1. Maryland Patient Safety Center 3Rs: Risks, Referrals and Readmissions

2. Maternal and Newborn Risks Risks are predictors of post partum adjustments for both mothers and newborns. The MPSC Perinatal & Neonatal Learning Networks developed maternal and newborn risk assessment tools to assist the healthcare provider in screening for these risks/predictors prior to discharge.

3. Maternal and Newborn Risks Maternal Risks Prescribed high risk medications Medical Risks Pregnancy Related Risks

4. Maternal and Newborn Risks Newborn Risks Apgar scores <4 at 5 min Birth defect/Genetic syndrome <1500 gm Congenital Infection Late Preterm 34-36 6/7 weeks Prematurity <34 weeks Hearing risk/failed hearing Medical condition

5. Maternal and Newborn Risks Newborn Risks (cont.) Neurological condition Metabolic disorder Positive toxicology Weight loss >10% at discharge ROP, IVH/PVL Gastroesophageal Reflux Failed CCHD Screen without confirmatory echo Hyberbilirubinemia Feeding Problems History of psychosocial stressors Hospital Stay <5 days

6. Maternal and Newborn Referrals Maternal OB/GYN-early post-discharge evaluation PMD Appropriate Outpatient Follow-Up Home visits WIC Local Health Department

7. Maternal and Newborn Referrals Newborn Pediatrician/HCP-early post-discharge evaluation Appropriate Outpatient Follow-Up Home visits WIC Local Health Department

8. Maternal and Newborn Referrals A special word about Local Health Department Referrals http://phpa.dhmh.maryland.gov/mch/SitePages/postpartum-referral.aspx Guidelines Low birth weight birth ( <1500 gm) NICU admission Teen mother No prenatal care Maternal substance abuse Previous infant death Any other circumstance deemed to be a risk for mother or infant

9. Maternal and Newborn Readmissions <30 Days CMS Hospital Readmission Reduction Program Penalizes hospitals for “greater than expected” readmission rates.

10. Maternal and Newborn Readmissions <30 Days Nationally (AHRQ 2011) Maternal- 4% Newborns- 5% http://www.medicaiddirectors.org/sites/medicaiddirectors.org/files/public/clinical_policy_1.pdf

11. QUESTIONS? See your Perinatal or Neonatal Team Lead OR Contact Bonnie DiPietro, RN, MS, Director of Operations, MPSC at: bdipietro@marylandpatientsafety.org bdipietro@marylandpatientsafety.org 410-540-5095