Minutes March 30 2012 Boulder Community Foothills Hospital by d2BW30q


									                  COLORADO PERINATAL CARE COUNCIL
A. MEETING                                   Colorado Perinatal Care Council
B. DATE                                      March 30, 2012
C. LOCATION                                  Boulder Community Foothills Hospital
                                             Boulder, Colorado
   Deborah Bopp, Memorial Health System, Colorado Springs
   Kathleen DeMarco, Presbyterian/St. Luke’s Medical Center, Denver
   Amy Dempsey, Lutheran Medical Center, Wheat Ridge
   Ellen Duran, North Suburban Medical Center, Thornton
   Sandy Gardner, Colorado Nurses Association, Aurora
   Tracy Heaberlin, Yampa Valley Medical Center, Steamboat Springs
   Steven Holt, M.D., Rose Medical Center, Denver
   Peter Hulac, M.D., Chairman, Member-at-Large, Denver
   Sheila Kaseman, The Children’s Hospital, Aurora
   Suze Ketchem, Exempla Good Samaritan Hospital
   Vicki Lemmon, Boulder Community Foothills Hospital, Boulder
   Paulette Mapes, St. Mary Corwin Hospital, Pueblo
   Mary McMahon, Association for Women’s Health OB & Neonatal Nurses
   Pat Pate, Parkview Episcopal Medical Center, Pueblo
   Alfonso Pantoja, M.D., Exempla St. Joseph Hospital, Denver
   Kathy Pehanich, St. Anthony North Hospital, Denver
   Pat Bohling Smith, Poudre Valley Hospital, Ft. Collins
   Neva Spencer, Medical Center of Aurora, Aurora
   Lynne Snyder, Avista/Portercare Hospital, Louisville
   Tina Wilson, Montrose Memorial Hospital, Montrose
   Jim Woods, M.D., Denver Health

   Elise Brown, M.D., Exempla Good Samaritan Medical Center
   Susan Clarke, The Children’s Hospital, Aurora
   Tamara D-Corbeil, Boulder Community Foothills Hospital
   Jennifer Dellaport, CDPHE, Denver
   Jamie Fricoll, Exempla Good Samaritan Medical Center
   Abraham Grinberg, M.D., Retired neonatologist, Denver
   Stacy Helmuth, The Medical Center of Aurora
   Lacy Hesslink, Pueblo
   David Horst, M.D., Presbyterian/St. Luke’s Medical Center, Denver
   Nina Huffer, Healthone Cares
   Barbara Hughes, Invest in Kids, Denver
   Tara Kennedy, CHC
   Christy Math, University of Colorado Hospital, Aurora
   Debbie Mielcarek, Memorial Health System, Colorado Springs
   Carol Nelson, University of Colorado Hospital, Aurora
   Jen Pappas, The Children’s Hospital, Aurora
   Jackie Prinzi, North Suburban Medical Center, Thornton
   Cheri Proctor, St. Anthony North Hospital
   Connie Rusk, Rocky Mountain Hospital for Children, Denver
   Daniel Sahling, Regis University
   Judy Smith, Heart of the Rockies, Loveland
   Maiki Linda Teene, Regis University Nursing
   Maria Telfer, St. Mary Corwin Hospital, Pueblo
   Susan Wilczynski, St. Mary Corwin Hospital, Pueblo
   Rachel Wright, M.D., Denver Health
   Kathy Young, St. Mary Corwin, Pueblo
E. HANDOUTS (Available Upon Request)
   1. Treasurer’s Report
   2. Conference Calendar
   3. CPCC Meeting Dates & Locations-2012
   4. News Release from Colorado Department of Public Health & Environment: “State
       Laboratory adds “Bubble Boy” Disease to its Panel of Newborn Screenings”
   5. Article from Medical News Today: “Brain Development of Premature Infants May
       be Influenced by Maternal Obesity”
   6. Article from Medical News Today: “Potential Link between Antidepressant Use
       During Pregnancy and Hypertension”
   7. Article from Medical News Today: “During Pregnancy, Cell Phone Use May Lead to
       Behavioral Disorders in Offspring”
   8. Article from The Denver Post: “Doctors’ Preference Should be Natural Childbirth”
   9. Article from The Denver Post: “Disorder in Meth Babies”
   10. Summary of Dr. Ed Donovan’s talk: “NCABSI Data Summary Update – Colorado
       and National”
   1. The Council thanked Vicki Lemmon and Boulder Community Foothills Hospital for
       hosting the meeting.
