The maternity section is one of the most delicate units in a hospital. Infant mortality can be described as the number of infant deaths for every 1,000 live births. (CIA, 2014). The infant mortality rate of the world is 49.4 according to the United Nations and 42.09 according to the CIA World Fact book (CIA, 2014).
Before giving birth women are admitted to the hospital hours prior to the due process, observed and monitored by doctors and nurses and necessary steps taken for preparation of the method of delivery chosen. The medical staff have to be cautious because any mistake made can lead to the death of the unborn child, its, mother or both. Negligence in maternal care is one of the attributing factors leading to neonatal deaths in hospitals.
Neonatal deaths make up for 40% of death among children aged 5 years and below with the majority of deaths occurring within the first week of life. About 45 percent of the deaths occur within the first 24 hours making it a crucial period for the staff tending to expectant mothers (Krasikov, 2010). Within the first 24 hours new born babies and their mothers are still placed under observation to monitor their vitals and look out for any abnormalities. This requires round the clock supervision of the designated staff.
Common cases of negligence are contributing factors to the increase in infancy death rates. Approximately 10% of deaths occurring in the hospital come from the maternity unit, this is an increase from the previous years 6%. A team was set up to look into this issue and come up with a solid action plan for implementation.
Problem and mission statement
Upon research it was noted that the maternity section has a limited staff resource. The total hours of nursing care per patient, per day affected the overall service given in this maternity section in the hospital. (Blog)This has a direct impact on the infant mortality before, during or right after birth because any form of negligence can be attributed to the unavailability of necessary medical supervision (Khan, 2007).
Involvement of nurses in childbirth begins at the antepartum stage and goes till the postpartum stage. A total of six nurses should be available during the birthing process.
Antepartum nurse- plays the role of providing care to patients with complications that need hospitalization.
Labor and Delivery nurse (L&D) - plays the role of providing care to patients in labor for both complicated and uncomplicated cases.
Circulating nurse- plays the role of providing and managing care for patients undergoing cesarean delivery.
Scrub nurse- assists the surgeon during cesarean delivery.
Postpartum nurse- plays the role of provision of care to patients who have delivered.
Nursery nurse- plays the role of provision of care for new born babies.
Due to the high admission rate in this hospital and the shortage of nurses most of the nursing staff in the maternity unit ends up having to play more than one role. In extreme situations one nurse plays the role of all nurses involved during childbirth in order to let other nurses attend to other expectant mothers. This in turn translates to poor patient care and the possibility of poor service. According to hospital data provided 45% of newborns are lost during the childbirth process, 20% die when in the nursery and 35% die before making it to the delivery table.
Urgent action should be taken to resolve the increased infancy mortality arising due to possible poor patient care because the hospital is at risk of losing its reputation and credibility. In addition to this the hospital has lost 350,000 dollars within the previous year in settling damages related to legal suits pursued by affected parties.
The Infant Death Prevention Unit (IDPU) team was set up to address this urgent nursing indicator. The maternity section was selected as the basic unit for research. The core mission of IDPU team is to find prevent further infancy death and generate short and long term solutions for implementation. This goes in line with the hospitals mission of provision of quality service to ensure the health and safety of all patients.
Quality Improvement Model
Selection of a quality improvement model determines the outcome of the whole process. The model chosen should be able to produce primary change that leads in the anticipated direction, influence results in other affected parts of the system unintentionally and restore normal processes into acceptable ranges. The IDPU team settled for the Six Sigma model. This approach is commonly known as the DMAIC model. IT uses five steps in outlining a problem, finding its causes and highlighting resolution measures.
Define: includes the definition of the customer, the customers needs, the procedural competencies and the project objectives.
Measure: this step quantifies the key characteristics that show improvement in product performance and customer satisfaction. It also avails the data on which improvement is based on.
Analyze: this stage involves the analysis of data collected in the first stage. This involves the use of tools like charts, flow diagrams, and graphs.
Improve: after analysis follows, resource allocation leading to implementation of modifications suggested.
Control: In this stage, the implementation is closely monitored with the help of quality management tools like Pareto charts to ensure performance maintenance.
