“CODE LABOR”: An Evidence Based and Interdisciplinary Approach to Managing Women Experiencing Precipitous Labor Outside of the Labor and Delivery Unit

Local Problem: Precipitous deliveries can incite adverse obstetrical events and poor outcomes. In one rural northern Alabama hospital, 75-100 babies are delivered monthly with an average of two precipitous deliveries occurring monthly. Objective: The intent of the work was to address a cohort of obstetrical (OB) and emergency department (ED) nurses’ knowledge gaps regarding the care of women experiencing precipitous labor outside of the labor and delivery (L&D) unit. DESIGN A quasi-experimental design aimed at quality improvement at the healthcare system’s level was developed. A non-probability, quota sampling method was used to gather data. Participants: Fifty-seven ED and OB RNs participated. Intervention/Measurements: Education specific to managing women experiencing precipitous labor was presented. Surveys were conducted to evaluate perceived limitations and improvements in interdisciplinary teamwork and communication. Results: Pre-educational data revealed moderate-well communication was felt to occur between the OB and ED nurses and 50.8% of participating nurses felt comfortable or neutral when caring for an OB patient experiencing precipitous labor and delivery. Post-educational data revealed improved interdisciplinary communication and RN comfort level. Nine out of 343 women experienced precipitous labor during the project\u27s time frame. Seven delivered within 7 to 40 minutes after arriving to the L&D unit and two deliveries occurred outside of the L&D unit. Interviews revealed positive utilization of the CODE LABOR policy. Hospital Consumer Assessments of Healthcare Providers and Systems (HCHAPS) data were evaluated for process improvement related to patient experience. Data in the last quarter 2018 disclosed an 84.3% satisfaction rate of nurse/patient communication and a 70.6% recommendation of the hospital to friends and family. First quarter data 2019 revealed an 80.2% satisfaction rate of nurse/patient communication and 71.7% that would recommend the hospital to friends and family. Conclusion: Instituting an interdisciplinary policy helps nurses increase assessment skills, critical decision making processes, communication, and teamwork