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  1. Article ; Online: A Systemwide Postpartum Inpatient Maternal Mental Health Education and Screening Program.

    Torti, Jennie / Klein, Catherine / Foster, Mindy / Shields, Laurence E

    Nursing for women's health

    2023  Volume 27, Issue 3, Page(s) 179–189

    Abstract: Objective: To expand a hospital system's maternal mental health program to standardize screening for perinatal mood and anxiety disorders.: Design: Quality improvement initiative using a continuous Plan-Do-Study-Act (PDSA) cycle.: Setting/local ... ...

    Abstract Objective: To expand a hospital system's maternal mental health program to standardize screening for perinatal mood and anxiety disorders.
    Design: Quality improvement initiative using a continuous Plan-Do-Study-Act (PDSA) cycle.
    Setting/local problem: In a hospital system consisting of 66 maternity care centers across the United States, there was significant variation in maternal mental health screening, referral, and education practices. The COVID-19 pandemic and increasing rates of severe maternal morbidity further elevated system-level concern about the quality of maternal mental health care being provided.
    Participants: Perinatal nurses.
    Methods: An "all-or-none" bundle methodology was used to measure adherence to a system standard for maternal mental health screening, referral, and education.
    Interventions: A toolkit was designed internally to support streamlined implementation and ensure standardization for screening, referral, and education. This comprehensive toolkit includes screening forms, a referral algorithm, staff education, patient education literature, and a community resource list template. Training on how to use the toolkit was provided to nurses, chaplains, and social workers.
    Results: The initial system bundle adherence rate was 76% (2017) in the first year of the program. The following year, the bundle adherence rate increased to 97% (2018). Despite the disruption caused by the COVID-19 pandemic, this mental health initiative has maintained an overall adherence rate of 92% (2020-2022).
    Conclusion: This nurse-led quality improvement initiative has been successfully implemented across a geographically and demographically diverse hospital system. The initial and sustained high rates of adherence with the system standard for screening, referral, and education illustrate perinatal nurses' commitment to the delivery of high-quality maternal mental health care in the acute care setting.
    MeSH term(s) Pregnancy ; Humans ; Female ; Anxiety/psychology ; Inpatients ; Pandemics ; Maternal Health Services ; COVID-19 ; Postpartum Period ; Health Education
    Language English
    Publishing date 2023-04-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2275619-X
    ISSN 1751-486X ; 1751-4851
    ISSN (online) 1751-486X
    ISSN 1751-4851
    DOI 10.1016/j.nwh.2022.12.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: On "using a team-centered approach to evaluate effectiveness of nurse-physician communications".

    Foster, Mindy

    Journal of obstetric, gynecologic, and neonatal nursing : JOGNN

    2015  Volume 44, Issue 2, Page(s) 173

    MeSH term(s) Communication ; Delivery, Obstetric ; Female ; Humans ; Labor, Obstetric/psychology ; Male ; Nurses/psychology ; Physician-Nurse Relations ; Physicians/psychology ; Pregnancy
    Language English
    Publishing date 2015-03
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 193135-0
    ISSN 1552-6909 ; 0884-2175 ; 0090-0311
    ISSN (online) 1552-6909
    ISSN 0884-2175 ; 0090-0311
    DOI 10.1111/1552-6909.12555
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Performance Characteristics of Sepsis Screening Tools During Delivery Admissions.

    Main, Elliott K / Fuller, Matt / Kovacheva, Vesela P / Elkhateb, Rania / Azar, Kristen / Caldwell, Morgan / Chiem, Vanna / Foster, Mindy / Gibbs, Ronald / Hughes, Brenna L / Johnson, Rebecca / Kottukapally, Nobin / Cortes, Magdalena Sanz / Rosenstein, Melissa G / Shields, Laurence E / Sudat, Sylvia / Sutton, Caitlin D / Toledo, Paloma / Traylor, Austin /
    Wharton, Kurt / Bauer, Melissa E

    Obstetrics and gynecology

    2023  Volume 143, Issue 3, Page(s) 326–335

    Abstract: Objective: To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions.: Methods: This was a case-control study using electronic health record data, including vital signs and ... ...