   2. Introduction of Council members and guests.
   3. Vicki Lemmon presented the perinatal services at Boulder Community Foothills
   4. David Horst, M.D., continued the discussion of treatment of asymptomatic infants
       whose mother had the diagnosis of Chorioamionitis prior to delivery.
   5. Edward Donovan, M.D., and Alfonso Pantoja, M.D., presented Colorado Perinatal
       Collaborative Possibilities: NCABSI Data Summary Update.
   6. The meeting was adjourned.
   1. Procedural Items
       a. The Council thanked Vicki Lemmon and Boulder Community Foothills Hospital
           for hosting the meeting and providing refreshments.
       b. Introduction of Council members and guests.
       c. The Minutes of the January 27, 2012 meeting were approved as written.
       d. The Treasurer’s Report was presented by Sandra Gardner, Treasurer. If
           interested, please contact Jan at the CPCC office for a copy.
           e. For a list of conferences, please refer to the Council’s website at:
           f. Conferences and other announcements: Peter Hulac, M.D., Chairman
               announced that Jan is going to be retiring after almost 24 years. Pat Bohling
               Smith put together a great job description, and they will begin the search for Jan’s
               replacement. Susan Clarke, from the Children’s Hospital stated that she put
               brochures on the back table. She specifically mentioned the Neonatal Advanced
               Practice Conference on June 22 at Aurora and video conference sites. The
               AWHONN National Conference will be held June23-27 in Washington, D.C.
               Jennifer Dellaport from the Breastfeeding Coalition announced a one day
               conference of September 8 to discuss best practices and baby friendly hospitals.
               She knows it is hard to achieve the status of “baby Friendly” but they are trying to
               move hospitals in that direction She needs more people on the planning
               committee and asked for volunteers. She also mentioned the Can Do 5 project.
               Last year at the July CPCC meeting they awarded plaques to 13 hospitals in the
               state for Can Do 5, and hope to be able to award more hospitals this year.
           g. Executive Committee Report: Peter Hulac, M.D., Chairman, stated that the
               group was planning future meetings and was very interested in input from the
               group as to what they wanted to hear. Please contact Peter with your ideas. He
               also stated that the group would be busy searching for Jan’s replacement.
II.   Perinatal Services at Boulder Community Foothills Hospital: “Birthing in Boulder/”
      Vicki Lemmon, RN, MSN, Director, Family Birth Center: Vicki began by explaining
      that she would give a brief overview. They have 2 OB practices with a total of 9 OBs.
      They have one certified nurse midwifery practice under one of the OB practices that has
      5 certified nurse midwives. She emphasized one area where she felt they excelled in that
      they have a low epidural rate in comparison to the rest of the state. She attributes that to
      a number of alternatives that they offer rather than medication. For the past 3 years, they
      have had a plan in place for skin to skin contact until the first breastfeeding takes place.
      The mom/baby unit has 16 beds. They recently implemented quiet time from 2-4 in the
      afternoon. They do not have a well baby nursery as all babies room-in. They are the first
      hospital in the country to receive certification for being “green.” Their breastfeeding
      initiation rate is 97%, and they were one of the hospitals that did receive the Can Do 5
      award last year. Vicki explained that their special care nursery is unique in the fact that
      each baby has its own suite, with the parent suite attached. Many other hospitals are
      following suit using them as the example. As a Level IIB, they have a partnership with
      the Children’s Hospital. They had 103 admissions in 2011. They transported 3 babies to
      the Children’s Hospital for head-cooling. They do have an active midwifery practice in
      Boulder and try to keep a good relationship. They hold annual teas in June to keep up
      this relationship. She did say that the Council asked for information about immunizations
      in Boulder. Only 60% of children are completely vaccinated. They are trying to work on
      this. 11% of children in elementary schools in Boulder do not have their immunizations.
      Colorado is second in the country for opt-out for immunizations, and is only beaten by
      Alaska. Vicki then looked at quality measures and stated that hey jut implemented the
      Division of Organizational Excellence. They are looking at the “Lean Project” and
      thereby reducing waste. They have 70 lean events projected for 2012 with a $2 million
      projected savings. New construction taking place is for the Anderson Medical Building
       that will have 16 out-patient surgery rooms. In addition, a majority of services now at the
       Broadway campus will be moving there in 2014. She concluded by stating that there are
       a lot of changes on the horizon.
