Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control

Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control

Author: BMJ Quality and Safety

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A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.

“Background: A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.

Methods: The change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a ‘delivery bundle’, an ‘oxytocin bundle’ and a ‘vacuum extraction bundle’; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming’s system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar?<7 after 5?min or pH?<7) were analysed using statistical process control.

Results: Compliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH?<7?and Apgar?<7 after 5?min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions.

Conclusion: This QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.

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