The Florida Perinatal Quality Collaborative (FPQC) has been busy this fall preparing for the final virtual meetings for our two maternal health quality improvement initiatives: PROVIDE (Promoting Primary Vaginal Deliveries) and MORE (Maternal Opioid Recovery Effort).

On September 23, over 130 attendees from 45 hospital teams, Healthy Start Coalitions, Medicaid Managed Care Organizations, and state agencies and organizations gathered virtually to learn how the PROVIDE initiative is progressing, hear tips from state and national experts on reducing Nulliparous Term Singleton Vertex (NTSV) cesarean births, and gain inspiration for making the “final push” in this initiative. Mary Mayhew, Executive Director of the Florida Hospital Association and former Secretary of the Agency for Healthcare Administration, congratulated the PROVIDE teams on their leadership, consistent commitment to best practices and on their progress in improving birth outcomes for women across the state. Dr. Bill Sappenfield, Director of FPQC and Kristina Svatos, PROVIDE Data Analyst, summarized the progress made since the beginning of the initiative, emphasizing that Florida’s NTSV cesarean rates have decreased 7.4% while the total US rate has only decreased by 1.5%. Dr. Cheryl Vamos, USF College of Public Health, shared her research findings regarding effective ways to educate busy obstetric staff and providers with tips about techniques perceived to be most effective and recommendations for successful training strategies.

Two speakers discussed California’s successes and challenges in reducing NTSV cesarean rates. Christa Sakowski, nurse lead from the California Maternal Quality Care Collaborative, emphasized there is no single successful strategy for supporting vaginal births; a culture change is needed for sustained change. She also stressed the importance of celebrating successes in this long journey. Dr. Ramy Eskandar from the Harbor UCLA Medical Center provided an honest description of the difficulty of culture change: it takes time and involves many steps. He emphasized the importance of involving the entire care team, including the patient, and aligning all levels of stakeholders, including executive management in a shared, unified vision

Both speakers acknowledged the powerful role of the bedside nurse in the labor process, both as a patient educator and as a patient advocate.

The final push for PROVIDE includes offering smaller, monthly coaching call groups led by a physician and nurse coach mentor and using a “What Can Florida Do” checklist with strategies used by California to reduce its rates.

Comments from attendees included:

“[I liked] Having a physician champion share frontline information and encouragement.”

“[I plan to] Improve education to our mothers, to impower them to become active participants in their delivery by asking the right questions.”

Further strategies included creating badge buddies for physicians who meet benchmark which read “ask me about my low c-section rates”, and a Wall of Stars recognizing physicians, midwives, and nurses who have contributed to a successful NTSV delivery. 

Likewise, the virtual mid-point meeting for the MORE initiative was held October 28 with participation from over 120 attendees representing 26 hospital teams, managed care organizations, Healthy Start Coalitions, and state partners. The MORE initiative will also be coming to a close in June 2022, so the teams were eager to learn tips about best practices regarding screening, community resources, referral strategies and ways to get Narcan, an overdose reversal medication, into the hands of pregnant and new moms with OUD and their families.

The meeting began with a compelling video telling the story of Angel (pictured), a mother in recovery, who has overdosed and been revived with Narcan several times. She emphasized the impact of a physician and  nurse who “believed in me until I could believe in myself” as well as her gratitude for having Narcan available so she could survive the overdoses, sustain her recovery and raise her daughters. Dr. Estefania Rubio, FPQC Data Manager, presented an update on progress with MORE.  Successes included a substantial increase in SUD screening as well as recommended secondary screening.

Dr. Pamela Carbiener, FPQC MORE Physician Coach, discussed the barriers to screening and referral for medication assisted treatment (MAT), debunked myths related to prescribing MAT, and reviewed recent federal and state changes supporting MAT prescribing by prenatal care providers. This was followed by a panel representing three Medicaid managed care plans describing the services available for Medicaid recipients in each plan. A brief description of behind-the-scenes work supporting pregnant women and new mothers with OUD by statewide agencies and organizations ended this segment of the agenda.

Dr. Cheryl Vamos, USF College of Public Health, also presented her work at this meeting. She emphasized that training should be ongoing, not just “one and done” and include system level training, interpersonal training using snippets, huddles and informal influencers, and intrapersonal – encouraging each individual to understand the impact of bias and stigma on the care and treatment of patients.

Elena Jensen, Executive Coach at eilumin Corporation, wrapped up the meeting with a presentation entitled “Of Course You Feel This Way: Compassion for Your Brain in the Midst of Chaos”. She emphasized personal resiliency and small things to lessen stress, or at least not compound stress, in day-to-day situations. She took attendees through a guided exercise around a stressful memory and offered techniques to self-calm. Given the challenges faced by medical professionals during the COVID-19 pandemic, these techniques and practices were much appreciated by attendees.

Comments from attendees included:

“[I enjoyed the] number of people showing their faces, speaking up, asking questions.”

“It was all very informative and needed, but I really enjoyed the self-care speaker.”

“The video enhanced my knowledge of Naloxone.”

FPQC looks forward to a strong finish for the current maternal initiatives and will soon be planning the next round of initiatives. Hospital teams are encouraged to stay tuned for more information in 2022.