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Perinatal Post | July 2009 Issue |
Perinatal Outreach Coordination
Section on Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
Wake Forest University School of Medicine | Mona Brown Ketner RN, MSN, C-EFM
Perinatal Outreach Coordinator
mketner@wfubmc.edu
(336) 716-7981 | Lisa A. Canada
Secretary
lcanada@wfubmc.edu
(336) 716-3662 |
Region 2 Perinatal Meeting, Thursday, October 22, 2009
Iredell County Health Department, Statesville, North Carolina | | 10:00 a.m. | Registration | 10:30 a.m. | Meeting | 11:30 a.m. | Lunch – Fee $15.00 | 12:00 Noon | Speakers: | Lauri P. Cox, FNP-BC, IBCLC and Phoebe Hardee, LPN | | | Lyndhurst Gynecologic Associates | | | Winston-Salem, North Carolina | | Program: | “URINARY/FECAL COMPLAINTS AFTER PREGNANCY” | | 1.0 Northwest AHEC Contact Hour | 1:00 p.m. | Adjourn |
Limit: 40 People. Register early.
Please call Mona Brown Ketner, RN, MSN at (336) 716-7981 for questions
A registration form for this activity will be sent via e-mail. If you would like to receive
one, but did not, please contact Lisa A. Canada at (336) 716-3662 or lcanada@wfubmc.edu.
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~ 10A NCAC 41A .0204 (e) All pregnant women shall be tested for chlamydia, syphilis and gonorrhea at the first prenatal visit. All pregnant women shall be tested for syphilis between 28 and 30 weeks of gestation and at delivery. Hospitals shall determine the syphilis serologic status of the mother prior to discharge of the newborn so that if necessary the newborn can be evaluated and treated as provided in (c) (2) of this rule. Pregnant women 25 years of age or younger shall be tested for chlamydia and gonorrhea in the third trimester or at delivery if the woman was not tested in the third trimester (April 1, 2008).
~ 10A NCAC 41A .0203 Control Measures – Hepatitis B
(7) (d) The following persons shall be tested for and reported in accordance with 10A NCAC
41A .0101 if positive for hepatitis B infections:
(1) pregnant women unless known to be infected;
~ 10A NCAC 41A .0202 Control Measures – HIV
Every pregnant woman shall be offered HIV testing by her attending physician at her first prenatal visit and in the third trimester. The attending physician shall test the pregnant woman for HIV infection, unless the pregnant woman refuses to provide informed consent pursuant to GS 130A-148(h). If there is no record at labor and delivery of an HIV test result during the current pregnancy for the pregnant woman, the attending physician shall inform the pregnant woman that the test will be performed, explain reasons for testing, and the woman shall be tested for HIV without consent using a rapid HIV test unless it reasonably appears that the test cannot be performed without endangering the safety of the pregnant women or the person administering the test. If the pregnant woman cannot be tested, an existing specimen, if one exists that was collected within the last 24 hours, shall be tested using a rapid HIV test. The attending physician must provide the woman with the test results as soon as possible. However, labor and delivery providers who do not currently have the capacity to perform rapid HIV testing, shall not be required to use a rapid test until January 1, 2009.
If an infant is delivered by a woman with no record of the result of an HIV test conducted during the pregnancy and if the woman was not tested for HIV at delivery, the fact that the mother has not been tested creates a reasonable suspicion pursuant to GS 130A-148(h) exists that the newborn has HIV infection and the infant shall be tested for HIV. An infant born in the previous 12 hours shall be tested using a rapid HIV test shall be performed. However, providers who do not currently have the capacity to perform rapid HIV testing shall not be required to use a rapid HIV test until January 1, 2009.
Testing for HIV may be offered as a part of routine laboratory testing panels using a general consent which is obtained from the patient for the treatment and routine laboratory testing, so long as the patient is notified that they are being tested for HIV and given the opportunity to refuse.
HIV pretest counseling is not required. Post-test counseling for persons infected with HIV is required, must be individualized and shall include risk reduction guidelines, referrals for medical and psychosocial and control measures.
Confirmed AIDS and HIV infection is reportable in 24 hours.
