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Statewide Attention on Maternal Mortality

August 23rd, 2018 by

DMHSStatewide Attention on Maternal Mortality
Part of a multi-column series focused on Maternal and Infant Health in Southeast Arkansas

By Kristen Smith, RN, director of Labor & Delivery/Nursery and Education at Drew Memorial Health System

As I mentioned last week in my previous column, my aim in writing is to help local women and their families understand more about the recent national attention that maternal health has received. I also hope to let Southeast Arkansans know about what has been done already to combat the startling statistics we’ve seen on a statewide and national level.

 

The University of Arkansas for Medical Sciences (UAMS) identifies many major health trends throughout our state, and is tasked with effective ways to combat poor health outcomes. You may be familiar with their ARSAVES program, a telemedicine network that connects rural emergency rooms with UAMS neurologists in order to reduce the number of stroke deaths in our state. The ARSAVES program was created when rural stroke patients were found to continually be at a disadvantage due to their distance from neurologists. Before ARSAVES was created in 2008, Arkansas was ranked first in the country in stroke deaths, but in just ten years, we are now ranked sixth, a strong shift statistically in the right direction. Similarly, the UAMS approach to maternal health is multifaceted – their aim is to best serve women all over the state and improve their health – based on statewide data they have collected- and by reviewing best practices even beyond Arkansas.

 

First, a quick review of national news. You may have read about California as a state making impressive waves in improving maternal outcomes. Their state’s hospitals have managed to decrease their maternal death rate by half. Their experts and hospitals collaborated and implemented something called “safety bundles” in their hospital delivery rooms. Bundles are a collection of resources, best practices and procedures put in place by medical systems and hospitals to identify and quickly respond to patients experiencing certain common medical emergencies. This plan of attack led to amazing results for the women in California, and it has already started helping women in Arkansas. Ultimately, the success of using safety bundles in California led our hometown hospital Drew Memorial to implement them last year.

 

In 2017, not long after California’s major overhaul, UAMS identified two priorities for their first statewide POWER Conference (Perinatal Outcomes Workgroup by Education and Research). All hospitals that provide obstetric services were invited. Because of our state’s high maternal death rate (4th in the nation), the focus was creating Safety Bundles for 1) Postpartum Hemorrhage and 2) Hypertensive Emergencies. POWER’s aim is to educate hospitals in our state about how to provide efficient, evidence-based care to achieve optimum outcomes for patients, and helps hospitals with putting those proposed improvements in place.

 

In very simplified terms, postpartum hemorrhage means a mother has lost too much blood during and (more commonly) after delivery. Blood loss can be very gradual which makes it harder to detect. Hypertensive emergency means a mother has hypertension brought on by pregnancy – this is often called preeclampsia. High blood pressure during pregnancy leads to Hypertensive Emergencies which put a mom at risk of dying during delivery.

 

We began using both safety bundles in 2017. We were early adopters of the bundles because Drew Memorial was selected by UAMS as one of four pilot hospitals. We introduced planning committee/task force teams for each of the two focus areas. The multidisciplinary staff teams focused on Postpartum Hemorrhage and Pregnancy-induced hypertension have been in place for a year now. They were vital as we first implemented the bundles and the teams continue to monitor opportunities for improving their use.

 

I was pleased to serve on a panel during this year’s statewide POWER conference with one of my colleagues because of our successful first year using safety bundles at Drew Memorial. The bundles have been highly successful in our facility and others, and we hope soon that all Arkansas hospitals providing obstetric services will implement them as well. We’ve seen significantly better patient outcomes by ensuring our staff can recognize both major issues early on, so patients are treated before further complications or death results. Through our sharing of evidence-based best practices, Arkansas hospitals really are making an impact on women’s health and combating the current maternal mortality rate. Next time I’ll explain more about how women are screened for certain risks and complications during pregnancy and delivery, as well as even more safety measures in place to protect local mothers.

 

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