Reducing Primary Cesareans
What Are Bundles?
The concept of the bundle was developed by the Institute for Healthcare Improvement (IHI) as a way to support health care professionals to provide the best care possible based on available evidence. According to IHI “A bundle is a structured way of improving the processes of care and patient outcomes by using a small, straightforward set of evidence-based practices— generally three to five— that, when performed collectively and reliably, have been proven to improve patient outcomes”1. The process of improvement through the use of a bundle is that it ties the evidence based care practices together into a package of approaches to care or interventions that are “followed for every patient, every single time”2.
With funding support from the Transforming Birth Fund ACNM has launched the Reducing Primary Cesarean Project. This project is focused on the development of hospital based perinatal collaboratives that implement one of three bundles which aim to reduce unnecessary cesareans. The three bundles, available in the bundles tool box, are the following:
Promoting Spontaneous Labor Progress
Promoting Comfort in Labor
ACNM has also participated in the development of several bundles as a part of multi-disciplinary teams to improve safety and quality in maternity care. In particular, ACNM has joined the Core Partnership of the Alliance for Innovation on Maternal Health (AIM) Program. AIM isa national partnership of organizations working to reduce maternal mortality by empowering every state in the US to implement quality improvement and safety bundles that address the significant contributors to pregnancy-associated maternal morbidity and mortality. Available bundles for the AIM project are located at http://safehealthcareforeverywoman.org/patient-safety-bundles/ and include the following topics:
Severe Hypertension in Pregnancy
Prevention of Venous Thromboembolism in Pregnancy
Support for Intended Vaginal Birth
Protocols and Resources to Support Patients, Families, and Staff
Postpartum Care Basics for Maternal Safety
Reduction of Peripartum Racial Disparities
Patient, Family, and Staff Support after a Severe Maternal Event
Resar R, Pronovost P, Haraden C, Simmonds T, et al.Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Joint Commission Journal on Quality and Patient Safety. 2005;31(5):243-248.
Institute for Healthcare Improvement (http://www.ihi.org/resources/Pages/ImprovementStories/WhatIsaBundle.aspx retrieved September 16, 2015).