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

Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period (ACOG Committee Opinion #767)

Emergency Department — Postpartum Preeclampsia Checklist



Preterm Birth

Nebraska clinicians and payers have been working together to increase the use of hydroxyprogesterone caproate (17P, Makena) in order to reduce the risk of preterm birth.

FAQ’s Hydroxyprogesterone Caproate (17P, Makena)

In 2020-2021, a statewide taskforce will be launched to examine 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 



Hyperbilirubinemia

Jaundice is a fairly common newborn condition that can result in devastating kernicterus. Evidence provides guidance in the identification of newborns at risk and their appropriate management. 

Video for Providers & Nurses by Dr. Ann Anderson Berry (20min)

Presentation slides for Providers & Nurses

Bhutani, V. K., Stark, A. R., Lazzeroni, L. C., Poland, R., Gourley, G. R., Kazmierczak, S., . . . Stevenson, D. K. (2013). Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. The Journal of Pediatrics, 162(3), 477-482.e1. doi:10.1016/j.jpeds.2012.08.022

Keren, R., Tremont, K., Luan, X., & Cnaan, A. (2009). Visual assessment of jaundice in term and late preterm infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 94(5), F317-F322. doi:10.1136/adc.2008.150714

Maisels, J.M., Bhutani, V.K., Boge, D., Newman, T.B., Start, A.R., and Watchko, J.F. (2009). Hyperbilirubinemia in the newborn infant > or = to 35 weeks gestation: An update with clarifications. Pediatrics, 124

Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. (2004). Pediatrics, 114(1), 297-316.

Shahid, R., & Graba, S. (2012). Outcome and cost analysis of implementing selective coombs testing in the newborn nursery. Journal of Perinatology: Official Journal of the California Perinatal Association, 32(12), 966-969. 


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.

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

This three year project involves state-wide implementation of parental depression screening, prenatal through the infant's first year of life. A referral system for parental depression will also be identified. This project is funded by the Pritzker Foundation through a sub-award from First Five Nebraska.  


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).


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.