(November 1, 2007) |
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Eliminating Elective Deliveries Before 39 Weeks | In the summer of 2009, the Perinatal Quality Collaborative of North Carolina (PQCNC, pronounced “picnic”) will launch its first initiative focused on maternal health. PQCNC, formed in 2007, is a voluntary community of organizations, agencies and individuals committed to making North Carolina the best place to be born. The goal of the upcoming initiative, which is receiving support from the March of Dimes, is to eliminate elective deliveries at a gestational age less than 39 weeks. An expert panel of obstetricians and nurse managers from hospitals in North Carolina that have already changed their practice to reduce these deliveries is providing guidance to the project.
Recent studies have highlighted the fact that it has become relatively common for women to have a planned delivery (either a scheduled cesarean section or an induction) without medical indication, and a significant subset of these take place before 39 weeks’ gestation.1 Recent papers published in the New England Journal of Medicine and the American Journal of Obstetrics and Gynecology document the higher rates of complications in infants delivered electively at 37 weeks and 38 weeks of gestation, including NICU admission, mechanical ventilation and sepsis, among others.2,3
This initiative was chosen through a collaborative process by PQCNC’s leadership team for the following reasons:
1. There is a well-established ACOG recommendation not to perform elective deliveries prior
to 39 weeks’ gestation in order to avoid iatrogenic prematurity.
2. The Joint Commission (JCAHO), Leapfrog and the Agency for Healthcare Research and
Quality (AHRQ) are or will soon be including the rate of elective delivery prior to 39 weeks’
gestation as a quality marker.
3. Measurable outcomes to demonstrate impact are easily obtained.
4. Improvement in this process will help mothers, their infants, and hospitals.
All hospitals in North Carolina with delivery services are invited to participate. The initiative will launch on August 3, 2009 with a web-based seminar. Each hospital will then be asked to abstract data from 50 charts of patients admitted for planned delivery during a specified time in 2008. The data will be submitted to PQCNC through a web-based data-entry system.
In September, participating hospitals will attend one-day Action Learning Lab as a team consisting of the chief of obstetrics or medical director of labor and delivery, the chief nursing administrator, the manager of labor and delivery or mother/infant unit, an obstetric nurse providing direct patient care, the chief quality administrator and/or risk manager, and one additional person, such as a patient representative, if desired. Each hospital will be required to identify a team leader, as well as a physician and nurse champion for the project. The Action Learning Lab will be held in Winston-Salem on September 16 and repeated in Chapel Hill on September 18. Travel expenses will be covered for those teams traveling from outside the area to attend the learning session.
At the learning lab, each team will receive a toolkit, which will include articles supporting the evidence base for this practice, information about quality improvement science, worksheets for completing data collection, other resources related to this topic, and analysis of the data submitted in August. All data will be kept confidential and results of data analysis will be provided to each hospital; only de-identified, aggregate data will be shared with the entire group.
Participating hospitals will be expected to collect data on every planned delivery at their site and to submit data monthly to PQCNC. PQCNC will host a quarterly webex for all teams to review their de-identified data as a group and to discuss areas of success and challenge. PQCNC will also facilitate monthly conference calls for the staff at each facility involved with data collection and the day-to-day issues of changing practice.
Some healthcare providers have concerns about responding to patient requests for elective delivery before 39 weeks. Preliminary feedback from obstetricians working on this issue suggests that a firm hospital policy to restrict elective delivery to gestational ages of 39 weeks or greater, an evidence base, and the ability to educate patients about this topic are the keys to success for this project. PQCNC will provide multiple copies of the March of Dimes brochure “Why the Last Weeks of Pregnancy Count” to physicians and midwives who deliver at the hospitals participating in the collaborative for them to share with their patients.
If your facility is interested in this initiative, please use the “Contact us” tab at www.pqcnc.org as soon as possible to request more information or to let PQCNC know you would like to join the collaborative.
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1. Oshiro B, Henry E, Wilson J et al. Decreasing Elective Deliveries Before 39 Weeks of
Gestation in an Integrated Health Care System. Obstet Gynecol 2009; 113:804-11.
