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Maryland Patient Safety Center 3Rs: Risks, Referrals and Readmissions Maternal and Newborn Risks Risks are predictors of post partum adjustments for both mothers and newborns. The MPSC Perinatal & Neonatal Learning Networks developed maternal and newborn risk assessment tools to assist the healthcare provider in screening for these risks/predictors prior to discharge. Maternal and Newborn Risks Maternal Risks •Prescribed high risk medications •Medical Risks •Pregnancy Related Risks Maternal and Newborn Risks Newborn Risks •Apgar scores <4 at 5 min •Birth defect/Genetic syndrome •<1500 gm •Congenital Infection •Late Preterm 34-36 6/7 weeks •Prematurity <34 weeks •Hearing risk/failed hearing •Medical condition Maternal and Newborn Risks Newborn Risks (cont.) •Neurological condition •Metabolic disorder •Positive toxicology •Weight loss >10% at discharge •ROP, IVH/PVL •Gastroesophageal Reflux • Failed CCHD Screen without confirmatory echo •Hyberbilirubinemia •Feeding Problems •History of psychosocial stressors •Hospital Stay <5 days Maternal and Newborn Referrals Maternal •OB/GYN-early post-discharge evaluation •PMD •Appropriate Outpatient Follow-Up •Home visits •WIC •Local Health Department Maternal and Newborn Referrals Newborn •Pediatrician/HCP-early post-discharge evaluation •Appropriate Outpatient Follow-Up •Home visits •WIC •Local Health Department Maternal and Newborn Referrals A special word about Local Health Department Referrals http://phpa.dhmh.maryland.gov/mch/SitePages/postpartum-referral.aspx Guidelines Low birth weight birth ( <1500 gm) NICU admission Teen mother No prenatal care Maternal substance abuse Previous infant death Any other circumstance deemed to be a risk for mother or infant Maternal and Newborn Readmissions <30 Days CMS Hospital Readmission Reduction Program Penalizes hospitals for “greater than expected” readmission rates. Maternal and Newborn Readmissions <30 Days Nationally (AHRQ 2011) Maternal- 4% Newborns- 5% http://www.medicaiddirectors.org/sites/medicaiddirectors.org/files/public/clinical_policy_1.pdf QUESTIONS? See your Perinatal or Neonatal Team Lead OR Contact Bonnie DiPietro, RN, MS, Director of Operations, MPSC at: [email protected] 410-540-5095