Discharge of mothers and babies from hospital after birth of a healthy full-term infant: developing criteria through a community-wide consensus process

OBJECTIVE

To ensure safe care of mothers and babies after birth, irrespective of length of hospital stay, and to ensure effective links between hospital and community postnatal services.

METHODS

Program aimed toward consumers and professionals working with them in Ottawa-Carleton (750,000 persons.) All pregnant women in the community included. Program developed by professionals, institutions and community agencies. Information on current practices elsewhere and early discharge literature studied. New provincial survey on practice changes performed in Ontario. Emergency room utilization data analyzed. Discharge and post-discharge criteria, and a common prenatal education curriculum, developed.

RESULTS

Multidisciplinary, multi-sectoral committees, institutions and agencies have developed programs for appropriate discharge practice and improved postnatal follow-up. Professionals have supported flexible discharge guidelines.

CONCLUSIONS

Provided discharge criteria and follow-up are available, flexible discharge timing and safety appear compatible. The Ottawa-Carleton process to develop criteria and programs has allowed a collaborative, consensus-based approach to 'early' newborn discharge.

Discharge of mothers and babies from hospital after birth of a healthy full-term infant: developing criteria through a community-wide consensus process

OBJECTIVE

To ensure safe care of mothers and babies after birth, irrespective of length of hospital stay, and to ensure effective links between hospital and community postnatal services.

METHODS

Program aimed toward consumers and professionals working with them in Ottawa-Carleton (750,000 persons.) All pregnant women in the community included. Program developed by professionals, institutions and community agencies. Information on current practices elsewhere and early discharge literature studied. New provincial survey on practice changes performed in Ontario. Emergency room utilization data analyzed. Discharge and post-discharge criteria, and a common prenatal education curriculum, developed.

RESULTS

Multidisciplinary, multi-sectoral committees, institutions and agencies have developed programs for appropriate discharge practice and improved postnatal follow-up. Professionals have supported flexible discharge guidelines.

CONCLUSIONS

Provided discharge criteria and follow-up are available, flexible discharge timing and safety appear compatible. The Ottawa-Carleton process to develop criteria and programs has allowed a collaborative, consensus-based approach to 'early' newborn discharge.

Evaluation of a fetal monitoring education program

OBJECTIVE

To evaluate the effectiveness of a fetal monitoring education program in increasing nurses' knowledge and clinical skills.

DESIGN

Multicenter randomized control trial.

SETTING

Twelve hospitals in eastern Ontario, Canada.

PARTICIPANTS

One hundred nine volunteer registered nurses randomly assigned, within each hospital, to an experimental (n = 47) or control (n = 62) group. Ninety-six nurses (40 in the experimental group and 56 in the control group) completed the 6-month follow-up (88% retention).

INTERVENTIONS

The experimental group participated in a 1-day fetal monitoring workshop and a review session 6 months later.

MAIN OUTCOME MEASURES

Performance on a 45-item knowledge test and a 25-item skills checklist. The passing score was at least 75% correct on each test.

RESULTS

The percentage of nurses in the experimental group passing both the knowledge and the clinical skills tests after the workshop was significantly higher (p < 0.01) than that of the nurses in the control group: 68.1% versus 6.5%, respectively. A large difference between the groups remained at the 6-month follow-up (experimental, 45%; control, 6.5%). The performance of the nurses in the experimental group improved to an 85% pass rate after they attended the 6-month review session.

CONCLUSION

This comprehensive, research-based program is effective in increasing fetal monitoring knowledge and clinical skills.

Change in smoking prevalence among pregnant women 1982-93

Maternal smoking is the most prevalent risk factor for low birthweight in Canada. This study compared the prevalence of maternal smoking before and during pregnancy from 1983 to 1992. Population-based surveys of 3,296 women during six months in 1983 and 7,940 women during 12 months in 1992 were conducted in Ottawa-Carleton using a self-administered questionnaire completed in the hospital postpartum period. The proportion of women smoking after the first trimester of pregnancy decreased from 28.5% in 1983 to 18.7% in 1992. This difference was due mainly to a reduction in the proportion of women who smoked before pregnancy (37.4% to 26.4%). Another factor was that more women stopped smoking early in pregnancy (23.9% to 29.2%). Gradients in levels of smoking by age, education, marital status and poverty level still exist; however, this is true for the general population. Programs to decrease smoking in pregnancy should continue to focus on reducing smoking among women in general and among those in the preconception and early stages of pregnancy in particular.

The Provision and Evaluation of a Neonatal Resuscitation Program

The need to train perinatal staff in neonatal resuscitation is widely accepted; however, standardized educational programs have not been available. This study used a randomized control trial to evaluate a one-day neonatal resuscitation education program with 190 nurses. Experimental subjects receiving the program had significantly improved knowledge and skill performance. Knowledge, but not skill performance, was maintained at six months for the experimental group. There was a significant relationship between subjects' self-rating of knowledge and performance, suggesting that this method could be used to prioritize staff for basic or refresher training. An effective format and evaluation instruments for neonatal resuscitation training have been developed. Strategies to maintain skills should be addressed in future research.