Quality Improvement Projects

Severe Hypertension in Pregnancy

Nebraska participates in the Alliance for Innovation on Maternal Health (AIM) national program to decrease maternal mortality and morbidity and is currently working on the Severe Hypertension in Pregnancy patient safety bundle.

ACOG Safe Motherhood Initiative

ACOG Practice Bulletin #203: Chronic Hypertension in Pregnancy

ACOG Practice Bulletin #222: Gestational Hypertension and Preeclampsia

SMFM Special Statement (Feb 2022): A Quality Metric for Evaluating Timely Treatment of Severe Hypertension

Emergency Department — Postpartum Preeclampsia Checklist

Practicing for Patients Obstetric In-Situ Drill Program

Preterm Birth

Currently, a statewide taskforce is examining factors associated with prematurity in Nebraska.

Neonatal Sepsis Screening and Antibiotic Stewardship

Implementation of universal newborn sepsis screening and antibiotic stewardship is underway this year in Nebraska hospitals which have NICUs. 

Neonatal Early-Onset Sepsis Calculator

Puopolo, K. M., Benitz, W. E., Zaoutis, T. E. (2018). Management of Neonates Born at ≥35
0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Committee on fetus and newborn and committee on infectious diseases. Pediatrics, 142 (6) e20182894; doi: https://doi.org/10.1542/peds.2018-2894

Puopolo, K. M., Benitz, W. E., Zaoutis, T. E. (2018). Management of Neonates Born at ≤34 6/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Committee on fetus and newborn and committee on infectious diseases. Pediatrics, 142 (6) e20182896; doi: https://doi.org/10.1542/peds.2018-2896

Puopolo, K. M., Lynfield, R., Cummings, J. J. (2019). Management of infants at risk for group B streptococcal disease.  AAP Clinical Report. Pediatrics, 144 (2) e20191881 https://pediatrics.aappublications.org/content/pediatrics/144/2/e20191881.full.pdf 

Puopolo, K. M., Draper, D., Soora, W., Newman, T., Zupancic, J., Lieberman, E., Smith, M., Escobar, G. J. (2011). Estimating the probability of neonatal early-sonset infection on the basis of maternal risk factors. Pediatrics, 128 (5) doi:10.1542/peds.2010-3436. https://pediatrics.aappublications.org/content/128/5/e1155 

Neonatal Encephalopathy Registry

This registry allows for quality improvement and research efforts to identify barriers to hypothermia therapy, monitor deviations to common guidelines, better understand etiologies of neonatal encephalopathy, and to monitor survival and neurodevelopmental outcomes of infants throughout the region. Dr. Eric Peeples, neonatologist at the University of Nebraska Medical Center/Children's Hospital & Medical Center, is the primary investigator for the registry which is funded by COPIC Medical Foundation.

Timely identification and treatment of neonatal encephalopathy is essential for optimal outcomes. Review this Initial Assessment and Screening for Neonatal Encephalopathy algorithm from Children's Hosital & Medical Center.

Breastfeeding Practices

A quality improvement initiative is underway to increase exclusive breastfeeding rates at Nebraska hospitals. Currently, the in-hospital state-wide exclusive breastfeeding is at 75% and breastfeeding initiation is at 90%. Many hospitals are participating in this improvement initiative.

ABM Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term and Late Preterm Neonates, 2021.

ACOG Committee Opinion No. 756 Summary "Optimizing Support for Breastfeeding as Part of Obstetric Practice"

Recommendations for Adopting the International Code of Marketing of Breast-milk Substitutes Into U.S. Policy.

Immediate and Sustained Skin-to-Skin Contact for the Healthy Term Newborn After Birth: AWHONN Practice Brief Number 5

Parental Perinatal Depressions Screening

Perinatal depression is one of the most common obstetric complications in the United States. It is estimated that 1 in 7 women and 1 in 10 men experience symptoms of postpartum depression. Perinatal depression is a tragic and preventable cause of maternal and infant morbidity and mortality.  

The American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), and the U.S. Preventative Services Task Force (USPSTF) recommend universal screening of pregnant and postpartum women for depression as a component of quality obstetric care. Screening for postpartum depression in both mothers and fathers is recommended by Bright Futures and the American Academy of Pediatrics (AAP) and is a best practice in caring for infants and their families.  

This three-year statewide depression screening and referral project is funded by the Pritzker Foundation through a sub-award from First Five Nebraska. This project aims to establish perinatal depression screening as the standard of care and to identify statewide treatment referral systems. 

For screening recommendations:  

USPSTF Screening for Depression in Adults (January, 2016)  

ACOG Committee Opinion 757  (October, 2018)  

AAP Policy Statement (January, 2019)  

AAP Call to Action: Screening Fathers (January, 2020)  


Prevention of the 1st Cesarean Delivery

The rising cesarean delivery rate in the United States has been in the news. In 2014, ACOG and SMFM published a consensus document on the Safe Prevention of the Primary Cesarean Delivery. The plan is to facilitate dissemination of this information throughout the state and to support the implementation of the recommendations. Baseline data on Nebraska cesarean rates have been collected.

American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine, Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014 Mar;210(3):179-93

Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012 Nov;120(5):1181-93.

Chang, A. L., Pacheco, M., Yoshine, K., Miyamura, J., Maddock, J. Comparison of Primary Cesarean Delivery Rates Among Low-Risk Women in Urban and Rural Hospitals in Hawaii. Maternal Child Health Journal (2016) 20:1965-1970.

Bell, A. D., Joy, S., Gullo, S., Higgins, R., Stevenson, E. Implementing a Systemic Approach to Reduce Cesarean Birth Rates in Nulliparous Women. Obstetrics & Gynecology, 130 (5).

CMQCC. Toolkit to Support Vaginal Birth and Reduce Primary Cesareans

AIM. Safe Reduction of Primary Cesarean, patient safety bundle

Nebraska Safe Babies

Nebraska Safe Babies is a campaign to reduce the infant mortality rate. All birthing hospitals and clinics caring for moms and infants are encouraged to become CHAMPIONS in this effort by promoting safe sleep environments for infants and educating about abusive head trauma. For more information, visit Nebraska Safe Babies.

In addition to addressing infant mortality, Nebraska Safe Babies also recognizes hospitals that provide excellence in early identification of hearing loss in infants. Learn more about the Nebraska Newborn Hearing Hospital Champion Campaign.

Count the Kicks

Kick counts are a simple way for mothers to identify if their unborn baby is healthy. The Count the Kicks campaign, which originated in Iowa, strives to educate pregnant women and provides tools to assist them with kick counts. Kick counts are an easy way to prevent stillborn babies. Nebraska hospitals and providers may order free brochures to share the campaign with their patients. Order your brochures today. In addition, social media is being utilized to reach childbearing women in Nebraska.