Larson says that improving communications among staff was needed because they used terms like minimal variability or moderate variability in their conversations, but those terms meant different things to different people. The result: a wide variation in the way clinicians responded to sometimes-critical information.
Larson says a "multipronged strategy" based on guidelines developed by the nonprofit organization Institute for Clinical Systems Improvement has successfully resulted in full compliance with protocols designed to prevent any staffers from unintentionally leaving a foreign object in a patient during a vaginal delivery.
Nurses involved in the procedures complete a checklist to document the use and removal of needles, sponges, or other objects used in the procedures. The hospital accounts for the procedures with a regular audit as well as unannounced audits from a nurse designated by a review staff known as a unit practice council and overseen by nurses. The ongoing audits have shown increased compliance with the protocol, from 95% in 2008 to 100% in 2009 and 2010, according to Larson.
The hospital also established initiatives to improve staff communication with patients, she says. The hospital has a standard procedure in which nurses and doctors acknowledge patients by name, introduce themselves, explain their functions, and provide patients with a card that has a photo of the provider who is in charge of the patient's care. The procedure is based partly on a framework called AIDET, for acknowledge, introduce, duration (letting patients know if there is a delay and how long it will take), explanation, and thank you.
Success key No. 3: Water births
When the Lovelace Women's Hospital opened its natural birthing center in 2010, it sought to provide a place for women who wanted a natural delivery while avoiding medical interventions. It also offered water births, which have become one of the most popular aspects of the center, says Terri Caspary Schmidt, CNM, a nurse midwife with ABQ Health Partners, which is under contract to run the birthing center's water birth program.
While some hospitals are reluctant to embrace the concept, others like Lovelace are diving in. Schmidt says the birthing center has continually increased its patient load, and hospital officials believe that the water birth program is somewhat responsible for that. The hospital noted that the "new service is being provided to meet the growing demand of mothers, families, and providers who seek a more peaceful and natural birth process."
Water birth is a procedure for birthing that involves immersion of the mother in warm water, or using water as part of the labor process.
The Lovelace Women's Hospital includes a 41-bed mother-baby unit, as well as 16 labor and delivery rooms. The birthing center also has four private labor/delivery/recovery and postpartum rooms with water birthing tubs. The 509-bed Lovelace Health System in Albuquerque operates the facility.
Of 350 births at the hospital's birthing center, there were 60 water births in 2011, according to Schmidt.
Proponents believe this method is safe and provides many benefits for both mother and infant, including pain relief for the mother and a less traumatic birth experience for the baby.
"Many mothers find that labor and delivery can be an intense process. Women who choose to labor and deliver in our tubs find that the water's buoyancy relieves pressure and that the constant temperature provides comfort," says Schmidt.