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Improving Perinatal Care
Torrance Memorial Medical Center
F U T U R E T M M C H O S P I TA L
2015
TMMC
Community Hospital in South Bay
401 total beds
3200 annual deliveries
Private OB/GYN physicians
Perinatology consultants
Level 3 NICU, 25 beds
24 hour in house neonatologist
24 hour in house anesthesiologist
TMMC IHI/BETA Team Members
 Larisa Bargman, RN
 Kenneth Chan, MD
 Colleen Champlin, RN
 Albert Chen, MD
 Monika Chudoba, RN
 Esther Schmuel, MD
 Debbie Ernst, RN
 Ruth Idah, Clin.Qual.Analyst
 Maria Hovsepian, RN
 Heather Shay, Dir. of Quality
 Carol Kretsch, RN
 Linda Dobie,
 Tina Susatio, RN
 Donna Yukihiro, RN, CNS
 Maria Koegel, L&D Manager
 Diane Galati, Dir. MCHS
VP Risk Manage.
Oxytocin Deep Dive
 References
 JCAHO Standard MM.7.10
The organization develops processes for managing highrisk or high-alert medications

ISMP alert, August 9, 2007

Simpson, Kathleen Rice. Measuring Perinatal Patient Safety:
Review of Current Methods. JOGNN.35, 432-442.2006
Oxytocin Deep Dive
 Chart audit occurred June 8, 9, & 10, 2010
 124 charts pulled (deliveries occurring April 18th-30th)
 64 charts audited (oxytocin used)
 Results – Positive
 Careful Monitoring (98%)
 Results – Improvement needed
 Documentation of oxytocin dose & pattern during handoff (2%)
 Tachysystole with normal fetal heart rate identified/managed
(3%)
 Discontinued oxytocin if labor progressing (5%)
 Oxytocin ↓ or discontinued due to tachysystole with significant
fetal heart rate decelerations (6%)
Oxytocin Deep Dive
 Results – Surprises
 Vaginal
exam not done consistently prior to initial
oxytocin administration
 Order to discontinue oxytocin (12 AM) & to
restart (6 AM) even with patients with ruptured
membranes
 Inconsistent notification of MD in change of
oxytocin dose
Vaginal Exam (VE) & Oxytocin Audit Tool
VE & Oxytocin Results
 25 charts audited (August)
 No vaginal exams prior to initiation of oxytocin (5)
 Vaginal exams done prior to initial oxytocin dose (20)
 VE done prior to initiation of oxytocin (80%)
 Goal:
 Plan:
100%
Continue to audit charts and review results
Manager to follow up with staff
Tachysystole Algorithm
Tachysystole Algorithm
Tachysystole with normal fetal heart rate identified/
managed (3%)
 Goal

Nurses will identify, manage & document tachysystole
Plan




Nurses & physicians will be inserviced
Tachysystole algorithm implemented
Chart audit