Includes bibliographical references.

From the Editors -- Tachysystole and Liability: Bumps in the Road?: Erratum -- Predatory Publishing: What Do Perinatal and Neonatal Nurses Need to Know -- Medication Use During Pregnancy and Lactation -- Differentiating Between Research and Quality Improvement -- Patient Safety Organizations -- Internet Resources -- Crosswalk -- Navigating the Perinatal Quality Landscape -- Patient Safety During Induction of Labor -- REACT -- Following the Evidence -- Human Factors in the NICU -- The Journey to High Reliability in the NICU -- Interdisciplinary Teamwork and the Power of a Quality Improvement Collaborative in Tertiary Neonatal Intensive Care Units -- On Mentoring.

[Article Title: From the Editors/ Diane Angelini, Peggy Gordin and Joan R. Smith, p. 93-94]

https://doi.org/10.1097/JPN.0000000000000094

[Article Title: Tachysystole and Liability: Bumps in the Road?: Erratum, p. 94]

https://doi.org/10.1097/JPN.0000000000000111

[Article Title: Predatory Publishing: What Do Perinatal and Neonatal Nurses Need to Know/ Diane Angelini and Susan Bakewell-Sachs, p. 95-96]

https://doi.org/10.1097/JPN.0000000000000095

[Article Title: Medication Use During Pregnancy and Lactation/ Jackie Tillett, p. 97-99]

https://doi.org/10.1097/JPN.0000000000000097

[Article Title: Differentiating Between Research and Quality Improvement/ Katherine E. Gregory, p. 100-102]

https://doi.org/10.1097/JPN.0000000000000107

[Article Title: Patient Safety Organizations/ Lisa A. Miller, p. 103-104]

https://doi.org/10.1097/JPN.0000000000000103

[Article Title: Internet Resources/ Susan Blackburn, p. 105-106]

https://doi.org/10.1097/JPN.0000000000000100

[Article Title: Crosswalk/ Laura Mahlmeister, p. 107-115]

Abstract: Perinatal nurses rely upon a myriad of resources in the course of providing care. Although not always appreciated by direct-care nurses, nurse managers, and administrators, regulatory and accrediting bodies exert a pervasive influence over the provision of care in almost every hospital in the United States. The Centers for Medicare and Medicaid Services (CMS), a federal agency, and The Joint Commission (TJC) offering voluntary accreditation programs for hospitals hold a primary goal in common. They both aim to protect the health and safety of patients and improve the quality of hospital care. To further that aim, TJC has published a matrix, the “TJC-CMS Crosswalk.” The “Crosswalk” provides a visual illustration of the alignment between TJC hospital accreditation standards and the CMS “Conditions of Participation for Hospitals in Medicare.” This article defines the Conditions of Participation and associated Joint Commission Standards. A secondary goal is to explain the collaborative role of TJC in hospital certification for reimbursement in Medicare and its impact on hospital-based practice, perinatal education, and performance improvement activities.

https://doi.org/10.1097/JPN.0000000000000093

[Article Title: Navigating the Perinatal Quality Landscape/ Elisabeth Howard, p. 116-129]

Abstract: The National Quality Strategy, mandated by the Affordable Care Act, outlines the triple aim of better health, better care, and lower costs. Perinatal nurses are integral to the National Quality movement as care providers, leaders, and experts. The most notable accomplishments in perinatal care of the last decade relate to the endorsement of quality measures by the National Quality Forum that provide unified goals and the quality improvement frameworks provided by the Institute for Healthcare Improvement that help systems create action and change through education, team building, process improvement, and structure. Fourteen perinatal quality measures are currently endorsed by the National Quality Forum, 5 of which are mandated by The Joint Commission and required for accreditation. Understanding the current perinatal quality measures and the resources available for implementation is essential to nursing care delivery. Realizing the nurses' role within the quality improvement landscape and mobilizing nationally endorsed quality measures as levers for nurse-led improvement projects promise actualization of marked quality improvement in perinatal care.

https://doi.org/10.1097/JPN.0000000000000092

[Article Title: Patient Safety During Induction of Labor/ Jan M. Kriebs, p. 130-137]

Abstract: Rates of induction of labor have risen rapidly since 1990, from 9.6% in that year to a peak of 23.8% of the 2010 singleton births in the United States. Even as the definition of term pregnancy has been refined to reflect the continuing maturation needs of the fetus, and mothers have been encouraged to “go the full forty,” management strategies for pregnancy conditions that increase risk have included early induction. Labor induction should only be undertaken when there are specific indications for interrupting the normal processes of pregnancy. These indications may relate to maternal, fetal, or placental conditions or simply reflect the understanding that in all pregnancies, the placenta will eventually lose its ability to adequately provide oxygen, nutrition, and waste removal for the fetus. Patient safety—for both the mother and the child—can be improved when clinicians practice within clinical guidelines that follow the best available evidence and women are able to make informed decisions regarding plans for labor.

