A Project to Reduce Opioid Administration for Women in the Postpartum Period.

OBJECTIVE: To decrease the need for opioids for women in the postpartum period by using the PainPack Protocol to administer alternating acetaminophen and ibuprofen. DESIGN: Quality improvement project. SETTING: Southwestern Ohio Level II community hospital with approximately 4,000 births per year. PARTICIPANTS: A pilot group of women who gave birth from July 2017 through December 2017 (n = 210). Full implementation included women who gave birth from January 2018 through June 2019 (n = 5,560). INTERVENTION/MEASUREMENTS: The PainPack Protocol used in the outpatient setting was modified and implemented for use in the inpatient setting. Outcomes were measured via chart review and were based on morphine milligram equivalents (MMEs) given in the hospital and prescribed after discharge. Feedback from women during nurse leader rounds was also considered. RESULTS: The average amount of MMEs administered in the hospital was reduced from 143.2 to 105.8 for women birthing via cesarean and from 32.8 to 26.1 for women birthing vaginally. The average amount of MMEs prescribed at discharge was reduced from 281.0 to 166.9 for women birthing via cesarean and from 99.0 to 45.0 for women birthing vaginally. CONCLUSION: This protocol was associated with reduced amounts of opioids administered to women during postpartum hospitalization and prescribed upon discharge. At the same time, women reported effective pain control during nurse leader rounds.

A High-Fidelity Human Patient Simulation Initiative to Enhance Communication and Teamwork Among a Maternity Care Team.

OBJECTIVE: To use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies. DESIGN: Quality improvement initiative. SETTING/LOCAL PROBLEM: The labor and delivery team at a large suburban Level 2 facility in the Midwestern United States sought to apply evidence and use simulation to improve communication and teamwork. PARTICIPANTS: Approximately 170 maternity care staff members, including nurses, anesthesia providers, and pediatric and obstetric physicians. INTERVENTION/MEASUREMENTS: During each simulation, there were two scenarios with a debriefing session at the end of each. Teamwork and communication were evaluated using participant surveys. RESULTS: Participants reported improved communication (p = .031) and teamwork (p = .041) after simulation. Additionally, 81% of respondents believed that their ability to perform clinical skills improved. CONCLUSION: Use of high-fidelity human patient simulation was associated with improved teamwork and communication for a maternity care team. Simulation has been incorporated into standard education. We hope to sustain successful outcomes by providing ongoing simulation experiences for labor and delivery staff annually.