Maternal mortality is an ongoing crisis in the US most recent data available as of 2022, the national maternal mortality rate is 22.3 deaths per 100,000 live births. Unfortunately, stories are all too common of pregnant or recently pregnant people whose maternal health problems are misdiagnosed or overlooked, leading to serious morbidity or even death.
THE PROBLEM
Combined with evolving rights to reproductive care, this creates more barriers for physicians at the bedside and can limit treatment and healthcare team actions. This increases the challenges we face in tackling this crisis.
“Specifically at St. Luke’s we had experienced two obstetrics and gynecology adverse events in a short period of time and knew it was time to address the underlying causes,” says Claire Beck, manager, transition to practice, at St. Luke’s Health System. . “We identified an education program that was appropriate for the entire healthcare team, including caregivers and nurses.
“We were also very involved with our national chapter of the Association of Women’s Health, Obstetric and Neonatal Nurses and identified a perinatal safety initiative that AWHONN and Relias co-sponsored at the time in 2016 called ‘Mothers and Babies First,’” she continued. “This initiative proposed an educational solution of simulation-based team training.”
While key clinical outcome measures are monitored, St. Luke’s is expected to see improvement in perinatal outcomes. The focus was mainly on obstetric bleeding and improving safety in this area. This led the organization to Relias OB, with whom it is still a customer.
“Relias OB aligned closely with our perinatal safety initiatives, focused on continuous improvement to ensure our clinical teams are aligned with proven practices,” Beck explains. “We sought to reduce variability in care, increase reliability, reduce risk and improve outcomes for both mothers and babies. We liked that the education solution was assessment-based and provided personalized learning, with each could meet the doctor wherever he or she was.”
PROPOSAL
Relias OB offers data-driven digital learning technology that can be personalized for each student. A key differentiator that drew St. Luke’s to Relias education was its prioritization of critical thinking skills – not only analyzing whether a physician can activate their newly acquired skills, but also how to apply this knowledge and critical thinking in rapidly changing healthcare environments.
“We wanted to ensure that our training both educated members of the clinical team while also measuring their judgment, something that is extremely important in maternal care,” Beck noted. “High-quality learning, however, is not a one-time event. We need to continually evaluate how we’re meeting our team’s needs, and Relias’ detailed reporting was the solution to help us do that.
“With Relias’ offering, we can use the assessments not only as tests, but also as tools to improve quality of care,” she added. “This allows us to identify patterns and trends that can help our newest and most experienced nurses with additional training.”
MEETING THE CHALLENGE
The Relias OB systems are integrated into the St. Luke’s Perinatal Transition to Practice (TTP) program. To prevent the stress new nurses feel and instill confidence in their abilities, the staff offers them several months of induction and a full year of practice before they are even assigned a personalized learning course.
New nurses are trained using AWHONN’s Perinatal Orientation and Education Program and the Intro to Fetal Monitoring Course (offered on the Relias platform). To apply the knowledge from this curriculum, employees attend application workshops that use various modalities to promote group learning and teamwork.
“These include structured skills practice sessions, tabletop simulations, escape rooms, unfolding case studies and immersive simulations,” said Beck. “In the clinical setting, staff use Elsevier’s Clinical Skills, which guide their practice as policies and procedures. For practice areas where cesarean sections are performed outside the main OR, the ‘Periop 101: A Core Curriculum’ curriculum is for caesarean sections apply. used to prepare our nurses for the circulating role.
“The AWHONN Intermediate and Advanced Fetal Monitoring courses are then completed when you have completed one year and three years of employment respectively,” she continued. “We use Relias OB multi-layered learning technology for our ongoing education and assessment process for various maternal health conditions and complications.”
The data from the personalized learning courses is used to adjust the objectives for the immersive simulations conducted in each training area. The nurses complete the personalized learning courses for hypertensive disorders of pregnancy, obstetric and postpartum hemorrhage, fetal monitoring and shoulder dystocia.
“Relias OB works by evaluating each doctor’s knowledge and judgment and then personalizing training modules based on individual skills,” Beck explains. “These modules include interactive simulations and real-world scenarios that mimic situations nurses may encounter in the field.
“The system continuously analyzes data for continuous improvement by comparing each nurse’s performance against their peers, our internal healthcare system and even individuals in other healthcare systems,” she continued. “The training is data-driven and provides St. Luke’s with detailed insights to track and measure our team’s progress and improvements.”
In St. Luke’s antepartum, labor and delivery and postpartum units alone, more than 500 nurses have received training in hypertensive disorders and postpartum hemorrhage. In addition, more than 200 antepartum and delivery nurses have completed fetal monitoring training using Relias OB.
“We have been using these courses in our OB training for over five years now and have seen great improvement overall,” Beck reported. “These digital learning courses give us access to gaps and areas where concepts need to be reinforced at the individual and site level.”
RESULTS
After completing the fetal monitoring program, St. Luke’s seven medical centers achieved improvements over a two-year initiative, with three achieving remarkably high improvement rates of 39%, 22% and 20% for all nursing staff.
“More than four years since implementation, our nurses have achieved an 18% improvement in bleeding assessment,” said Beck. “For hypertensive conditions, our nurses achieved a 16% improvement. And finally, through Relias OB, a 15% improvement was achieved in the overall assessment of fetal monitoring.
“Our teachers use the data from the personalized learning courses to correct staff who scored below the 50th percentile,” she continued. “Staff will be assigned the associated Clinical Pearls and/or associated courses in preparation for retaking the personalized learning course.”
Teachers also attend one-on-one and group sessions to discuss areas or concepts with staff. Employees can also attend regularly scheduled application workshops at any time to discuss concepts and skills. To promote continuous learning and current practice, staff are encouraged to complete the Clinical Pearls or related courses outside the assessment period.
Many nurses use available advanced nursing education credits to maintain their certification.
ADVICE FOR OTHERS
“For other organizations looking to introduce similar data-driven training systems, first ensure there is a strong governance structure or steering committee to guide the use of technology and the data that will be reported,” Beck advised. “Leadership and educators must create a structured plan to integrate this technology into ongoing education plans. Involve stakeholders early in this process, by defining roles, responsibilities and an accountability plan.
“When data is collected through these learning systems, I recommend universal transparency,” she continued. “Leaders should be open with staff about how learning scores will be used, emphasizing that these are not intended to determine whether or not a clinician has passed a particular skill or area of learning, but rather to inform continuous improvement efforts to inform.”
Organizational leaders should socialize how and what data will be used in these efforts by providing refresher courses on statistics, especially around percentiles, for students and teachers, Beck added.
“Review this data with each clinician and highlight opportunities for improvement in a positive and supportive manner to avoid the perception that this data will be used in a punitive manner,” she said.
“Just state the facts, discuss any barriers and focus on the next steps for improvement,” she concluded. “Finally, emphasize success and improvement. Promote clinical growth by celebrating wins, big or small, individually or in groups.”
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