An Initiative to Improve Postpartum Discharge Education.

OBJECTIVE: To evaluate an online POST-BIRTH Warning Signs (PBWS) project focused on improving nurses' knowledge and how they teach individuals in the postpartum period about potential complications. DESIGN: Quality improvement project with exploratory pretest/posttest. SETTING: Seventy hospitals with maternity services throughout the United States. PARTICIPANTS: A sample of 2,363 registered nurses. INTERVENTION/MEASUREMENTS: An online educational program with four surveys and a chart audit tool were used as evaluation measures. RESULTS: There was an 11% increase in nurses' knowledge after the online course intervention. A majority of nurses reported that they would improve how they educate patients and families about PBWS, that they would change their clinical practice based on what they learned, and that their facility implemented a protocol to educate patients about PBWS after the implementation of the course. The nurses' reported confidence in their teaching increased 59% after implementation of the course. CONCLUSION: The majority of maternal deaths in the United States occur during the postpartum period. Therefore, it is vital that nurses provide standardized and structured educational messaging when teaching individuals in the postpartum period about signs and symptoms of potential complications. This quality improvement project demonstrated that the PBWS online education course was associated with an increase in nurses' knowledge and confidence when teaching about potential complications that can arise during the postpartum period.

Interrater Reliability Testing of the Maternal Fetal Triage Index.

OBJECTIVE: To conduct interrater reliability testing of the Maternal Fetal Triage Index (MFTI), a standardized tool for obstetric triage. DESIGN: Observational study of a convenience sample of nurses' triage assessments of hospital-based obstetric patients. SETTING: A birth unit of a suburban hospital located in a large metropolitan region with approximately 5,200 births annually. PARTICIPANTS: Ten registered nurses provided triage assessments of 211 pregnant women. METHODS: Using blinded paired triage assessments, we assessed the reproducibility of the triage priority levels assigned using the MFTI. RESULTS: Priority levels assigned by the MFTI research nurse and the study nurses were in agreement for 154 of the 211 (72.9%) triage assessments. The strength of agreement was classified as good based upon the weighted kappa score of 0.65. There was no statistically significant difference in the accuracy of assigning priority levels between the day and night shifts CONCLUSION: The interrater reliability of the MFTI met the minimum strength of agreement threshold goal of 0.60 when used by nurses in a large birth unit to assign priority for evaluation. Based on this finding, the MFTI can be recommended for use in obstetric triage settings. Additional testing should be done to measure how this standardized tool improves care processes and outcomes.

Content Validity Testing of the Maternal Fetal Triage Index.

OBJECTIVE: To describe the development and content validity testing of the Maternal Fetal Triage Index (MFTI), a standardized tool for obstetric triage. DESIGN: Online survey. PARTICIPANTS: Participants included 15 registered nurses, 15 certified nurse-midwives, and 15 physicians from across the United States who provided maternity care. METHODS: A convenience sample of experienced clinicians was used as content validators for the MFTI. An item content validity index (I-CVI) was computed for the tool's items and a scale content validity index (S-CVI) was computed for the tool's scale based on the responses submitted via the online survey. Two rounds of content validation occurred. RESULTS: In the first round of testing, a total of 12 of 61 items in the MFTI did not meet the I-CVI threshold of greater than 0.78 because of disagreement about clinical condition (75%) or priority level placement (25%). In the second round of testing, all but 3 of the 69 content items in the revised version of the MFTI had I-CVI thresholds greater than 0.78. These 3 items were related to vital sign values. The overall S-CVI score calculated for Round 2 only was 0.95, which was greater than the threshold of 0.90. CONCLUSION: The results of the content validity testing of multidisciplinary validators suggest that the MFTI is a valid tool for use in obstetric triage and evaluation settings.

Newborn clinical outcomes of the AWHONN late preterm infant research-based practice project.

OBJECTIVE: To describe the neonatal health risks (hypothermia, hypoglycemia, hyperbilirubinemia, respiratory distress, the need for a septic workup, and feeding difficulties) experienced by late preterm infants (LPIs) from a large multisite study and determine how these risks were affected by gestational age at birth. DESIGN: Descriptive analysis of prospective data obtained as part of the AWHONN Late Preterm Infant Research-Based Practice Project. SETTING: Fourteen hospitals located through the United States and Canada. PARTICIPANTS: Late preterm infants (802) born at gestational ages between 34 0/7 and 36 6/7 weeks. METHODS: Nurses at each site obtained consent from the mother of the infant. The data about the infant were gathered from the infant's medical record. RESULTS: Thirty-six percent of LPIs were initially cared for in a special care nursery; approximately one half of these infants were eventually transferred to a well-baby nursery. Of the 64% of LPIs initially cared for in a routine nursery, 10% were transferred to a special care unit or neonatal intensive care unit (NICU). More than one half of LPIs experienced hypothermia, hypoglycemia, feeding difficulties, hyperbilirubinemia, and respiratory distress and/or needed a septic workup. The risk for these problems was higher in infants of younger gestational ages. Thirty-two percent of the infants were bathed during the first 2 hours of life, and by 4 hours, more than two thirds had had their first bath. Fifty-two percent received kangaroo care during the first 48 hours of life. CONCLUSION: These findings support those of smaller studies indicating that LPIs are at high risk for developing health problems during their neonatal hospitalization. Nurses may be able to ameliorate some of these health problems through early identification of problems and simple, inexpensive interventions such as avoiding early bathing and promoting kangaroo care.