Exposure to routine availability of immediate postpartum LARC: effect on attitudes and practices of labor and delivery and postpartum nurses.

OBJECTIVES: Nurses play an integral role in intrapartum and postpartum patient education. This exploratory study aims to assess the attitudes, knowledge, and practices of labor and delivery and postpartum nurses regarding contraception and evaluate for changes in these measures 1 year after an institutional initiative allowing routine availability of immediate postpartum long-acting reversible contraception (LARC). STUDY DESIGN: In 2014, Montefiore Medical Center began to routinely offer comprehensive immediate postpartum contraception. The initiative included education and feedback sessions for labor and delivery and postpartum nurses on contraception, including immediate postpartum initiation of LARC. Nurses completed anonymous surveys at the beginning of the initiative (n=59) and at 1 year (n=56). We compared baseline and 1 year survey results of contraceptive knowledge, attitudes and practices using χ2 test, Fisher's Exact Test, or t test as appropriate. RESULTS: Nurses who stated they counseled patients on contraception "always" or "most of the time" increased from 27/59 (46%) to 40/56 (71%) (p=.005). The number of nurses who would recommend the intrauterine device and implant for postpartum contraception increased from 1/59 (2%) to 18/56 (32%) (p<.0001). Attitudes towards injectable contraception and breastfeeding remained negative; 27/59 nurses (46%) at baseline and 34/56 (61%) at 1 year agreed with the statement "DMPA [depot medroxyprogesterone acetate] has a negative effect on breastfeeding." CONCLUSIONS: Experience working in a location with routine access to immediate postpartum contraception is associated with increased awareness among nurses of postpartum contraceptive options, especially LARC, and increased contraceptive counseling. Concerns about the impact of hormonal contraception on breastfeeding, specifically DMPA, are persistent and prevalent. IMPLICATIONS: Labor and delivery and postpartum nurses' knowledge regarding immediate postpartum contraception, particularly LARC methods, may change with exposure to routine access to these methods. This exposure may also impact nurses' practices of providing patient counseling on what methods are appropriate for postpartum women.

Sustained Improvement in Administration of the Hepatitis B Vaccine Birth Dose: A Quality Improvement Initiative.

The New York State Department of Health recommends the administration of the hepatitis B vaccine birth dose within 12 hours of life (HOL) for all full-term babies irrespective of maternal hepatitis B status. The primary and secondary aims of the project were to improve the timeliness of vaccine administration and increase the total number of infants vaccinated prior to discharge. Multiple Plan-Do-Study-Act cycles were performed. Statistical process charts of percentages of vaccination within 12 HOL and prior to discharge were constructed with 3-σ (data within 3 standard deviations from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Administration within 12 HOL improved from 13% to ≥65% within 6 months, and has been sustained for >1 year. Vaccine administration prior to discharge increased from 94% to 98%. Quality improvement methods can rapidly improve adherence to newborn vaccine recommendations and these effects are sustainable.