ASPIRE Obstetric Anesthesia Subcommittee Meeting
February 15, 2023
Agenda
Announcements
December 2022 Meeting recap
PCRC Overview- Mike Mathis, MPOG Director of Research
QI Story: ABX-01 (Bronson Kalamazoo)
Oxytocin Survey Results
PONV Updates
OB Dashboard tutorial
Announcements
OB Subcommittee Meetings:
– May 24, 2023 1pm EST
– November 15, 2023 1pm EST
December Meeting Recap
• Subcommittee voted to exclude Cesarean Deliveries from TEMP-01
data. This change has been implemented: score changes minimal (-2.2-
+5 points).
• Discussed Oxytocin dose ranges at MPOG sites. A survey was sent out to
gather information from sites – will share later in meeting.
• Dr. Ashraf Habib and Nicole Zanolli presented the research project on
placenta accreta
.
Measure Updates
• GA-03-OB – Will likely go live by end of March. The Neuraxial and Obstetric Anesthesia
Type phenotypes need revisions before we make this measure public on dashboards.
• TEMP-01- Cesarean deliveries now excluded from this measure.
TEMP 05 Measure review
• TEMP-05 is the first obstetric-specific
measure due for review in early 2023.
• We are seeking one or two volunteers
from different institutions, to review this
measure and associated normothermia
literature.
• Reviewers name will be listed on the
Measure Spec
• Template form
MPOG Research Overview
OB-related Research Questions Answerable with MPOG:
• Do emergent C-sections tend to follow a diurnal pattern? Are anesthesia practice
patterns for emergent daytime C-sections different from emergent nighttime C-sections?
• Does the decision to use a vasopressor infusion for a C-section, mostly depend on the
patient's blood pressure
, or what hospital the patient went to?
• How is oxytocin dosed and administered during C-sections, and how does this associate
with hypotension, tachycardia, and estimated blood loss?
• Do anesthesiologists who commonly do obstetric anesthesia (e.g. >10% of cases are
obstetric cases) have better obstetric outcomes than anesthesiologists who don’t
?
• How are obstetric patients with advanced cardiac disease (e.g. mWHO Class IV "cardio-
obstetric
" patients) typically managed intraoperatively?
Steps to Developing a Research Proposal
MPOG website -->
Research -->
"
Research Proposal
Process
"
"Tips & Tricks" Research Modules
MPOG website -->
Research -->
"Tips & Tricks
"
Importance of Preparation...
• Before you begin:
– DataDirect Security Checklist and Authorization
– Tips & Tricks Modules
• Determine feasibility:
– Consult your local MPOG Site PI (Research Champion)
– Is question answerable with MPOG data?
– DataDirect for sample size estimates
MPOG Research Consultations
MPOG website -->
Research -->
"Consultation Request"
We're committed to your success...
Quality Improvement Story: ABX 01
Quality Champion: Brad Berndt, MD
OB Champion: Robert Nicholson IV, MD
ACQR: Denise Schwerin, RN
Bronson Kalamazoo
ABX-01
February 15, 2023
Dr. Robert Nicholson, IV
Kalamazoo Anesthesiology
ABX-01
• Collaborative focus
– L&D Nursing
– OB Physicians
– Anesthesia
• Surgeon order sets improved for ease of ordering
• Common antibiotics in Pyxis near L & D OR’s
– Cefazolin
– Clindamycin
– Azithromycin
Antibiotics and C-sections
• Anesthesia staff education
– Administer antibiotics prior to spinal
– Reminders posted in each L&D OR
Scheduled C-Section with Spinal
C-section After Laboring
• L&D nurse start azithromycin in patient room (ruptured/in
labor)
• L&D nurse may also start cefazolin (ex. Urgent case with
epidural in place)
Thank you!
bronsonhealth.com
Oxytocin Survey Results
Oxytocin Survey Results
• Survey was posted to the Basecamp forum to 26 participants on Jan 3
rd
, 2023
• Survey was active for 10 days & received 10 responses.
• Questions focused on oxytocin administration following delivery of neonate: describe
bolus dose ranges and infusion amounts as well as duration of infusions following
labor.
• Asked the group to share policies related to oxytocin administration at their site.
• Requested any additional topics for subcommittee to discuss throughout the year.
Oxytocin Survey Results
Bolus dosage ranged from 1-3 units after
delivery.
One site reported 30 units – ‘wide open,
after cord clamped.’
