Mary Campbell Bliss, RN, MS, CNS
Mary Campbell Bliss recognized that initial assessment of preterm labor patients at Sutter Medical Center Sacramento would be improved with standardization. Wide practice variation in assessment of patients presenting with the signs and symptoms of preterm labor was causing congestion on L&D units as well as unnecessary hospitalizations and medication use. With this goal in mind, Ms. Bliss facilitated a team of perinatologists, clinical nurse specialists, management, staff nurses, lab and finance personnel. Their first goals were to assess current preterm labor patient length of stay in triage and inpatient and to develop a nursing protocol and physician order set utilizing the Rapid fetal fibronectin (R-fFN) test. This stage of quantifying the problem and implementing improvements occurred over 6 months. The process of implementing the test required obtaining R-fFN equipment, training of perinatal staff and lab certification, as well as continual reporting and quality review.
Once the framework was in place, the pilot project began, including collection of data pre, during and post implementation of the new process. The pilot project went on for 6 months, however data was followed for 2 years after implementation of the test. Follow-up results after 6 months of the R-fFN test showed that average length of stay decreased from 3.4 days to 1.34 days for patients admitted for preterm labor and discharged undelivered in ≤4 days. Average triage evaluation of patients presenting with signs and symptoms of preterm labor decreased from 6.0 hours to 1.6 hours. Ms. Bliss and her team had decreased length of stay, triage time, improved resource utilization and standardization of practice amongst independently diverse practitioners through use of R-fFN screening for symptomatic preterm labor (Hedriana, Bliss, Gilbert, Am J OB/Gyn Supplement, Abstract #145, Dec., 2005). The outcomes obtained at 6-month follow-up have been sustained and the process has been utilized as a model for implementation of the March of Dimes Preterm Labor Assessment Toolkit.
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