Oregon AWHONN

Promoting the Health of Women and Newborns

December 2018 Vol. 5 No. 4

In This Issue

Carrying 2018’s Success Into 2019

by Becky Moore RNC-MNN, BSN


What a busy and reflective time of year! I find myself as well as my family, friends and colleagues very busy with holiday gatherings and festivities. Many of us often reflect on the previous year and discuss plans for the next as we come together to celebrate.

2018 has been a year of exciting success for Oregon AWHONN!

We have solidified a legislative team to keep our Oregon AWHONN members abreast and coordinate action on local and national legislation related to Obstetric, Neonatal and Women’s Health issues. I am deeply grateful to Nancy C. Alt, BSN RN, RNC-OB and Amy Brase, MSN, RN, CNE, both of Salem, who will be leading this important work. Amy and Nancy will be attending AWHONN on Capitol Hill in Washington, D.C. April 7-9 and we look forward to hearing about this exciting opportunity in an upcoming newsletter. 


Our annual Fall Conference was the largest ever, topping out at 267 attendees from a total of thirteen states! The evaluations were overwhelmingly appreciative of the outstanding speakers, networking and learning opportunities. One comment in particular stood out to me. “Thank you for all your hard work and dedication to AWHONN. Every year I’m blown away by the speakers. I cannot tell you how inspiring and helpful it is to be in a room of 300 nurses who share a strong passion for women and newborns. This is an indispensable resource to have in our state.” 


Once again, our nurse attendees showed their generosity by donating 3,771 diapers and $1,858 to the local charity, Family Promise, adopted for this year’s conference. Oregon AWHONN matched the monetary donation for a total of $3,716. Family Promise was overwhelmed with the generosity and support of AWHONN nurses.

Let’s start planning now to keep these successes alive in 2019! 

Get ready with contact information for your local and state legislators so that you can respond quickly to calls for action from our legislative team. Watch our Facebook page and newsletters for legislative information and updates. Our accomplishments at Conference demonstrate that together, AHWONN nurses are a mighty force! 


Consider launching a diaper drive in your local chapter or community. AWHONN National is ready to help you coordinate the effort to eradicate diaper need. Visit the Healthy Mom&Baby Diaper Drive page at https://www.awhonn.org/page/DiaperDrive?&hhsearchterms=%22diaper%22.


If you learned something at conference that you have implemented or launched an AWHONN initiative in your place of work this year, please share! Post your story and outcomes on our Facebook page to inspire others and let us celebrate with you. The winning post will receive an Oregon AWHONN jacket. 

Wishing you blessings, success and continuous learning in 2019.

Women's Health and Neonatal Update

New Perinatal Core Measure Coming: Unexpected Newborn Complications

by Pat Scheans, DNP, NNP-BC & Kara Johnson, DNP, RNC-OB, CNS


A new Joint Commission Perinatal Core measure is coming January 1, 2019. The new measure will be known as PC-06 Unexpected Newborn Complications (UNC). Taking home a healthy newborn may be the most important outcome for families. While there are several quality measures that examine clinical practice and outcomes in preterm babies, there are no other outcome measures for term newborns even though they represent the highest percentage of births in the United States. The UNC composite measure identifies babies without preexisting conditions (prematurity, multiple gestations, birth defects or other fetal conditions), and who are normally grown and were not exposed to maternal drug use, that had severe or moderate neonatal complications (CMQCC, 2018). 


The Perinatal Care (PC-06) UNC measure will include three rates: overall rate, severe rate, and moderate rate. Although there is not a set target rate, a decrease in rate would indicate improvement. Complications are categorized from the viewpoint of families. For severe complications: “Would I be fearful of my baby’s survival or long term outcome if my baby had…..?” For moderate complications “Would I be upset if my baby had….?” (Main & Gould, 2016). 


