HEALTHIER PREGNANCY: PATIENT SAFETY GOALS JASSIN M. JOURIA, MD DR. JASSIN M. JOURIA IS A MEDICAL DOCTOR, PROFESSOR OF ACADEMIC MEDICINE, AND MEDICAL AUTHOR. HE GRADUATED FROM ROSS UNIVERSITY SCHOOL OF MEDICINE AND HAS COMPLETED HIS CLINICAL CLERKSHIP TRAINING IN VARIOUS TEACHING HOSPITALS THROUGHOUT NEW YORK, INCLUDING KING’S COUNTY HOSPITAL CENTER AND BROOKDALE MEDICAL CENTER, AMONG OTHERS. DR. JOURIA HAS PASSED ALL USMLE MEDICAL BOARD EXAMS, AND HAS SERVED AS A TEST PREP TUTOR AND INSTRUCTOR FOR KAPLAN. HE HAS DEVELOPED SEVERAL MEDICAL COURSES AND CURRICULA FOR A VARIETY OF EDUCATIONAL INSTITUTIONS. DR. JOURIA HAS ALSO SERVED ON MULTIPLE LEVELS IN THE ACADEMIC FIELD INCLUDING FACULTY MEMBER AND DEPARTMENT CHAIR. DR. JOURIA CONTINUES TO SERVES AS A SUBJECT MATTER EXPERT FOR SEVERAL CONTINUING EDUCATION ORGANIZATIONS COVERING MULTIPLE BASIC MEDICAL SCIENCES. HE HAS ALSO DEVELOPED SEVERAL CONTINUING MEDICAL EDUCATION COURSES COVERING VARIOUS TOPICS IN CLINICAL MEDICINE. RECENTLY, DR. JOURIA HAS BEEN CONTRACTED BY THE UNIVERSITY OF MIAMI/JACKSON MEMORIAL HOSPITAL’S DEPARTMENT OF SURGERY TO DEVELOP AN E-MODULE TRAINING SERIES FOR TRAUMA PATIENT MANAGEMENT. DR. JOURIA IS CURRENTLY AUTHORING AN ACADEMIC TEXTBOOK ON HUMAN ANATOMY & PHYSIOLOGY. Abstract Preparing women early on in a pregnancy to follow a plan for routine prenatal care has been shown to promote healthy outcomes for expectant mothers and the developing baby during all phases of pregnancy. Proper nutrition and prevention should be reviewed at the first prenatal visit and for every visit throughout the pregnancy. To ensure that best care practices are followed and that promotion of maternal and infant health is of top priority, all health professionals should understand patient safety goals and standards of practice. The health team should understand the importance of working in unison not only with other clinicians and associates, but also with patients and their families. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacy content is 0.5 hours (30 minutes). Statement of Learning Need Clinicians need to understand the components involved in the initial prenatal assessment including assessing for pre-existing hypertension, glucose in the urine, and sexually transmitted diseases. Additionally, identifying existing risks at the first prenatal appointment through open communication regarding unhealthy lifestyle choices can make a profound difference in the health outcomes of the expectant mother and baby. Course Purpose To provide nurses with the fundamental skills and elements involved in managing healthy pregnancies, as well as basic concepts, which should be well understood by healthcare clinicians at all levels of patient care. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. Using the Estimated Date of Delivery (EDD) method, the care provider will always _____________________ from the first day of a woman’s last menstrual period. a. count forward 266 days b. count backward 266 days c. count forward 280 days d. count backward three months 2. ______________ of women deliver on their actual Estimated Date of Delivery (EDD). a. One half b. One-third c. Twenty percent d. Four percent 3. True or False: Properly determining a woman’s due date is nominally important because the patient’s contractions will provide enough notice. a. True b. False 4. Which pregnancy due date method or rule involves counting backwards three months from the first day of the last missed period and then subsequently adding 7 days? a. Naegele’s rule b. The hCG test c. The menstrual cycle method d. EDD method 5. Using the Estimated Date of Delivery (EDD) method, the care provider will always count forward 266 days from the date of conception if a. the woman took a home pregnancy test. b. the woman recorded the first day of her menstrual period. c. the exact date of conception is known. d. if the date is confirmed through urinalysis. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction Having a child is a deeply personal and challenging experience even for the parents who have previously had a child. All health professionals providing care to expectant mothers and their families should promote feelings of confidence in them that pregnancy safety goals are a high priority of the health team. To ensure that best care practices are followed and that promotion of maternal and infant health is of top priority, all health professionals need to understand patient safety goals and standards of practice. The health team that works in unison not only with other clinicians and associates, but also with patients and their families, will be better able to develop detailed, open communication with a focus on building strong and long-term relationships. When working collaboratively, health professionals and patients can promote a positive pregnancy outcome of healthy mothers and babies. Planning The Prenatal Visit The initial prenatal visit is an emotionally charged event for most women. During this time there are a variety of competing factors related to physiological and environmental changes an expectant mother may be experiencing; her body is changing in ways she cannot control, her family will have begun anticipating big changes in their lives, and she is likely anxious about the health care. The pregnant woman and her family will want reassurance that they are safe and in good hands. Health clinicians working with pregnant women will need to understand their underlying feelings of becoming a mother; whether they are thrilled with being pregnant, terrified of the process, or unsure or even remorseful regarding their pregnancy. At the initial visit, all members of the health team should help the expectant mother through all of her emotions as well as nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 those of her family. Patient engagement and healthy responses to teaching during all aspects of the pregnancy is promoted through the initial encounter of building a warm and trusting atmosphere, and the use of compassionate and therapeutic communication. During the initial prenatal visit, the health clinician will determine the expected date of delivery, perform a physical assessment of the mother and fetus, identify any underlying risks to a successful pregnancy, and understand how the mother and other members of her family are adapting to the pregnancy. Assessing The Estimated Delivery Date This section discusses the various and common strategies used in identifying a pregnant woman’s expected delivery date. Properly determining a woman’s due date is of utmost importance, because the more accurate the prediction of the due date, the less likely complications related to unnecessary medical interventions will arise.1 Evaluation of Gestational Age and Expected Date of Delivery The estimated date of delivery (EDD) method2 has been the principal method in determining a pregnant woman’s due date for more than 200 years. On top of using paper wheels or charts, some clinicians will use EDD calculators online based on the 280-day rule. The clinician must always count forward 280 days from the first day of a woman’s last menstrual period, or forward 266 days from the date of conception if this exact date is known, which is usually in cases of in vitro fertilization. The EDD method assumes that a woman’s ovulation occurs on day 14 of her cycle but this is untrue for many women, especially those with irregular nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 cycles. There are limitations of using the EDD method in evaluating gestational age.2 Only 4% of women deliver on their actual EDD because of natural biological variations in gestation and hormonal cycles. EDD is based on a 28-day menstrual cycle and does not account for women with varying period lengths or those with alternate fertile days due to changes in episodes of heightened luteinizing hormone (LH), the chemical signal responsible for the release of an ovum. Occasionally, the first day of the last menstrual cycle is unknown, either because the mother has irregular