2018 Research Forum

Reducing nulliparous, term, singleton, vertex (NTSV) cesarean section rate with mobility Investigator/Presenter Team: Jessica Melendez RN, Jessica Gutierrez RN, Lindsey Bogner RN, Dalayne Nettles RN Departmental Sponsor: Pamela Gavin RN BSN, NRP Coordinator Jessica Melendez RN 1 , Jessica Gutierrez RN 1 , Lindsey Bogner RN 1 , Dalayne Nettles RN 1 1 Cohort 2, Nurse Residency Program INTRODUCTION Kern Medical has the highest cesarean section rate in NTSV mothers in Bakersfield and California has the highest rate (23.9%) in the United States. Can nursing improve the mobility of NTSV mothers and decrease the C-section rate in a high risk obstetrical mothers. PURPOSE Our C-Section rate is documented in California Department of Health statistical reports. This study seeks to utilize the team’s previous observations that L&D patients are not being repositioned as frequently as to help with their labor progress. METHOD A structured educational approach was initiated: • Provide resource information that even with epidurals, repositioning laboring patients is possible, especially because research shows that early labor epidurals slowdown progress due to immobility • Abundant evidence shows that different positions help the NTSV population and the multiparous population progress in labor faster (Image 1) • Demonstrate peanut ball labor positions (Image 2) and present benefits: shorter labor, shorter pushing phase and anatomically improved pelvic positions; widening of the pelvic outlet. • Provide the California Maternal Quality Care Collaborative “pre-cesarean checklist” and their “failure to progress” checklist that need to be followed before diagnosing NTSV population as candidates for cesarean section RESULTS Two findings demonstrated success. • Our staff nurses “strongly agreed” in post class surveys that the presentation helped them understand the importance of mobility and committed to reposition their patients every 30 minutes to every 1 hour as recommended by ACOG. (Graph) • NTSV Cesarean Section rates have decreased since educating our Staff Nurses on mobility, and even more since implementing the use of the peanut balls. Delivery time for NTSV patients being induced have also been faster when using the peanut ball and repositioning or mobilizing than for those who do not. DISCUSSION The team’s goal is to reach a Kern Medical rate of 16.1% to 17.73% for NTSV C-sections; our NTSV C-section rate was 20.97% in December 2017 and 24.17% In January 2018. Modest change in December 2017 and bounce-back in January 2018 may have been due to the late implementation of pelvic expanding peanut balls (presently in use). However, in December we were below the National Goal of 23.9%. CONCLUSIONS Monthly monitoring of NTSV cesarean section rates and nursing staff use of mobility to reposition mothers and peanut balls during labor may bring consistent reduction of NTSV C-section rates for Kern Medical.

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