Severe complications include newborn death, transfer to another facility for higher level of care, extremely low Apgar Score (≤3 at either 5 or 10 minutes of life), birth injury such as intracranial hemorrhage or nerve injury, hypoxic ischemic encephalopathy, meconium aspiration with symptoms, or sepsis. Moderate complications include less severe respiratory complications (such as transient tachypnea of the newborn) or infections with a longer length of stay, excluding sepsis. Most moderate complications require a newborn length of stay that exceeds that of the mother, validating that it is a significant complication. 


Perinatal Care Joint Commission National Quality Measures (2018)

Set Measure ID
Measure Short Name
Description
PC-01
Elective Delivery
Patients with elective vaginal delivery or elective cesarean births at ≥37 and <39 weeks of gestation completed
PC-02
Cesarean Birth
Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth
PC-03
Antenatal Steroids
Patients at risk of preterm delivery at >=24 and <34 weeks gestation receiving antenatal steroids prior to delivering preterm newborns
PC-04
Healthcare-Associated Bloodstream Infections in Newborns
Staphylococcal and gram negative septicemias or bacteremias in high-risk newborns
PC-05
Exclusive Breast Milk Feeding
Exclusive breast milk feeding during the newborn's entire hospitalization
PC-06
Unexpected Complications in Term Newborns
The percent of infants with unexpected newborn complications among full term newborns with no preexisting conditions

UNC also serves as a balancing measure for maternal measures such as NTSV cesarean rates and early elective delivery rates. The purpose of a balancing measure is to guard against any unanticipated or unintended consequences of quality improvement activities for maternal measures (Joint Commission, 2018). For example, if a hospital is working towards lowering their NTSV rate and yet  have an increase in their UNC rate (perhaps due to birth trauma or low Apgar scores). It allows hospitals to review individual cases, not only for appropriate newborn resuscitation and care, but appropriate maternal antepartum and intrapartum care, which may have affected the newborn. An example of this might be an analysis of a case identified with neonatal respiratory complications. The team could review the management of second stage for care practices that potentially lead to acidemia in the fetus with resultant neonatal metabolic acidosis manifesting as respiratory distress (tachypnea to compensate for metabolic acidosis). Could this have been preventable?


The UNC measure reflects the patient/family perspective of anticipating taking home a healthy baby, but nurses and providers also identify with it since it is sensitive to both obstetric and newborn care.  The UNC Perinatal Care measure identifies adverse outcomes resulting in moderate or severe morbidity in otherwise healthy term infants without preexisting conditions. This allows hospitals to identify areas and tactics for quality improvement for both maternal and term newborn care. 


Oregon joined California and Washington state as a member of the Maternal Data Center (MDC) -- a collaborative benchmarking tool for performance metrics on maternity care services. This online database facilitates Identification of quality issues and opportunities. Stakeholders include hospitals, state agencies and the March of Dimes.

The MDC allows the 200 plus participating hospitals to generate nationally endorsed perinatal quality metrics to support the Joint Commission Core Measures like PC-06, as well as to compare themselves to statewide and regional benchmarks. The OMDC is overseen by the Oregon Health Care Quality Corporation (Q Corp), which manages the OMDC on behalf of the Oregon Perinatal Collaborative (OPC), a group of health care leaders in Oregon convened by the March of Dimes in 2011 to improve perinatal outcomes through collaboration and evidence-based practices. Their success with reduction of early elective deliveries in the Portland metro area led to expansion state-wide (Snowden, et al.,2016).

References


California Maternal Quality Care Collaborative (2018). Oregon MDC. Retrieved from https://www.cmqcc.org/maternal-data-center 


California Maternal Quality Care Collaborative (2018). Unexpected Complications in Term Newborns. Retrieved November 25, 2018 from https://www.cmqcc.org/focus-areas/quality-metrics/unexpected-complications-term-newborns


Main, E.K. & Gould, J.B. (2016). Pursuit of the holy grail: Measuring outcomes for term babies. California Maternal Quality Care Collaborative presentation.


