Allina Health delivers more than 14,000 infants annually. While only a small percentage of these births result in complications, Allina Health recognized that in cases of shoulder dystocia (when an infant’s shoulders get stuck behind the mother’s pubic bone) the hospital was seeing a greater need for infant resuscitation and long-term care of the infant, as well as injuries to the mother. Shoulder dystocia can lead to fractures, brachial plexus injury (injury to the network of nerves that sends signals from the spine to the shoulder, arm and hand), or the need to resuscitate due to lack of oxygen. The hospital set a goal to improve on three measures:
- Decrease the length of time from identification of shoulder dystocia to delivery of the infant
- Improve infant APGAR scores
- Improve the cord gas pH to >7 at 5 minutes of age (an indicator of the well-being of the infant)
“By improving on these three measures, we were able to greatly reduce the incidence of infant resuscitation in our hospitals,” said Alice Timm, RNC, patient care supervisor at Unity Hospital, part of Allina Health. In fact, across Allina Health’s 10 hospitals that perform births, newborn complications were cut in half, from 13.5 percent in 2007 to 6.7 percent as of September 2013.
To achieve its improvement goals, Allina Health focused on nurse and provider education. Beginning in 2008, Allina provided education and simulated scenarios to providers and labor and delivery nurses.The evidence-based education focused on identification of shoulder dystocia, initial interventions that needed to be done, invasive maneuvers that providers needed to perform, and the evaluation of the mother and infant following delivery as well as the proper documentation of that evaluation. The simulated training focused on different shoulder dystocia scenarios that could occur during delivery.
In one Allina Health hospital, the length of time between identification of shoulder dystocia and delivery was previously three to five minutes. After the education sessions and simulation, it is down to one minute.
“One of the keys to our success was teamwork and communication among the caregivers. It was something we emphasized throughout our training,” said Timm. “As a result, providers feel that nurses know exactly what is needed and are ready for the interventions before it’s even asked. This helps the team work together more seamlessly and helps the delivery go more smoothly,” she added.
To ensure nurses and providers are current on the techniques and information, Allina offers refresher education and simulation every two years in addition to new nurse education that occurs quarterly. New physicians also attend this training or it is provided one-to-one at individual hospital sites.