CSI Project

Fetal Demise Process: Handling the Unimaginable

Methodist Hospital and Methodist Children’s Hospital (San Antonio, Texas)

CSI Summary

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Summary

CSI Presentation

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Presentation

CSI Toolkit

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Toolkit

Added to Collection

Project Topic:

Decreasing errors in the fetal demise paperwork process and increasing staff comfort with pregnancy loss care

Hospital Unit(s):

Women’s Specialty Unit (WSU)

Labor and Delivery (L&D)

CSI Participants:

  • Kristen Bodoczy, RN
  • Christine Niekamp, BSN, RN, RNC-EFM
  • Susan Wright, BSN, RN, CMSRN

Project Goals/Objectives:

  1. Decrease errors in fetal demise paperwork 10%
  2. Increase staff comfort with pregnancy loss care
  3. Decrease provider turnover and burnout

Project Outcomes:

  1. Increased staff comfort with pregnancy loss ― achieved a 60% cumulative score in the “comfortable” and “very comfortable” categories on a post-project fetal demise process survey
  2. First trimester paperwork mistakes decreased 81% (from 43% to 8%) and second and third trimester paperwork errors decreased 100% (from 17% to zero).
  3. Increased patient/family satisfaction
  4. Improved patient/family outcomes
  5. Reduced provider turnover and burnout

Project Overview:

Our CSI team chose this project to assist with improving the fetal demise paperwork process and help staff feel more comfortable caring for patients who have experienced perinatal loss. At the beginning of our project, estimates indicated that required paperwork was incorrect about 25% of time (50% of the time in some cases).

We updated our units’ fetal demise resource binders, delivered in-services to educate staff about the required paperwork and launched a monthly newsletter on loss care topics. Our CSI team also conducted pre and post surveys to assess staff’s comfort with the process of caring for patients with perinatal loss and the associated paperwork.

As a result, the Histology department noted a decrease in the volume of incorrect paperwork. First trimester paperwork mistakes decreased 81% (from 43% to 8%) and second and third trimester paperwork errors decreased 100% (from 17% to zero).

Staff feedback about our project has been very positive. Patient feedback indicates that nurse confidence in the process has increased and enhanced the patient experience. We have also benefited from some unintended positive outcomes, such as increased collaboration between several units.

Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.