2. Clark SL, Miller DD, Belfort MA, et al. Neonatal and maternal outcomes associated with elective
term delivery. Am J Obstet Gynecol 2009; 200:156.e1-156.e4.
3. Tita ATN, Landon MB, Spong CY, Lai Y, et al. Timing of Elective Repeat Cesarean Delivery at
Term and Neonatal Outcomes. N Engl J Med 2009; 360:111-20.
Kate Berrien, RN, BSN, MS, State Perinatal Outreach Coordinator
Nancy Chescheir, M.D., PQCNC Maternal Project Director |
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Membership in the North Carolina Perinatal Association | Imagine with me that you are in a group that is dynamic, energized, and committed to promoting health and wellness in families across North Carolina! Think of what it looks like when professionals join forces to learn and grow together to improve perinatal care. This is just a glimpse of how it is to participate in the North Carolina Perinatal Association. We are a diverse group of professionals with extraordinary commitment to improve perinatal outcomes in North Carolina.
Maybe you see the perinatal world through the lens of the health department you work for, but come away from this group exposed to the latest hospital updates! Suddenly your ability to prepare your patient for their hospital experience or with the latest procedures available is supported by the latest evidence-based research. On the other hand, it might be just the opposite as you provide care in the hospital setting. What an opportunity and useful investment of your time, to network with the community organizations and resource people that influence perinatal care in North Carolina!
You are the reason we exist. Without you as our membership face in the various places that perinatal care is provided in North Carolina, we are invisible. So, whether you are holding the tiny little babies we wish were not so small, or you are working in maternity clinics helping women prepare for the healthiest outcomes, it is you that we need to keep NCPA visible, strong, and as an advocate for perinatal care in North Carolina. We invite you and your colleagues to join us as we grow our membership into a mighty army.
Membership applications are accepted throughout the year from any health care professional or consumer advocate interested in perinatal health. Membership benefits include lower registration fees for the annual conference, which is scheduled for August 30- September 1, 2009 in Greensboro, NC, free/reduced registration for upcoming educational web conferences, and news/information updates via our NCPA list serve. Please visit our website to view the 2009 conference brochure and membership application forms. We are hosting our first webinar free to our members on July 23rd and we have a list serve for our membership to keep them informed on advocacy and NCPA activities.
The future is bright as we have launched a new website in order to add new benefits to our very low cost membership. Please contact Frieda.Norris@carolinashealthcare.org if you have any questions about membership. Our website is http://www.ncperinatalassociation.org/. We are waiting for you to join us! Feel free to email us at info@ncperinatalassociation.org if you have questions or comments.
Frieda L. Norris, RN, BSN, LCCE
Perinatal Outreach Program Coordinator, NC Region 3
704-650-8142 |
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YOU QUIT, TWO QUIT
NEW SMOKING CESSATION PROGRAM FOR PREGNANT AND POSTPARTUM WOMEN | The N.C. Health and Wellness Trust Fund has awarded a grant to the UNC Center for Maternal and Infant Health to fund the You Quit, Two Quit perinatal smoking cessation program. You Quit, Two Quit includes a statewide education and outreach campaign and four pilot projects based in Columbus, Davidson, Richmond and Wilkes counties, where the smoking rates among pregnant women are substantially higher than the statewide rate of 11 percent.
The You Quit, Two Quit website – www.youquittwoquit.com – is available to all North Carolinians, with special sections for pregnant women, new moms, family members, and health care providers. In the health care provider section of the website, you will find information on using the 5 As model for smoking cessation counseling, free patient education materials, and up-to-date, evidenced-based information about smoking during pregnancy and postpartum.
There are several resources available to assist you in helping your patients quit smoking. As of January 1, 2009, Medicaid reimburses for smoking cessation counseling. Physicians, Nurse Practitioners, Certified Nurse Midwives, and allied health professionals can receive reimbursement for the following CPT codes:
99406 – Intermediate visit (3-10 minutes)
99407 – Intensive visit (over 10 minutes)
An appropriate tobacco-related diagnosis, such as ICD-9 code 305.1 (tobacco abuse), must be filed in addition to the Evaluation and Management code and submitted with the CPT code. See the January 2009 NC Medicaid Bulletin at http://www.ncdhhs.gov/dma/bulletin/0109bulletin.htm for more details. Quitline NC –1-800-QUIT-NOW – is available for free, confidential counseling from 8 a.m. to 3 a.m., seven days per week. Fax referral forms in English and Spanish can be accessed from the NC Health and Wellness Trust Fund’s Quitline NC website at www.quitlinenc.com.