The six-sigma model approach is useful in finding a solution for the nursing indicator because it seeks to meet the needs of the patients as well as improve cash flow and profitability in an organization as demonstrated by (Coppens, 2005) It is effective for hospitals because it has been proven to reduce errors made by medical staff including nurses, improve patient results and to hasten insurance claims reimbursement among other issues. A good example is Yale New Haven Medical Centre who discovered an increase in the number of blood infections occurring in the hospital. They used the six sigma approach in their intensive care unit after they discovered that the physicians made errors in the laboratories. The six sigma approach provided a solution and had them save 1.2 million dollars annually and a 75% reduction in the number of bloodstream infections occurring in the intensive care unit.
Data presented for use is obtained from the National Maternity Collection (MAT). It integrates data from the Lead Maternity Care (LMC) and National Minimum Dataset (NMD). MAT is the source of demographic, clinical, and statistical data on selected maternity service providers. This data, ranging from a period of nine months prior to and three months after birth, is used for strategy, policy development and service evaluation.
Maternity health information is normally loaded onto the NMDS by all public hospitals and private hospitals with publicly funded maternity units. The Ministry of Health shares this information and management of participating health centers (Health M. o., 2011).
Strategies for Managing Ethical Dilemmas
In the course of work the IDPU team came across two ethical dilemmas. The first one was the issue of direct access to the maternity section. The maternity section is restricted to a few people including close family of patients, doctors and nursing staff only. The dilemma was letting the team members access the area in order to gather information.
Secondly, the nurses faced an ethical dilemma of sharing patient information which his confidential. They are required to keep personal information pertaining to patients private whereas we needed the information to conduct research.
Dealing with ethical issues requires assessment of the dilemma and the effect it has on the patients, unit and organization as a whole. Dealing with ethical dilemmas also requires moral sensitivity and prompt but sensible decision making. The moral sensitivity is weighed against any legal issues presenting themselves in order to make a decision.
On assessing the first dilemma the team decided to select a few people who were part of the IDPU and had access to the maternity section. They were to collect the data required under guidelines provided by the team.
The second dilemma was dealt with by having the head of the team seek permission to access the information. In order to get the information an application was made to the head of the maternity section and head of the hospital. This information would still remain confidential as the team was not given mandate to publish patients names or give details that would lead directly to the patients. This used the utilitarian approach of solving dilemmas whereby the good of all parties involved is upheld.
Team Selection Process
The team selection process is very critical in any project management tasks because it involves the pooling of individual effort to deliver set goals in an organization. Each of the members selected in a team should be able to independently carry out assigned tasks, willing to take responsibility, work in cohesion with the group, be productive and also goal oriented. Team selection for serious project management work should also be based on the ability of individual to inspire others and good results (Tanner, 2008).
According to Tanner (2008) a team is comprised of a collection of people who are independent in their responsibilities, share accountability for the expected results, who see themselves and are seen by others as an intact social body surrounded in several bigger and much larger social bodies. These people manage their relationships across boundaries of an organizational setting.
Selection of team members relies on several factors, for example discipline, honesty, leadership qualities, experience in the selected field and performance. This IDPU team should be able to understand the needs of the project, select the right project leader, choose members who will meet the objectives set for the project, furnish the team with expertise needed to cover project gaps needs and have the knowledge on how to monitor performance of the team.
The IDPU team comprised of a number of people. Most of them were in the medical field due to their knowledge and expertise (Association of Womens Health).
Head Nurse, Maternity Section this is the person in charge of the unit therefore familiar with the standard operating policies of the hospital.
Head Doctor, Maternity Section head doctor is conversant with all the issues that affect patients before and during childbirth. This information is vital for the research.
Head Obstetrician the obstetricians specialized in pregnancy management before and after birth. This person is also key in giving vital information regarding infancy mortality.
Sonographer their role is to provide information of complications that occur before birth arising from negligence.
Radiologist the radiologist is also responsible for providing information pertaining to pre-birth conditions.
Labor nurse this nurse is present during delivery and will also give us their experience on functioning under limited staff number (Health E. A., 2015) (Hungry, 2015).
Hospital librarian- this person was key in assisting the group to access records pertaining to the project research.
Data analyst- the data analyst in this team was to spearhead the data analysis process. There are various methods in which data received could be translated. The work of the data analyst was to find relevant methods in which the team would assess the data received.
Nursery nurse this nurse was also key in pr...
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