    Abstract Objective: To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions.
    Methods: This was a case-control study using electronic health record data, including vital signs and laboratory results, for all delivery admissions of patients with sepsis from 59 nationally distributed hospitals. Patients with sepsis were matched by gestational age at delivery in a 1:4 ratio with patients without sepsis to create a comparison group. Patients with chorioamnionitis and sepsis were compared with a complete cohort of patients with chorioamnionitis without sepsis. Multiple screening criteria for sepsis were evaluated: the CMQCC (California Maternal Quality Care Collaborative), SIRS (Systemic Inflammatory Response Syndrome), the MEWC (the Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System), and the MEWT (Maternal Early Warning Trigger Tool). Sensitivity, false-positive rates, and C-statistics were reported for each screening tool. Analyses were stratified into cohort 1, which excluded patients with chorioamnionitis-endometritis, and cohort 2, which included those patients.
    Results: Delivery admissions at 59 hospitals were extracted for patients with sepsis. Cohort 1 comprised 647 patients with sepsis, including 228 with end-organ injury, matched with a control group of 2,588 patients without sepsis. Cohort 2 comprised 14,591 patients with chorioamnionitis-endometritis, of whom 1,049 had sepsis and 238 had end-organ injury. In cohort 1, the CMQCC and the UKOSS pregnancy-adjusted criteria had the lowest false-positive rates (6.9% and 9.6%, respectively) and the highest C-statistics (0.92 and 0.91, respectively). Although other screening criteria, such as SIRS and the MEWC, had similar sensitivities, it was at the cost of much higher false-positive rates (21.3% and 38.3%, respectively). In cohort 2, including all patients with chorioamnionitis-endometritis, the highest C-statistics were again for the CMQCC (0.67) and UKOSS (0.64). All screening tools had high false-positive rates, but the false-positive rates for the CMQCC and UKOSS were substantially lower than those for SIRS and the MEWC.
    Conclusion: During delivery admissions, the CMQCC and UKOSS pregnancy-adjusted screening criteria have the lowest false-positive results while maintaining greater than 90% sensitivity rates. Performance of all screening tools was degraded in the setting of chorioamnionitis-endometritis.
    MeSH term(s) Pregnancy ; Female ; Humans ; Chorioamnionitis/diagnosis ; Chorioamnionitis/epidemiology ; Case-Control Studies ; Retrospective Studies ; Endometritis ; Sepsis/diagnosis ; Systemic Inflammatory Response Syndrome
    Language English
    Publishing date 2023-12-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005477
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions.

    Bauer, Melissa E / Fuller, Matt / Kovacheva, Vesela / Elkhateb, Rania / Azar, Kristen / Caldwell, Morgan / Chiem, Vanna / Foster, Mindy / Gibbs, Ronald / Hughes, Brenna L / Johnson, Rebecca / Kottukapally, Nobin / Rosenstein, Melissa G / Cortes, Magdalena Sanz / Shields, Laurence E / Sudat, Sylvia / Sutton, Caitlin D / Toledo, Paloma / Traylor, Austin /
    Wharton, Kurt / Main, Elliott

    Obstetrics and gynecology

    2023  Volume 143, Issue 3, Page(s) 336–345

    Abstract: Objective: To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions.: Methods: This was a case-control study using electronic health record data obtained ... ...

    Abstract Objective: To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions.
    Methods: This was a case-control study using electronic health record data obtained between 2016 and 2021 from 67 hospitals for antepartum sepsis admissions and 71 hospitals for postpartum readmissions up to 42 days. Patients in the sepsis case group were matched in a 1:4 ratio to a comparison cohort of patients without sepsis admitted antepartum or postpartum. The following screening criteria were evaluated: the CMQCC (California Maternal Quality Care Collaborative) initial sepsis screen, the non-pregnancy-adjusted SIRS (Systemic Inflammatory Response Syndrome), the MEWC (Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System) obstetric SIRS, and the MEWT (Maternal Early Warning Trigger Tool). Time periods were divided into early pregnancy (less than 20 weeks of gestation), more than 20 weeks of gestation, early postpartum (less than 3 days postpartum), and late postpartum through 42 days. False-positive screening rates, C-statistics, sensitivity, and specificity were reported for each overall screening tool and each individual criterion.
    Results: We identified 525 patients with sepsis during an antepartum hospitalization and 728 patients with sepsis during a postpartum readmission. For early pregnancy and more than 3 days postpartum, non-pregnancy-adjusted SIRS had the highest C-statistics (0.78 and 0.83, respectively). For more than 20 weeks of gestation and less than 3 days postpartum, the pregnancy-adjusted sepsis screening tools (CMQCC and UKOSS) had the highest C-statistics (0.87-0.94). The MEWC maintained the highest sensitivity rates during all time periods (81.9-94.4%) but also had the highest false-positive rates (30.4-63.9%). The pregnancy-adjusted sepsis screening tools (CMQCC, UKOSS) had the lowest false-positive rates in all time periods (3.9-10.1%). All tools had the lowest C-statistics in the periods of less than 20 weeks of gestation and more than 3 days postpartum.
    Conclusion: For admissions early in pregnancy and more than 3 days postpartum, non-pregnancy-adjusted sepsis screening tools performed better than pregnancy-adjusted tools. From 20 weeks of gestation through up to 3 days postpartum, using a pregnancy-adjusted sepsis screening tool increased sensitivity and minimized false-positive rates. The overall false-positive rate remained high.
    MeSH term(s) Pregnancy ; Female ; Humans ; Case-Control Studies ; Postpartum Period ; Hospitalization ; Puerperal Infection ; Sepsis/diagnosis ; Sepsis/epidemiology ; Systemic Inflammatory Response Syndrome ; Retrospective Studies
    Language English
    Publishing date 2023-12-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005480
    Database MEDical Literature Analysis and Retrieval System OnLINE

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