Quality Improvement Projects

Severe Hypertension in Pregnancy

More information on the safety bundle.

Initiative participants may access recordings of web meetings. If you don't participate in this initiative, you will not be able to access these materials. 

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)

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. In 2020, this will be rolled out to all hospitals with birth services.

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 


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

Prevention of CMV

In Nebraska, there are approximately 156 CMV infected newborns born every year. Unsuspecting pregnant women may contract CMV and pass it on to their developing baby in-utero. Some of these newborns will have hearing loss as a result of the CMV infection. Public education programs have been effective in reducing the transmission of CMV to pregnant women. Social media is being utilized to education childbearing women in Nebraska about this disease and hygienic measures to prevent CMV transmission.

 Learn more:

National CMV Foundation

ACOG Practice Bulletin 151: Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy

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 promote safe sleep environment for infants and to educate caregivers about abusive head trauma.

Be recognized as a Safe Sleep Hospital. Get your brochures, videos, and learn about a great educational resource here.

Learn how to become a Nebraska Safe Sleep Champion.

The goal of the Abusive Head/Shaken Baby Syndrome Prevention Hospital Campaign is to provide evidence-based education to parents of newborns as well as birthing hospital staff. Learn more about how your birthing facility can become a Champion. Join the 20 who have already pledged.

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.