0
1
2
3
4
5
6
5 units/hr for 6 hours 7.5 units/hr 15 units/hr 20 units/hr 30 units/hr for 1 hr
RESPONSES
Oxytocin Infusion Following Delivery
PACU Rate and Duration
3.72 units/hr for 4 hrs
1
4.8 units/ hr x 2 hours
1
5 units/
hr 1
7.5 units/
hr 1
10
-15 units/hr 1
15 units/hr x 4 hrs
1
30 units over 4 hours
1
30 Unit bag over 30 min
1
30 units/
hr for 1 hr then 3.6 units/hr x 1hr 1
Discussion
• How is success of the infusion measured? Uterine tone grading?
• Is there opportunity to standardize oxytocin infusion rates across sites? Has anyone
experienced adverse effects from oxytocin infusion in their patients?
• Other data the group would be interested in?
Future topics
• Topics the OB Subcommittee would like to discuss in 2023 per January 2023 OB
Subcommittee Survey:
– NPO for labor epidural (not possible with MPOG data)
– Reducing the wet tap rate (not possible with MPOG data)
– Chloroprocaine spinals for short OB procedures (Can send out survey if interested)
– Epidural monitoring and labor analgesia (not possible with MPOG data)
– BMI Stratification across sites
– Transfusion and EBL
*Any other topics or suggestions please reach out to Monica Servin or Nicole Barrios, and we will add
these to our agenda. All suggestions welcome!
Postoperative Nausea and Vomiting (PONV)
ASPIRE Measures
Basecamp Discussion – Jan 2023
• Question posted to Basecamp regarding
data on the use of two agents for
preventing PONV during a cesarean
delivery.
• Question also raised at previous meetings
via chat in Zoom meetings.
• Information presented during February
2022 meeting.
PONV 05
• For cesarean delivery cases only: At least two prophylactic pharmacologic antiemetic agents from different
classes preoperatively or intraoperatively (per SOAP ERAS 2021 guidelines)
• Excludes labor epidurals
• PONV Risk factors not considered for cesarean delivery patients
• Measure time period for cesarean delivery cases: 4 hours before cesarean delivery start time to PACU
Start
(Cesarean conversion cases are determined using the Obstetric Anesthesia Type phenotype value codes 1,
7, & 8)
*1- Conversion (Labor epidural and cesarean delivery combined),
7- Conversion (Cesarean delivery portion),
8- Conversion (Cesarean hysterectomy portion)
Dec 2020- Nov 2021
Quality Dashboard Tutorial
MPOG Quality Dashboard Tutorial
• From the https://mpog.org home screen, select dashboard
login.
• Enter credentials on next page:
– Username: Your institutional email address
– Password: Created by user when account was established – use forgot
password button if needed.
MPOG Dashboard
Once you see the dashboard view, select the dropdown
highlighted above and filter for Obstetric.
Search for a
provider
Dashboard Con’t - Live Demonstration
• The performance metrics for OB cases will be shown on your dashboard.
• You can toggle between dashboard views as you like!
THANK YOU!
Nicole Barrios MHA, BSN-RN
Obstetric Anesthesia Subcommittee Lead
nicbarri@med.umich.edu
Monica Servin, MD
MPOG Obstetric Anesthesia
Subcommittee Chair
monicar@med.umich.edu
GA-03-OB Specification: DRAFT
Description:
Percentage of cesarean delivery cases converted to general anesthesia after epidural
• GA-03b-OB: Percentage of cesarean delivery cases converted to general anesthesia after
combined spinal epidural
Inclusion:
Cesarean delivery cases with epidural anesthesia administered
• GA-03b-OB: Cesarean delivery cases with combined spinal epidural
Exclusion:
• Cesarean Hysterectomies as determined by the “Obstetric Anesthesia Type” Phenotype.
• Non-cesarean delivery cases, including labor epidural only cases
• Cesarean delivery cases without epidural placement (or CSE for GA-03b)
Review of Existing General Anesthesia Measures for Cesarean Delivery
GA-01-OB: Percentage of cesarean delivery cases where GA was used
GA-02-OB: Percentage of cesarean delivery cases where GA was administered
after neuraxial anesthesia
GA-03-OB: Percentage of cesarean delivery cases converted to general anesthesia
after epidural
GA-03b-OB: Percentage of cesarean delivery cases converted to general
anesthesia after combined spinal epidural
