Care of the Obstetric Patient in the Intensive Care Unit: A Quality Improvement Study Executive Summary Problem Statement and Significance

 

 

 

 

Care of the Obstetric Patient in the Intensive Care Unit:

A Quality Improvement Executive Summary

 

 

 

Caitlin E.D. Luebcke, MSN, APRN, AGACNP-BC, AGNP-C, CCRN

School of Nursing, Purdue University

Karen Foli, Ph.D., RN, ANEF, FAAN, Committee Chair

Kristen Kirby, DNP, RN, FNP-BC, CNE, Committee Member

Cheryl Wolverton, Ph.D., RN, CCRN, NEA-BC, Committee Member

November 16, 2021

 

 

Care of the Obstetric Patient in the Intensive Care Unit: A Quality Improvement Study Executive Summary

Problem Statement and Significance

Maternal mortality, as defined by the World Health Organization (2020), is the death of a woman while pregnant or within 42 days of being pregnant, from any cause related to or aggravated by the pregnancy or its management, though not due to accidental or incidental causes. Though considered preventable in as many as sixty-three percent of cases, the United States has seen a steady rise in its maternal mortality rate from 7.2 deaths per 100,000 live births in 1987 to 17.4 deaths per 100,000 live births in 2018 (CDC Foundation, 2018; Centers for Disease Control and Prevention, 2020; Hoyert & Minino, 2018). On average, women in the United States, at the time of their first live birth, are older than they have ever been, with the mean age of women rising 1.4 years, from 24.9 years of age in 2000 to 26.3 years of age in 2014 (Mathew & Hamilton, 2016). Women are also larger than they have ever been. In the forty-eight states who adopted the revised U.S. Standard Certificate of Live Birth, the District of Columbia, and New York City, the prevalence of women with a pre-pregnancy body mass index (BMI) categorized as overweight has increased by two percent while the prevalence of women with a pre-pregnancy BMI categorized as obese has increased by eight percent from 2011 to 2015 (Centers for Disease Control and Prevention, 2018a). Finally, obstetric patients are more chronically ill than they have ever been. There has been a rise in gestational diabetes rates from 5.2% in 2012 to 5.6% in 2016 and in cases of both chronic and pregnancy induced hypertension: from 6.1 cases in 10,000 hospital deliveries in 1993 to 166.9 cases in 10,000 hospital deliveries in 2014 and 528.9 cases in 10,000 hospital deliveries in 1993 to 912.4 in 10,000 hospital deliveries in 2014, respectively (Centers for Disease Control and Prevention, 2018b and 2019). All of this contributes to a rise in the risk for a variety of maternal and fetal complications, up to and including death.

When an obstetrics patient experiences complications and faces an increased threat of morbidity and mortality, she is often admitted or transferred to an intensive care unit (ICU); with the goals of placing her in a scenario where nursing staff are better prepared to quickly and effectively respond to further deteriorations in her condition. There have been a number of studies published that examine maternity patient experiences in the ICU (Engstrom & Lindberg, 2012; Hinton et. al, 2015; Wang et. al, 2021); however, few have been published that specifically examine critical care nurses’ experiences in caring for this patient population, with the notable exception of Kynoch’s et. al oft cited 2010 study of intensive care nurses’ attitudes toward caring for obstetric patients in the ICU. Nurses interviewed expressed feeling that they lacked the competence to care for the obstetric patients, citing the dearth of education on obstetric critical care conditions since their initial training as nurses, as well as unfamiliarity with obstetric assessments, breast milk expression, and infant care. They specifically cited the desire for a resource manual or folder that could be referred to when these patients are encountered, a situation that may become increasingly common within the United States (Kynoch et al., 2010).

To fill this gap in ICU nurses’ perceived competence, the overarching goal of this project was to provide both continuing education and sustainable resources (i.e., a quick reference manual) in this specialty group. The overall aim was to strengthening ICU nurses’ knowledge base and skills sets, and ultimately, increase self-efficacy in the care of obstetric patients within the ICU.

Methodology

Study Design

Within the umbrella of quality improvement at the local level, this was a quasi-experimental, pre-test, post-test study, conducted in-person, on-site, at three different ICUs within a single, 462- bed hospital on the south side of Indianapolis, Indiana. The three ICU units were: an 8-bed, cardiovascular, surgic

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