Projects

At TIPQC Annual Meetings, hospitals and practices select projects for development and pilot testing for future statewide projects.

Current State Wide Projects

OB — Reduce Elective Deliveries Before 39 Weeks

This project is being piloted in Davidson County, under the leadership of Dr. Frank Boehm. Late preterm and near-term infants experience increased neonatal, infant and lifetime morbidity compared to infants born at term. The project is now open for state-wide enrollment.

NICU — Neonatal Abstinence

This project aims to develop a treatment plan to treat Neonatal Abstinence Syndrome (NAS) that will: consistently evaluate the presence and severity of withdrawal symptoms; initiate appropriate non-pharmacological interventions and pharmacotherapy to control symptoms; we can the opioid-dependent infant as quickly as possible while providing good control of withdrawal symptoms.

NICU — Family Involvement Team

The aim of this project is to build greater resources and to develop a statewide qualitative step-wise improvement effort to support families who have children in the NICU.

Breastfeeding Promotion: Delivery and Post-partum

At the 2009 meeting, the Obstetric community voted to develop a project to promote breast milk feeding. A project development group was convened to review Tennessee’s progress toward the Healthy People 2020 goals, identify locally successful strategies to promote breast milk feeding, and develop a project to improve the rates of breast milk feeding across the state. The original project was divided into three components: antenatal, hospital, and post-natal.

NICU — Golden Hour

This project was nominated by The Med and was voted on by the membership to develop for TIPQC, focusing on the first critical hour of life for neonates.

Antenatal Steroids

Tennessee data notes an opportunity for improvement in optimizing the use of maternal antenatal corticosteroids to improve neonatal outcomes.  This project corresponds well with the timing of Perinatal Core Measure 3, which also addresses the administration of antenatal corticosteroids.  A committee is being formed under the leadership of Bobby Howard, MD to build and develop this project for statewide implementation in January 2014.

NICU — Hospital Acquired Infection

The HAI 2.0 Project Kickoff was held on February 24, 2014 with 70 attendees from 11 TN hospitals as well as representatives from other state collaboratives, and additional stakeholders. Phase 2 project was voted to be developed under the leadership of Esmond Arrindell, MD and Beverly Reed, RN.  For an application and the tool kit,  please contact the TIPQC office.

Projects Being Piloted

For these projects, teams of state leaders and pilot hospitals have been developing these projects and a fully implementable change package. These committees are formed from volunteers across the state, and their first task involved reviewing the literature, available guidelines and best practices for testing prior to inclusion in the change package. This group of volunteer subject matter experts will serve as consultants to assist the project teams who are building and testing the interventions on the local level. Volunteers are TIPQC members who can commit time to project development activities and who bring specific expertise in the subject area to the committee.

Projects Being Developed

For these projects, teams of state leaders and pilot hospitals have been developing these projects and a fully implementable change package. These committees are formed from volunteers across the state, and their first task involved reviewing the literature, available guidelines and best practices for testing prior to inclusion in the change package. This group of volunteer subject matter experts will serve as consultants to assist the project teams who are building and testing the interventions on the local level. Volunteers are TIPQC members who can commit time to project development activities and who bring specific expertise in the subject area to the committee.

Maternal Mortality

Tennessee ranks 38th for maternal deaths in the nation, with 11.7 deaths per 100,000 live births. Twenty-one states currently have maternal mortality review committees, but Tennessee does not. This project will first work with the TN legislature to establish a maternal mortality review committee. Once established, data can be collected from reviews of individual cases. The committee with seek to identify patterns in preventable deaths with a goal of reducing and preventing the number of deaths related to pregnancy, birth and the puerperium.

NICU — Human Milk for NICU Infants Project, Phase 2

The membership of TIPQC voted to develop a Phase 2 HM4NICU/ Nutrition Project under the leadership of Dr. Reddy Dhanireddy and Ashley Smith.  The new project will be ready for pilot testing this Summer and statewide spread in the Fall 2013. To volunteer to be a pilot center, please contact the TIPQC office.

View the percentage of VLBW infants (Birthweight < 1500 grams) receiving human milk for their initial enteral feeding in participating NICUs here.

Safe Sleep

The membership of TIPQC voted in 2013 to explore developing the Safe Sleep Project.  The development team/leadership of this project are forming to see if this is an opportunity for improvement in the state.

Projects in Sustainment

NICU — Central Line Associated Blood Stream Infection

Central Line Associated Blood Stream Infections are a recognized source of excess morbidity, mortality, costs, and length of stay. Multiple reports have described successful reduction in CLABSI rates by systematic application of evidence-based practice in the context of a collaborative, multi-center quality improvement project.

NICU — Admission Temperature

This is the first improvement project for neonatology (NICU) which was launched at the Annual Meeting on March 5-6, 2009. Thermal management prior to admission to the NICU is a recognized challenge, especially for sick and premature infants.

NICU — Human Milk for the NICU Infant

Complications associated with initiation of enteral feedings in very low birth weight (VLBW) babies & all NICU babies are a widely recognized source of excess morbidity, mortality, costs, and length of stay in the neonatal intensive care unit. Multiple reports have documented the efficacy of human breast milk in reducing NICU feeding morbidity.

OB — Breastfeeding Promotion

At the 2009 meeting, the Obstetric community voted to develop a project to promote breast milk feeding. A project development group was convened to review Tennessee’s progress toward the Healthy People 2020 goals, identify locally successful strategies to promote breast milk feeding, and develop a project to improve the rates of breast milk feeding across the state.

NICU — Undetected Critical Congenital Heart Disease Registry

Congenital heart disease occurs in 7 to 9 of 1000 live births in the United States. One-fourth of these infants have critical congenital heart disease (CCHD) which is defined as severe and life-threatening disease requiring surgical or catheter intervention in the first year of life.

NICU — Neonatal Follow Up Work

An opportunity exists in Tennessee to expand communication with NICUs across the state who are interested in providing follow-up to their graduates, explore opportunities to improve communication and engagement of primary care providers with resources for high-risk follow up of NICU graduates, and to consider development of a statewide QI project aimed at optimizing high-reliability follow up for high-risk NICU graduates using an ultra-thin data set.