Quality Initiatives - Reducing Sepsis Mortality

Sepsis is the most common cause of death in hospitals in the United States. Approximately 200,000 people die every year from sepsis. With that in mind, AHMC Anaheim Regional Medical Center has taken aggressive steps in reducing the mortality from sepsis. Our CMS 30-Day Sepsis Mortality Rate has fallen from 33.82% (Quarter 1 2015) to 9.43% (Quarter 4 of 2018), well below the goal of 21.16%.

AHMC Anaheim Regional Medical Center clinicians follow nationally recognized practice guidelines known ("sepsis bundle") to identify and treat sepsis. This bundle includes early recognition of sepsis by identifying infections, obtaining and monitoring lab work, administering antibiotics and IV fluids within certain time frames. Evidence supports that using the bundle improves patient outcomes. We educated our ED physicians and nursing staff on early sepsis recognition and treatment and implemented practices to promote use of the bundle.

We provide ongoing feedback to the physicians and nursing staff on sepsis bundle use and continue to improve our practices with sepsis management to save lives!

AHMC Anaheim Regional Medical Center "Peanut Ball" Intervention to Reduce C-Sections among First Time Mothers

A cesarean birth (C-Section) is the surgical delivery of an infant through incisions made in the mother's abdomen and uterus. In the United States, one in three infants is delivered by cesarean (also known as a C-Section), or more than 1 million births annually.

A cesarean birth can be performed for many medical or personal reasons, but it is important to realize that a cesarean presents increased medical risks for both the mother and infant.

Possible risks from a cesarean birth (which are also associated with vaginal birth) include:

Infection
Blood loss
Formation of blood clots in the legs, pelvic organs, or lungs
Injury to the bowel or bladder
Reaction to medication or anesthesia used

Among women who have one cesarean delivery, more than 90% will deliver their subsequent pregnancies by cesarean. The more cesarean births a woman has, the greater risk there is for problems with future pregnancies, including problems with the placenta, the risk of uterine rupture, which can be life threatening for the mother and her unborn child, hemorrhage, and the need for hysterectomy (removal of the uterus) at the time of delivery.

AHMC Anaheim Regional Medical Center has developed the "Peanut-Ball" (PB) intervention as an effort to reduce cesarean section rates among first-time mothers. Current literature suggest that the Peanut Ball (PB) is a safe, cost effective, and efficacious intervention for reducing cesarean sections rates [C/S] and there is moderate evidence to support its use amongst laboring women with epidurals. The benefits are two-fold; the PB intervention decreases C-Section rates while shortening the second stage of labor.

The main mechanism of action is thought to be the PB capacity to widen the pelvic outlet in women who are already experiencing "pelvic floor relaxation (i.e., epidural side effect)."

AHMC Anaheim Regional Medical Center developed a policy and staff training has occurred with the clinical shift manager team. The policy outlines the following:

1. Patient selection is strictly based on nursing assessment and judgment.
2. To be utilized only during the first stage of labor and early second stage to facilitate fetal descent (mainly with patients who have labor epidurals).
3. Not to be utilized outside of bed by patients with intrathecal analgesia.
4. PB size (40 cm, 45 cm, and 50 cm) varied based on patient BMI.

Since the introduction of the PB Intervention, it has proven to significantly reduce the cesarean sections rate at ARMC. In the pilot phase, women in who utilized the PB experienced a 5.5% cesarean rate while women who did not utilize the PB experienced a 14% cesarean rate. Patients who utilized the PB were significantly less likely (2%) to experience a C/S in comparison to their NTSV counterparts who did not utilize the PB as an intervention (8%), thus reinforcing the benefits of the PB as a simple intervention to reduce C/S rates amongst this group.

Currently, data does not exist on the second stage of labor length or group comparison for similarity, but collection for these items will be added to future statistical analyses.

Patients have verbalized empowerment in the labor process when using the PB. Staff nurses and physicians alike have shown a positive attitude and appreciation for the simple intervention in decreasing C/S rates amongst our patients. Team effort and collaboration was critical. System use of the PB at all AHMC perinatal facilities was initiated with corporate support.