Alliance for Innovation on Maternal Health – Patient Safety Bundles

Overview

“The Alliance for Innovation on Maternal Health or AIM, is a national, cross-sector commitment designed to support best practices that make birth safer, improve maternal health outcomes and save lives” – AIM website

West Virginia is proud to have joined the AIM initiative in 2018 with support from the state Chapter of ACOG, AWHONN, WV Hospital Association, Office of Maternal Child and Family Health and the Bureau for Public Health. An AIM Task Force was created and co-chaired by Melanie Riley, RN, MSN and Coy Flowers, MD. The AIM Task Force continues to work on patient safety initiatives under the medical support from Shon Rowan, MD, WVU Medicine and Emily Sloane, MD Marshall University, Joan C. Edwards School of Medicine.

Obstetric Hemorrhage Patient Safety Bundle

In response to high rates of severe maternal morbidity (SMM) due to hemorrhage, in 2018, the West Virginia Perinatal Partnership began implementation of the AIM Obstetric Hemorrhage patient safety bundle in 22 of the 23 birthing facilities in the state. Between January 2018 and June 2020, the percentage of participating facilities who reported having a hemorrhage cart increased from 76% to 95%.

Additionally, the statewide rate of SMM among birthing patients who experienced obstetric hemorrhage, excluding those who only received blood transfusions, decreased from 7% during the baseline period (2016-2017) to 6% in 2018, a reduction of 14%. In 2024 99% of the hospitals report completing hemorrhage risk assessments on patient admitted in labor, 91% employing Quantification of Blood Loss to improve early detection of hemorrhage and establishing hemorrhage supplies and policies for rapid response.

For more information on the Obstetric Hemorrhage patient safety bundle, click here.

For more information about West Virginia’s work on obstetric Hemorrhage, contact Melanie Riley at rileym@marshall.edu

Severe Hypertension in Pregnancy Patient Safety Bundle

In 2021, 13% of women giving birth in West Virginia were identified as experiencing a hypertension disorder during pregnancy or postpartum, amounting to 2,383 women impacted in one year. A recent review of maternal outcomes compared to Maternal Level of Care, revealed that pre-eclampsia and HELLP syndrome were found to be the most common cause of adverse maternal outcomes, in both low level birthing facilities and tertiary care centers in West Virginia. In 2020 the WVPP launched implementation of the Severe Hypertension in Pregnancy Patient Safety Bundle with a goal to reduce the rate of harm from hypertensive disorders among pregnant and postpartum patients. Despite the impact of a global pandemic, the overall trend rate of decreasing SMM with hypertension, excluding blood transfusion, has continued to decrease from a high of 9.1% in 2016 to 6.0% in 2023.

In 2024 over 90% of physicians and nurses in West Virginia hospitals with obstetric units, have received education or training on severe hypertension in pregnancy, including an increase in the number of simulation drills and respectful care practices. In addition, timely treatment to care for women with severely elevated blood pressures has increased, postpartum follow up and blood pressure monitoring has improved and 80% of women receive education on postpartum warning signs on discharge from the hospital.

For more information on the Severe Hypertension in Pregnancy Patient Safety Bundle, click here.

For more information about West Virginia’s work on hypertension in pregnancy, contact Melanie Riley at rileym@marshall.edu

Perinatal Mental Health Conditions Patient Safety Bundle

Recent maternal mortality reports in West Virginia have noted an increase in pregnancy related deaths due to overdose and suicide. In addition, the rate of women identified as having a perinatal mental health condition on delivery admission rose from 11.2% in 2012 to 26.4% in 2023 an increase of 200%. In 2024 the West Virginia Perinatal Partnership launched the implementation of the Perinatal Mental Health Conditions bundle in all delivery hospitals in the state. In addition, a statewide taskforce, the Maternal Mental Health Advisory Council was formed to coordinate efforts among multiple organizations and agencies for a more cohesive plan of action under which the AIM Task Force is a subcommittee.

Implementation of the Perinatal Mental Health Conditions Bundle has included review of screening tools, establishing a multidisciplinary team at each facility, developing response protocols for screening and education in mental health conditions. Webinars on Screening Tools and processes and Postpartum Psychosis have been shared with participants across the state.

In 2024 a third of the hospitals reported establishing their multidisciplinary team and beginning to map resources in the medical facility and community. Over 90% of women discharged from the hospitals after giving birth are receiving education on perinatal mental health conditions and when to seek medical care.

For more information on the Perinatal Mental Health Conditions Patient Safety Bundle, click here.

For more information on West Virginias efforts on the Perinatal Mental Health Conditions Patient Safety Bundle, please contact
Melanie Riley at rileym@marshall.edu