NorthBay Health: Delivering on Safer Care for Mothers and Babies

The Challenges

Ensuring every nurse is ready to help care for every patient in OB’s high-risk environment.

To bridge the gap of not having a Perinatal Educator or Perinatal Clinical Nurse Specialist (CNS) on staff to help deliver evidence-based content, the leadership team at NorthBay Medical Center was forced to think outside the box.

Assessing staff competence

NorthBay’s patients and families trust the care teams to know what to do, while the hospital administration is expecting the leaders to be accountable for the patient outcomes on the units. This challenge is what keeps managers and directors up at night—the unknown and the “what ifs”. Efforts to improve perinatal safety education and adoption of a standard approach to care (including the use of evidence-based toolkits) was not new to NorthBay Medical Center, a hospital located in California, (in a state known for its progressive maternal safety standards). However, a more focused effort to improve perinatal safety proved to set NorthBay ahead of the rest.

The change

To implement perinatal safety improvement efforts, Katie Lydon, MSN, RN, NE-BC, CPXP, Director of Women and Children’s Health and NorthBay Medical Center, led the hospital’s charge to fully use Relias OB. As a former new grad nurse at the facility, Katie saw firsthand the benefits of the course content, but after moving into a leadership role in 2011, could give the implementation a new sense of focused energy to accelerate the hospital’s perinatal safety journey.

After developing the expectation of staff attendance at quarterly simulation training and a focused implementation schedule for the Relias OB Modules, NorthBay could recognize where the team needed to focus its training efforts, who needed to improve their skills, and in which areas of risk. This also provided the opportunity to celebrate the nurses who were among the top in the country in knowledge and judgment pertaining to electronic fetal monitoring, obstetrical hemorrhages, hypertensive disorders in pregnancy and shoulder dystocia events. The analytic capabilities within Relias OB enabled Katie to understand where to target additional efforts to improve patient care.

NorthBay could recognize where the team needed to focus its training efforts, who needed to improve their skills, and in which areas of risk. This also provided the opportunity to celebrate the nurses who were amongst the top in the country.

Being able to compare each individual nurse’s performance on the modules provided insight into staff competence. Knowing the team’s level of knowledge and judgment compared to thousands of nurses across the country created a sense of pride and confidence in the care that was being delivered.

NorthBay’s approach to success

1. Implemented initial expectation of completion of the Relias OB modules quarterly in 2015 and 2016, then focused on hands-on simulations based on the team’s Relias OB modules performance, in addition to real high-risk events that took place on the unit.
2. Encouraged flexibility after staff indicated a need for the Personal Proficiency Modules to be something they completed every other year. Due to staff turnover, getting new team members on the same cadence for completion was a challenge. Because of this, the calendar year for completion varied among staff members, increasing the importance of personal accountability and clear communication.
3. Modified expectations based on a nurse’s experience level (i.e., not expecting a nurse new to labor and delivery to perform as well on these modules as someone with years of experience).
4. Promoted continuous quality improvement throughout the team, given the high-risk environment for labor and delivery. Individual ownership of competence and team training is essential to keeping perinatal safety front and center as an ongoing priority.
5. Shared individual results with nurses, comparing their first attempts to subsequent attempts as well as their personal rankings compared to nurses nationwide, which proved to be a huge motivator.

The impact

Although California has perhaps the most impressive perinatal safety rates in the nation, NorthBay is exceeding the state’s high standards. Katie credits much of the hospital’s improvement in perinatal care to the individual knowledge obtained from Relias OB and organizational participation in the California Maternal Quality Care Collaborative (CMQCC).

Katie noted, “Relias OB is about changing behaviors, strengthening communication, and actually improving patient care on an ongoing basis.”

Continued success

NorthBay Medical Center has achieved nothing short of impressive results in providing high quality care for its mothers and babies. The team’s culture promotes individual accountability and instills a sense of responsibility in the staff to actively participate in training and education for the best interest of not only patients, but for the entire team as well.

While the team is setting a high standard for the rest of the nation to meet, they’re far from slowing down efforts.

Katie noted, “Because we work in such a high-risk environment, continual quality improvement is a must. Individual ownership of competence along with team training and a focus on communication will make us an even better place to have a baby.”

“Because we work in such a high-risk environment, continual quality improvement is a must. Individual ownership of competence along with team training and a focus on communication will make us an even better place to have a baby.”