Regional One Health has helped a statewide organization tackle the biggest health threats facing moms and babies, from post-partum hemorrhage to weak lungs in premature newborns. Now, they’re looking to improve care for opioid-addicted women and their infants.
The Tennessee Initiative for Perinatal Quality Care, or TIPQC, uses the shared knowledge of medical professionals to develop projects that improve care statewide.
“That’s why we work so hard on these projects – because we’re a leader,” says Bonnie Miller, a clinical nurse specialist at Regional One Health.
TIPQC recently honored Regional One Health’s team for their work on several of those initiatives. Ramasubbareddy Dhanireddy, MD, Ajay Talati, MD and NICU Nurse Manager Kelley Smith spearhead TIPQC’s neonatology projects at Regional One Health; while Giancarlo Mari, MD, Danielle Tate, MD and Clinical Nurse Specialist Bonnie Miller oversee obstetrical and labor & delivery projects.
Miller said Regional One Health is proud to be part of an organization that has fostered huge strides in care. “We found when we work together and talk to each other, patients have better outcomes,” she said. “We have a collective knowledge, and by breaking down silos we can answer the question, ‘What can we do for the betterment of moms and babies?’”
Smith agrees. “It has improved the relationship between NICUs in the state and within the city,” she said. “We all struggle with the same things, and we all take care of the same patients – but before, we never knew it. Now, we’re building those relationships and learning from each other.”
“We’re building those relationships and learning from each other,” notes NICU Nurse Manager Kelley Smith of Regional One Health’s work with TIPQC.
That is certainly true with TIPQC’s latest project, a partnership with the Tennessee Alliance for Innovation on Maternal Health to address opioid addiction. Many babies born to mothers who abuse opioids suffer from Neonatal Abstinence Syndrome, which causes irritability, poor sleep and eating, diarrhea, etc. as their tiny bodies go through painful withdrawal.
“In Eastern Tennessee, they actually have NICUs just for this,” Smith said. “So they’re light years ahead in terms of experience with getting these babies healthy and out of the hospital quicker.”
And that experience has shown the most successful care is also the most compassionate: Letting moms remain with their babies even after their own discharge. Encouraging cuddling and skin-to-skin contact. Promoting breastfeeding. Involving family and friends as a support system.
Armed with that knowledge and TIPQC’s backing, Miller and Smith hope to answer the question: What does that standard of care look like at Regional One Health?
“We’ll start with moms who are asking for help and who are committed to recovery,” Miller said, nothing obstetricians will connect the women with rehab programs and actively support them in their recovery. “We have to stop looking at it as, ‘She wants to do drugs.’ Addiction is a disorder, and we need to treat patients long-term.”
In the NICU, where NAS cases have increased in recent years, they’ll treat the babies’ symptoms while also finding ways to keep mom and baby together, like private cuddle rooms and rooming-in. They’ll teach moms about breastfeeding as a way to help wean babies off narcotics, and build a cocoon of support: “Whether it’s cousins, aunts, friends – developing that support structure for these particular babies is important, because they need constant care,” Smith said.
TIPQC’s projects related to maternal health have focused on everything from post-partum hemorrhage to contraception.
Smith noted NAS babies usually spend about 30 days in Regional One Health’s NICU. With the TIPQC project, she hopes to see that drop closer to the national average of 17 days.
It will require finding additional physical space to devote to mom-baby bonding, deciding how to finance the new services, educating more nurses to care for NAS infants, etc. All of those things are challenging, but Miller and Smith believe they can make a difference with TIPQC’s backing.
They cited the organization’s strong track record of addressing infant and maternal mortality, an issue felt acutely in Shelby County, where rates are high.
TIPQC has improved outcomes for premature babies thanks to efforts like ensuring all mothers in early labor receive a steroid that strengthens their baby’s lungs.
One of the first projects Regional One Health worked on involved giving women in premature labor steroids to promote lung maturity in their babies. “They knew this worked, but hospitals weren’t doing it,” Miller said. “We aimed to get to 100 percent for women between 24 and 31 weeks of pregnancy, and we’ve been 100 percent every time. Now, all hospitals and emergency rooms in Tennessee have access so they can provide the first injection.”
They also addressed postpartum hemorrhage by requiring doctors to use standard, scientific steps to measure every mother’s blood loss during vaginal birth. “By taking the guesswork out of it, we decreased the risk of a woman hemorrhaging and not realizing it,” Miller said. “An obstetric hemorrhage is a medical emergency. When we call for hemorrhage protocol, everyone gets into gear and starts working very quickly to stop the bleeding and save the mother’s life.”
TIPQC has also helped reduce infant mortality by avoiding elective deliveries before 39 weeks, and improved maternal and infant health through an initiative to provide immediate postpartum long-acting reversible contraception. “By spacing out pregnancies and giving women time to get healthier, they’re having healthier babies,” Miller explained.
Regional One Health has been at the forefront of those projects, as the idea behind TIPQC is for larger systems to gather evidence on what works so smaller systems can adopt the guidelines.
Now, they’ll do the same to assist some of the most vulnerable victims of the opioid crisis. “It’s about not having to reinvent the wheel when it comes to best practices,” Smith said.
“That’s why we work very hard on these projects,” Miller added. “Because we’re a leader.”