Go the Full 40

Updated: Aug 28, 2018


Nurses please don't forget to continue to encourage your patients to go to www.gothefull40.com . This will link them to Awhonn's reparable website on evidence-based positive   messages about waiting until their baby is ready for delivery.


We Can Change This: Role in Maternal Mortality see www.safehealthcareforeverywomen.com for more detailed information!

For the Patient Safety Bundle on Reduction of Peripartum Racial/Ethnic Disparities click https://safehealthcareforeverywoman.org/patient-safety-bundles/reduction-of-peripartum-racialethnic-disparities/


Every Health System

  • Establish systems to accurately document self-identified race, ethnicity, and primary language.

  • Provide system-wide staff education and training on how to ask demographic intake questions.

  • Ensure that patients understand why race, ethnicity, and language data are being collected.

  • Ensure that race, ethnicity, and language data are accessible in the electronic medical record.

  • Evaluate non-English language proficiency (e.g. Spanish proficiency) for providers who communicate with patients in languages other than English.

  • Educate all staff (e.g. inpatient, outpatient, community-based) on interpreter services available within the healthcare system. Provide staff-wide education on:

  • Peripartum racial and ethnic disparities and their root causes.

  • Best practices for shared decision making.

  • Engage diverse patient, family, and community advocates who can represent important community partnerships on quality and safety leadership teams.


Every patient, family, and staff member

  • Provide staff-wide education on implicit bias.

  • Provide convenient access to health records without delay (paper or electronic), at minimal to no fee to the maternal patient, in a clear and simple format that summarizes information most pertinent to perinatal care and wellness.

  • Establish a mechanism for patients, families, and staff to report inequitable care and episodes of miscommunication or disrespect.


Every Clinical Encounter

  • Engage in best practices for shared decision making.

  • Ensure a timely and tailored response to each report of inequity or disrespect.

  • Address reproductive life plan and contraceptive options not only during or immediately after pregnancy, but at regular intervals throughout a woman’s reproductive life.

  • Establish discharge navigation and coordination systems post childbirth to ensure that women have appropriate follow-up care and understand when it is necessary to return to their health care provider.

  • Provide discharge instructions that include information about what danger or warning signs to look out for, whom to call, and where to go if they have a question or concern.

  • Design discharge materials that meet patients’ health literacy, language, and cultural needs.


Every Clinical Unit

  • Build a culture of equity, including systems for reporting, response, and learning similar to ongoing efforts in safety culture.

  • Develop a disparities dashboard that monitors process and outcome metrics stratified by race and ethnicity, with regular dissemination of the stratified performance data to staff and leadership.

  • Implement quality improvement projects that target disparities in healthcare access, treatment, and outcomes.

  • Consider the role of race, ethnicity, language, poverty, literacy, and other social determinants of health, including racism at the interpersonal and system-level when conducting multidisciplinary reviews of severe maternal morbidity, mortality, and other clinically important metrics.

  • Add as a checkbox on the review sheet: Did race/ethnicity (i.e. implicit bias), language barrier, or specific social determinants of health contribute to the morbidity (yes/no/maybe)? And if so, are there system changes that could be implemented that could alter the outcome?


References

Racial and Ethnic Disparities in Obstetrics and Gynecology. Committee opinion No. 649. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015 Dec;126(6):e130-4.


§ Sokol-Hessner, L., Folcarelli, P., & Sands, K. (2016). The practice of respect. New England Journal of Medicine. § The University of Chicago. Finding answers: Solving disparities through payment and delivery system reform.


Agency for Healthcare Research and Quality. The SHARE approach. Hardeman, R. R., Medina, E. M., &


Kozhimannil, K., B. (2016). Structural racism and supporting black lives—The role of health professionals. New England Journal of Medicine. Harvard University. Project Implicit.


Hogan, V. K., Rowley, D., Bennett, T., & Taylor, K. D. (2011). Life course, social determinants, and health inequities: Toward a national plan for achieving health equity for African American infants—a concept paper. Maternal and Child Health Journal, 16(6), 1143- 1150. Institute for Healthcare Improvement. TA 102: Improving health equity.


Jones, C. P. (2000). Levels of racism: A theoretic framework and a gardener’s tale. American Journal of Public Health, 90, 1212-1215. § Massachusetts General Hospital Institute for Health Policy. Improving quality and achieving equity: A guide for hospital leaders.


Sokol-Hessner, L., Folcarelli, P., & Sands, K. (2016). The practice of respect. New England Journal of Medicine. The University of Chicago. Finding answers: Solving disparities through payment and delivery system reform. 3. RESPONSE Agency for Healthcare Research and Quality. The SHARE approach.


Reproductive life planning to reduce unintended pregnancy. Committee opinion No. 654. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016 Feb;127(2):415.


Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making – the pinnacle of patient-centered care. New England Journal of Medicine, 366, 780-781.


Centers for Disease Control and Prevention – Division of Community Health. (2013). A practitioner’s guide for advancing health equity: community strategies for preventing chronic disease.


Keller, V. F., & White, M. K. (1997). Choice and changes: A new model for influencing patient health behavior. Journal of Clinical Outcomes Management, 4(6). § Massachusetts General Hospital Institute for Health Policy. Improving quality and achieving equity: A guide for hospital leaders.


Sokol-Hessner, L., Folcarelli, P., & Sands, K. (2016). The practice of respect. New England Journal of Medicine. § U.S. Department of Health and Human Services Office of Minority Health. The National CLAS Standards. § The University of Chicago. Finding answers: Solving disparities through payment and delivery system reform.


Centers for Disease Control and Prevention National Center for Health Statistics. (2016). The validity of race and Hispanic-origin reporting on death certificates in the United States: An update. § Centers for Disease Control and Prevention National Center for Health Statistics. (2016). Births: Preliminary data for 2015. Retrieved March 17, 2017.



CREDENTIALS

LaShea Haynes M.Ed, MSN, AGCNS-BC, APRN, RNC, C-EFM

Perinatal Clinical Nurse Specialist


AWHONN Instructor Trainer


AWHONN Obstetric Program Instructor


AWHONN Georgia Lead PPH Project


Independent Legal Consultant


International & National Speaker


Inpatient OB Course Instructor

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