Since 2007, perinatal champions from five of the most populous states, CA, FL, IL, NY, and TX, which represent nearly 40% of the births in the U.S., have been working together to improve birth outcomes. Following the initial success of the Big 5 State early elective delivery pilot, (results published in Obstetrics and Gynecology Vol. 121, No. 5, May 2013) leaders have been planning the launch of the next Big 5 State initiative, improving the utilization of antenatal corticosteroids, a Joint Commission National Quality Measure (PC-03).
On September 18, 2015, more than 50 individuals from 15 Florida hospitals and several Florida perinatal health organizations met in Orlando to launch a one-year pilot project aimed at improving antenatal corticosteroid treatment (ACT) utilization. The goal of the March of Dimes Big 5 Perinatal Quality Collaborative’s ACT pilot is to reduce neonatal morbidity and mortality by reaching 100% administration to at-risk mothers 23-34 weeks gestational age within the optimal timing, or “sweet spot” or 24 hours – 7 days prior to preterm delivery.
While antenatal steroid use is high, administration during this optimal time period (24 hours – 7 days prior to delivery) is not often met. A lack of standardized ACT protocols leads to inconsistent medical practice, and there is poor documentation of ACT administration. Hospitals from the Big 5 states chosen to participate in the pilot have committed to putting all process improvements in place at their institution. Hospital quality improvement teams have agreed to:
- Identify and assemble a strong team,
- Standardize ACT processes and procedures in their hospital,
- Develop or amend ACT hospital policy to document standardization of ACT processes,
- Ensure ready availability of ACT on labor and delivery units,
- Track ACT rates among preterm delivery patients who delivery between 23-34 weeks gestation, and
- Participate in Big 5 State webinars to support ACT practice changes.
In Florida, the Florida Perinatal Quality Collaborative, ACOG District XII, and the Florida Chapter of the March of Dimes have teamed up to build a supportive collaborative learning environment to support our hospitals with driving change. The FPQC will work with champions to roll out the project in hospital units, conduct on-site technical assistance meetings, support education Grand Rounds, and prepare interim and final reports to disseminate results of this collaborative pilot project.
Physician and nurse champions and hospital administrators who attended the September 18th Kick Off training received training on the latest recommendations for ACT administration, practiced and discussed clinical scenarios, learned how to implement the process changes in their hospitals, and were instructed on data collection. Sessions were presented by Dr. Karen Bruder and Dr. Karen Harris, FPQC Clinical Co-Leads for this project in Florida, and other members of the Florida ACT Advisory Committee, including Dr. Washington Hill and Dr. Anthony Lai. Attendees also heard a patient story from a woman who delivered prematurely and received antenatal steroids, and received patient education materials from the March of Dimes.
This event would not have been possible without Florida Hospital Orlando and our partnerships with the March of Dimes Florida Chapter and ACOG District XII, and the enthusiastic hospitals in our state who are committed to improving quality of care for mothers and babies.
For updates on the Florida ACT project, visit our FPQC ACT website.