Nursing Team Leads Cleveland Clinic Florida Hospitals To Earn Coveted Perinatal Certification

Nurses have an innate ability and desire to identify and solve issues that affect patient care. Continuously seeking ways to improve nursing programs enhances care outcomes, quality, safety, patient experience and other key measures of success.

Perinatal care nurses at Cleveland Clinic Florida’s Tradition Hospital and Martin Health North are no strangers to the benefits of continuous improvement (CI). For several years, these nursing teams have been on a CI journey. And in 2022, they achieved one of their most sought-after goals — earning The Joint Commission’s Perinatal Care (PNC) certification.

The certification signifies that, when perinatal care measures are monitored and adhered to, organizations are more likely to reduce infant/mother mortality rates, maternal/delivery complications and associated costs, unnecessary inductions, prematurity rates and more. Martin Health’s certification applies to the labor and delivery, mother-baby, outpatient, neonatal intensive care unit and home health nursing units at Tradition Hospital and Martin Health North.

“Although certification was for both hospitals, we function as one,” explains Valerie Bell, BSN, RN, CNML, CLC, RNC-OB, Nurse Manager, Ambulatory – Maternal Child Outpatient & Home Care Services, Martin Health. “We have the same policies and standards, and patients receive the same level of care and service at both locations.”

Martin Health is one of only two organizations to earn PNC certification in the state of Florida, one of only 33 to earn it in the U.S., and the first to hold the credential within the Cleveland Clinic system.

“The certification had been a goal of ours for a while,” says Bell. “We wanted to reinforce to our teams that the hard work they were doing put us at the top.”

The road to success

Martin Health nurses started their voluntary PNC certification journey during the COVID-19 pandemic. Beth Hawn, MSN, RNC-NIC, NE-BC, Maternal Child Nursing Director at the time, says the team felt confident pursuing the certification because they knew they had a good program in place.

“It was a thoughtful process — and even though we were taking on one more thing, we were confident we met or exceeded the certification standards,” Hawn says. “The certification was all about quality and safety, and we weren’t going into it trying to figure out how to meet what was required. We were already there. Our CI work set us up for success.”

Martin Health’s perinatal CI effort was first inspired by Hawn’s participation on the health system’s Maternity Morbidity Task Force, which was formed when Martin Health joined Cleveland Clinic in 2019. Comprised of system executives, nurse leaders, physicians and others, the task force was created to focus on quality and safety. After their initial work was complete, the group identified opportunities for improvement across the perinatal care spectrum and was eventually renamed the Florida Perinatal Performance Improvement Committee.

“It’s the most important OB department meeting we have,” Hawn says. “We look at quality and safety indicators every month, and we get a lot of work done. It’s helped us get to where we are today.”

In less than two years, Martin Health perinatal care teams met many committee-outlined improvement goals.

• They implemented region-wide protocols for quantitative blood loss and antepartum management of IV iron infusions.
• They participated in simulation drills with provider colleagues for eclampsia, pre-eclampsia and obstetric hemorrhage.
• They exceeded enterprise Hospital Consumer Assessment of Healthcare Providers and Systems goals in nurse communication and responsiveness, discharging and medication communication.
• They actively educated the community on topics such as safe sleep awareness, pool and water safety, infection prevention and breastfeeding support.
• They worked with groups like the Florida Perinatal Quality Collaborative to bring nulliparous, term, singleton, vertex rates well below the national average.

“Nursing teams should always strive to get better,” Hawn says. “No one is 100% perfect all the time, so you can’t be afraid to admit that you have things to work on. Identify where you need to improve and openly discuss it.”

Step-by-step process

Showcasing the demonstrated performance improvements within the application for PNC certification fell to Bell, who managed the process for Martin Health.

“The first thing you need to do when attempting to earn a certification like this is find someone who is project-oriented and will keep everything (and everyone) on track,” Hawn says.

Bell’s organized plan included the following key components:

• Conduct a gap analysis.
• Assign gap analysis standard ownership and develop an action plan.
• Set expectations for timeline and deliverables.
• Incorporate and educate frontline caregivers.
• Ensure ongoing meetings with core performance improvement teams.
• Assess readiness.
• Hold a mock survey.

“Every step was important, but the gap analysis was imperative,” Bell explains. “You need to take small bites in the beginning and utilize all resources. For example, we often turned to our regulatory department to keep them involved from beginning to end.”

Kick-off meetings were held with all perinatal caregivers early in the process to ensure complete buy-in from the hospital’s clinical teams. Along the way, information was shared via daily huddles and in monthly meetings.

“It was a true multidisciplinary effort,” Bell says. “Frontline staff were heavily involved, helping develop our program philosophy and participating in nearly every step along the way. It fostered great relationships and brought us all closer together during a difficult time.”

She adds, “The fact that we achieved our goal during the COVID-19 pandemic was an incredible accomplishment. Even commission surveyors were impressed that we never lost our footing.”

Contributing to Martin Health’s esteemed designation is its highly unique Fourth Trimester Mother Baby Home Visitation program, where home-care nurses deliver an individualized treatment plan following hospital discharge. All members of the home visitation team hold either a CLC or IBCLC lactation certification.

“Our home visitation program has been around for 33 years, and when we presented it to the surveyors, they were very impressed,” says Bell. “It really sets us apart.”

Hawn, who now serves as Martin Health’s Maternal Child C-ONQC Program Manager, believes there will always be opportunities to learn and improve in healthcare. “The most successful programs are those that continually push to be better,” she says.

Tradition Hospital and Martin Health North have already begun the re-certification process for The Joint Commission’s new advanced PNC certification, which they hope to obtain in 2024. Cleveland Clinic Indian River is also working to earn the accolade.