For more information about the You Quit, Two Quit program, please contact Erin McClain at erin_mcclain@unc.edu. |
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WORLD BREASTFEEDING WEEK - AUGUST 1-7, 2009 | August 1-7 has been designated each year as World Breastfeeding Week by the World Alliance for Breastfeeding Action (WABA). The theme for World Breastfeeding Week (WBW) 2009 chosen by WABA is “Breastfeeding-A Vital Emergency Response”.
This year’s theme provides an opportunity to educate your community about the importance of breastfeeding in times of natural disasters or other types of emergencies. To help you recognize this week and to promote the importance of breastfeeding in your community, we are providing you with credible internet links for information and promotional materials.
® Free Downloadable Resources
The official website for downloadable World Breastfeeding Week resources is sponsored by the
World Alliance for Breastfeeding Action (WABA).
http://www.worldbreastfeedingweek.org)
American Academy of Pediatrics Clinician Tool
Infant Feeding During a Disaster: Breastfeeding and Other Options
http://www.aap.org/breastfeeding/files/pdf/InfantNutritionDisaster.pdf
® Materials for Purchase
World Breastfeeding Week promotional items may be purchased from the International Lactation
Consultant Association. To access information about these materials, go to the online bookstore
at ILCA and scroll down to World Breastfeeding Week.
http://www.ilca.org
NOTE: The Nutrition Services Branch has submitted a request to purchase an ILCA WBW kit
for each local agency, but we are unsure of when this purchase will be completed and sent to
each local WIC Program. If you haven’t done so already, we encourage you to purchase a kit
directly from ILCA to help plan WBW activities in your community.
® Idea Flyer
Flyer with resources and ideas for celebrating World Breastfeeding Week 2009 is sponsored by
the National WIC Association.
http://www.paramountcommunication.com/nwica/WBW_Action_Ideas_June2009.pdf
® Webcast
Sponsored by the New York State University at Albany School of Public Health
To register for WBW Breastfeeding Grand Rounds free live webcast visit
http://www.albany.edu/sph/coned/bfgr/bfgr09.htm
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SPANISH IMMERSION | Our 2010 Spanish Immersion trip to Cuernavaca will be from Friday, January 29, 2010, until Saturday, February 13. For those who are only able to go for one week, the dates will be January 29 until Sunday, February 7, to allow the opportunity for an excursion on Saturday, February 6. For further information email: mmoore@wfubmc.edu. |
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Upcoming Programs | *August 26-27, 2009
“Lamaze Teacher Education Seminar”
Raleigh, North Carolina
Information: Tara Owens Shuler (919) 684-2648 tara.owens@duke.edu | *October 20-21, 2009
“Lamaze Teacher Education Seminar”
Shelby, North Carolina
Information: Tara Owens Shuler (919) 684-2648
tara.owens@duke.edu | September 22 and 29, 2009
“OB/Neonatal Review”
Winston-Salem, North Carolina
Information: Mona Brown Ketner (336) 716-7981 | October 28, 2009
“Advanced Monitoring Update”
Morganton, North Carolina
Information: Mona Brown Ketner (336) 716-7981 | *September 24-26, 2009
“Lamaze Teacher Education Seminar”
Hampton Roads, Virginia
Information: Tara Owens Shuler (919) 684-2648 tara.owens@duke.edu | November 16-17, 2009
“27th Annual Gravidas at Risk”
Hickory, North Carolina
Information: Mona Brown Ketner (336) 716-7981 | October 13, 2009
“Basic Fetal Monitoring”
Winston-Salem, North Carolina
Information: Mona Brown Ketner (336) 716-7981 | | *For Candidates in the Lamaze Childbirth Education Certification Program |
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