Date of Scholarly Project Submission

5-2018

Degree Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chairperson

Jane Campbell

Second Committee Member

Kristi Robinia

Third Committee Member

Michelle Johnson

Abstract

ABSTRACT

PRETERM LABOR ASSESSMENT TOOLKIT IMPLEMENTATION

Mandi Mae Wilkins

Every year 10% of babies in the United States are born premature. Prematurity is the leading cause of infant mortality. Standardized preterm labor (PTL) assessment protocols reduced preterm birth rates, decreased costs, and resulted in more timely diagnoses and prevented the overtreatment of pregnant women who were not experiencing true preterm labor. At a Midwestern, Level II trauma hospital with regional neonatal intensive care unit and 700 annual deliveries, a Preterm Labor Assessment Toolkit (PLAT) was implemented and pre- and post-data garnered. The toolkit contained a provider algorithm and an order set for triaging preterm labor (PTL) patients. Beginning in fall 2015, a chart audit from a convenience sample of 91 coded threatened PTL patients between 24 and 36.6 weeks’ gestation occurred. Post-implementation data was collected after two years on 90 patients with the same criteria. Key measures outlined and compared included disposition to decision times, frequency of sterile speculum and vaginal exams, fetal fibronectin collection, cervical length measurements, and the use of antenatal steroids and tocolytic therapies. In comparison to pre-implementation results, post-implementation findings showed increased numbers of sterile speculum exams, fetal fibronectin collection, and cervical length measurements. In the sample study, the disposition to decision time was cut in half and no patients delivered preterm after implementation of the PLAT protocol.

Keywords: Evidence-based, standardized protocol, preterm birth, quality improvement.

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