Snowden, J. M., Muoto, I., Darney, B. G., Quigley, B., Tomlinson, M. W., Neilson, D., ... & Caughey, A. B. (2016). Oregon’s hard-stop policy limiting elective early-term deliveries: association with obstetric procedure use and health outcomes. Obstetrics and gynecology, 128(6), 1389. doi:10.1097/AOG.0000000000001737


Specification Manual for Joint Commission National Quality Measures Version 2018B (2018). Retrieved November 25, 2018 from https://manual.jointcommission.org/releases/TJC2018B/PerinatalCare.html

Legislative Update

AWHONN Legislative Priorities

by Nancy C. Alt, BSN RN, RNC-OB and Amy Brase, MSN, RN, CNE


MOOD DISORDERS

An estimated 10%-20% experience depression or anxiety during pregnancy or in the postpartum period.  Access to support and services are limited. AWHONN supports legislation, policies and public health initiative that will help these women. Improved awareness, removed stigma, reduced barriers to treatment and expanded research for perinatal mood and anxiety disorders are all areas for improvement and are promoted by AWHONN. For more information see the AWHONN Position Statement: Mood and Anxiety Disorders in Pregnant and Postpartum Women.


BREAST FEEDING

AWHONN supports legislation to support breastfeeding in a myriad of ways. For example, ensuring laws support breastfeeding in public and private locations, funding for programs like WIC and CDC that offer support for breastfeeding women, enhanced family medical leave policies, and increased funding for research related to breastfeeding—just to name a few. For more information see the AWHONN Position Statement: Breastfeeding.


MATERNAL MORTALITY

AWHONN’s goal is that every maternal death will be reviewed and more fully understood so maternal deaths can be prevented. AWHONN supports state and federal based Maternal Mortality Review Committees. In 2018, Oregon House Bill 4133 was passed that established a Maternal Mortality and Morbidity Review Committee in alignment with AWHONN’s recommendation. A federal review committee has not yet been established. AWHONN is advocating for that to happen.


PAID LEAVE

Currently, there is no national requirement for paid leave after birth. AWHONN is advocating with congress for enhanced family medical leave policies that provide paid leave for women in order to fully establish and maintain exclusive breastfeeding. New York, California, New Jersey and Rhode Island have state paid leave laws for pregnant women. Oregon has protected time, but no paid time.


SUBSTANCE USE DISORDERS IN PREGNANCY

AWHONN opposes laws and other reporting requirements that result in incarceration or punitive actions against women because of a substance abuse disorder in pregnancy. AWHONN supports improved access to comprehensive community-based substance about treatment programs optimally specifically for pregnant women. For more information see the AWHONN Position Statement: Criminalization of Pregnant Women with Substance Use Disorders.

Looking for the perfect gift idea for the nurse in your life?

Or do you want to treat yourself to a special treat this holiday season? Then consider purchasing a copy of the newly released book from Springer Publishing from our very own Oregon AWHONN Members, Sara Mosher and Pat Scheans.


For NICU and Labor and Delivery Nurses nurses alike, "Care Coordination in the NICU: Implementing Family Centered Nursing Care for Optimal Outcomes" focuses on nurturing the emotional health of patients and families in high risk situations to ensure improved outcomes for patients and their families. 


Each chapter focuses on a particular area of the perinatal/neonatal family journey, and includes current medical research, clinical examples, and recommendations for best practice alongside case studies that depict families experiencing a perinatal challenge. Most valuable of all, each chapter also includes stories directly from the source, the families, who have experienced the fear, isolation, and uncertainly of an NICU experience, and have greatly benefited from the emotional support of caring practitioners.


Key Features:

  • Examines the gamut of challenging patient and family issues that occur in the perinatal and NICU setting as they relate to care coordination throughout the process
  • Helps practitioners to incorporate family-centered care into their daily practices
  • Discusses effective listening and communication strategies for families in crisis
  • Includes examples of practice improvement strategies to improve clinical outcome and reduce the risk of re-hospitalization
  • Provides a Case-Based Learning section depicting real-world scenarios for discussion and problem-solving
  • Includes links to abundant resources and educational material
  • Contains chapters on palliative care and bereavement and supporting patients with special challenges.

Purchase your signed copy today! 

Cheers to a new year and another chance for us to get it right.

Oprah Winfrey