Mary Campbell Bliss

Perinatal Clinical Nurse Specialist
Sutter Sacramento--Sierra Region

Mary Campbell Bliss RN, MS, CNS, has been a Perinatal Clinical Nurse Specialist at Sutter Medical Center, Sacramento since 1991.  She has 29 years of perinatal nursing experience in both clinical and leadership positions.  She received her Bachelor of Science in Nursing from University of Wisconsin-Eau Claire and her Master of Science in Maternal-Child Nursing from the University of Wisconsin-Madison.  Throughout her career, Ms. Bliss has focused on quality improvement, standards of nursing care, education and program planning/development.  While she has worked on many initiatives, her most constant efforts as a healthcare advocate have been in the areas of domestic violence and breastfeeding. Ms. Bliss serves on many committees including the Sacramento County Domestic Violence Coordinating Council, Sacramento County Domestic Violence Death Review Team, and Maternal Quality Improvement Panel (MQIP).  She created and co-chairs the Sutter Health Sacramento-Sierra regional WING (Woman’s and Infant’s Nursing Group) and the CNS/Nurse Director Committees.  Ms. Bliss was the clinical lead of the RPPC Region 2 (NCPOP) Breastfeeding Resource Binder and the CPQCC Perinatal HIV Toolkit, as well as the clinical coordinator of the California March of Dimes Preterm Labor Assessment Toolkit. These efforts resulted in consensus based documents to standardize and improve care of women and infants.  In 2006, Ms. Bliss received the Nursing Spectrum Excellence in Nursing-Community Service Award.

The establishment and measurement of quality benchmarks in maternal care should lead to the improvement of both infant and maternal health outcomes. Women and children in California deserve no less than our best efforts state-wide in reaching these quality care goals.

Profile in Improvement

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.