https://doi.org/10.1097/JPN.0000000000000099

[Article Title: REACT/ Suzanne McMurtry Baird and Cornelia R. Graves, p. 138-148]

Abstract: In recent years, there has been an increase in the number of pregnancies complicated by preexisting medical conditions as well as an increase in maternal morbidity and mortality in the United States. The goal of the REACT quality and safety initiative was to reduce maternal morbidity and mortality by providing an interprofessional education program for recognizing and managing the woman who becomes compromised during pregnancy, childbirth, or the puerperium. REACT is an acronym for Recognize, Educate, Activate, Communicate, and Treat early signs and symptoms of maternal compromise. Early signs and symptoms of maternal compromise outlined in the REACT program are similar to recently published recommendations by the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, the Society for Maternal-Fetal Medicine, the Health Resources and Services Administration, the Association of Women's Health, Obstetric and Neonatal Nurses, and the American College of Nurse-Midwives.

https://doi.org/10.1097/JPN.0000000000000098

[Article Title: Following the Evidence/ Patricia Clifford, Lauren Heimall, Lori Brittingham and Katherine Finn Davis, p. 149-161]

Abstract: Enteral tube placement in hospitalized neonates and young children is a common occurrence. Accurate placement and verification are imperative for patient safety. However, despite many years of research that provides evidence for a select few methods and clearly discredits the safety of others, significant variation in clinical practice is still common. Universal adoption and implementation of evidence-based practices for enteral tube placement and verification are necessary to ensure consistency and safety of all patients. This integrative review synthesizes current and seminal literature regarding the most accurate enteral tube placement and verification methods and proposes clinical practice recommendations.

https://doi.org/10.1097/JPN.0000000000000104

[Article Title: Human Factors in the NICU/ Rebecca Doerhoff and Barbara Garrison, p. 162-169]

Abstract: Human factors have been identified as the most frequent cause of and contributory factor to sentinel events. Many human factor errors are preventable, and neonatal nurses are instrumental at the point of care in working with system leaders to identify various problems and potentially safe practices that can be hardwired into daily practice. This article defines human factors that often occur in daily processes of care in many neonatal intensive care units (NICU) and specific evidence-based strategies to implement to reduce preventable human errors. Human factor evidence from other high-risk industries is relevant to healthcare and can be applied to the complex adaptive environment of the NICU. Nurses need to be mindful of their complex environment and to have a basic understanding of the role of human factors principles.

https://doi.org/10.1097/JPN.0000000000000105

[Article Title: The Journey to High Reliability in the NICU/ Patricia G. Bondurant, Jill Nielsen-Farrell and Lori Armstrong, p. 170-178]

Abstract: Neonatal intensive care units (NICUs) are at high risk for medical errors due to the population, setting, and complexity of care. Furthermore, “near misses” often precede actual errors yet are mostly underreported and unrecognized as safety concerns. There is a growing recognition that a systems approach to quality and safety is foundational to improving care at the bedside and patient outcomes. The High Reliability Organization model is one such approach. It recognizes the challenges of a highly complex system and combines this recognition with a continual emphasis on reducing errors. Although the principles of the High Reliability Organization hold promise in accelerating quality and safety in the NICU, it is imperative that nurses at the bedside as well as nurse leaders actually learn how to operationalize high reliability principles and strategies that lead to better outcomes. This article outlines the necessary principles, culture, strategies, and behaviors that NICU nurses and nurse leaders must adopt to achieve high reliability in their units.

https://doi.org/10.1097/JPN.0000000000000101

[Article Title: Interdisciplinary Teamwork and the Power of a Quality Improvement Collaborative in Tertiary Neonatal Intensive Care Units/ Theresa R Grover, Eugenia K Pallotto, Beverly Brozanski, Anthony J Piazza, John Chuo, Susan Moran, Richard McClead, Teresa Mingrone, Lorna Morelli and Joan R Smith, p. 179-186]

Abstract: Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.

The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the “SLUG Bug” project designed to reduce central line-associated bloodstream infections (CLABSIs).

The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.

CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more (“improvement”) was achieved by 94% of centers and a score 4 or more (“significant improvement”) was achieved by 35%.

Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases.

https://doi.org/10.1097/JPN.0000000000000102

[Article Title: On Mentoring/ Lisa A. Miller, p. 187-188]

https://doi.org/10.1097/JPN.0000000000000096