III.   Treatment of Asymptomatic Infants Whose Mother had the Diagnosis-Corioamnionitis
       Prior to Delivery: Different Points of View: (Continued): David Horst, M.D.,
       Neonatologist, Pediatrix: Elise C. brown, M.D., MPH, General Pediatrician: Dr. Horst is
       a neonatologist who had a fellowship at Texas Children’s Hospital in Houston. He came
       to Denver about 6 years ago and joined Pediatrix. He stated that he would attempt to
       define the problem and the actual risk in asymptomatic newborns. He explained that the
       problem we are talking about is simple on the surface, but affects every bit of how we
       operate the nursery. He said that Dr. Elise Brown did a nice review of the literature
       behind the concept. He stated that the concept is if you have a baby that does not have
       any symptoms but there are risk factors on the maternal side, specifically a mom that has
       chorioamnionitis, at what point do you intervene and treat the baby with antibiotics? Of
       course, any baby that is symptomatic is definitely treated but what about those without
       symptoms? The problem is that most babies do not have symptoms so we are then stuck
       with what to do with the infants that have a maternal risk factor but otherwise might be
       well. To define the problem, Dr. Horst said: What is the real risk to the baby with no
       symptoms? One of the reasons it is such a sticky problem is because there is no way to
       agree on the amount of risk. The full summary of Dr. Horst’s presentation can be found
       on the Council’s website at www.coloradoperinatalcarecouncil.com.
IV.    Colorado Perinatal Collaborative Possibilities: NCABSI Data Summary Update:
       Preliminary Colorado and National Data: Edward F. Donovan, M.D., Ohio Perinatal
       Quality Collaborative: Alfonso Pantoja, M.D., NCABSI State Leader for Colorado,
       CPCC Quality Collaborative Coordinator: Dr. Donovan began by saying that his focus is
       statewide, collaborative quality improvement with the focus on the population of all of
       Colorado. There are approximately 65,000 births to Colorado residents annually. Dr.
       Donovan wanted to look at the questions of what does it look like when you look at birth
       certificates in terms of the health of mothers and babies in Colorado? However, he also
       wanted to look at the limitations and potential benefits for using birth certificates for
       possible population based improvement. There are approximately 100 preterm births per
       week in Colorado for a prematurity rate of around 8%. He feels that roughly 50% of
       these births are preventable. He pointed out that we have not made much progress in
       preventing prematurity in Colorado in the last 12 years. Two points Dr. Donovan made
       were (1) More and more regulatory areas are looking at public birth records and (2) If
       there is interest in collaborative quality improvement at the population level, we need to
       improve the accuracy on birth certificates. He then looked at what it takes to build a
       successful, statewide, perinatal improvement collaborative. He stressed that you need
       well-connected committed, clinical leadership in both OB and pediatrics with at least
       25% effort for physician leaders. You need a population based rapid response data
       system and access to 1-2 years of baseline data. You need involvement of key state
       agencies and professional organizations and integration of community and academic
       providers. In conclusion, you must be open to the idea of transparent sharing of results.
       Dr. Donovan’s presentation with chart information will be available at the Council’s
     Dr. Pantoja (Paco) began by saying we were talking about large populations and quality
     improvement for situations that affect a large number of babies. Now, he is addressing a
     smaller population. There are 650-700 VLBW infants born in Colorado annually. 60-70
     infants have nosocomial infections and 3-4 die every year. He then stated that there was
     a project started last September through the Hospital Association and a grant using the
     data base from the University of North Carolina and work they had done. They began
     enrolling NICUs throughout the United States and in Colorado. Up to this point, they
     have over 100 NICUS doing the same thing. He emphasized that is an incredible amount
     of collaborative work. 77 have submitted data and they had 41,456 line days reported.
     He emphasized that this is a tremendous amount of information. He reported that the
     number of days between infections in Colorado has increased. He discussed CUSP &
     CABSI interventions and looked at why mistakes happen. In a staff safety assessment,
     the 2 questions asked were: Please describe how you think the next patient in your unit
     will be harmed, and please describe what you think can be done to prevent or minimize
     this harm. He pointed out that communication is the key. For the summary of Dr.
     Pantoja’s presentation, please refer to NCABSI Data Summary Update, Colorado and
     National, March 2012 at the Council’s website at:
V.   The meeting was adjourned. The next Council meeting is scheduled for Friday, June 1,
     2012 at Memorial Hospital North in Colorado Springs. The meeting will be from 9:00
     AM – 12:00 Noon.

                                                 Jan Goldberg
                                                 CPCC Coordinator

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