AHRQ Annual Meeting Toolkit: Development Process Bi-weekly in-person UNC-RTI meetings – UNC develops clinical content – RTI has taken the lead in developing the overall PSIP framework and converting the clinical content into toolkit modules complete with guidance and tools Integrate feedback from 2 Technical Expert Panel Meetings Integrate feedback from AHRQ Integrate feedback from field testing

10. AHRQ Annual Meeting Toolkit: Structure 7 clinical modules – Postpartum hemorrhage – Umbilical cord prolapse – Safe performance of Cesarean-section – Shoulder dystocia – Induction of labor/augmentation of delivery – The seizing patient – Identification of the hypoxic fetus 3 non-clinical – Implementation Basics – TeamSTEPPS – Rapid Response Team

11. AHRQ Annual Meeting Module Contents Goals and objectives Information about epidemiology, risk factors, clinical presentations, potential harms, and clinical interventions Pre- and post-test questions Simulations Process and outcome measures Tools and references (located in the Appendices for each module)

12. AHRQ Annual Meeting PSIP User Phases Phase I: Assessment and Planning Phase II: Implementation Phase III: Evaluation and Sustainment

13. AHRQ Annual Meeting Module Topics 5 modules completed, sent to AHRQ and ready for field testing – Implementation Basics – Postpartum Hemorrhage (PPH) – Umbilical Cord Prolapse – TeamSTEPPS – Obstetric Rapid Response Teams Remaining Modules – Shoulder dystocia – Induction of labor/augmentation of delivery – The seizing patient – Safe performance of C-section – Identification of hypoxic fetus

14. AHRQ Annual Meeting Field Testing To obtain feedback on the toolkit’s feasibility in civilian and military hospitals UNC Health Care and Womack Army Medical Center Field testing topics – Overall impressions – Feasibility and appropriateness – Changes needed?

15. AHRQ Annual Meeting Additional Activity HRET CUSP videos – PSIP team is working with HRET to produce videos for cord prolapse and PPH – Videos integrate CUSP with PSIP – September 30 th completion date