Presentation on theme: "Perinatal HIV Chart Review - Florida"— Presentation transcript:
1 Perinatal HIV Chart Review - Florida Please include the title of your presentation, your full name and affiliations (including your role within the AETC, if applicable).JoNell Potter, PhDRobert Lawrence, MDSheryl Carney, RN
2 Background- Why Did We Do This? Review of cases (missed opportunities) from DOH data;Developed a chart review tool headed by Rivero & Potter;Met with Florida Perinatal Nurse Coordinators at Annual Florida AETC meeting in October 2012 to engage & inform about the process;January 29, 2013: Letter to RPICC Medical Directors from DOH announcing the plan for a quality review of perinatal HIV (9 Centers in Florida);Some sites resistant - no outside reviewers, need IRB approval, no response from some, logistics complicated at some sites (multiple providers).
3 Plan: What We Did & How We Did It Develop & Refine Perinatal Chart Review ToolPilot Tool in S. Florida (WPB, Broward, Miami-Dade)Host a Statewide Summit for Key StakeholdersDOH & AETC to Co-Host: Invite & Engage RPICC Medical Directors & Florida Perinatal Nurse CoordinatorsDOH to Present Data on History of Perinatal HIV in the State and on New Perinatal HIV casesAETC to Present Summary of Findings from South Florida Perinatal Chart ReviewsDevelop a Strategic Plan for the Future
4 Regional Perinatal Intensive Care Centers (RPICC) Centers in Florida Tampa General Hospital - Tampa, FLShands Teaching Hospital - Gainesville, FLShands -Jacksonville - Jacksonville, FLJackson Memorial Hospital, Jackson Health System - Miami, FLSacred Heart Hospital - Pensacola, FLWinnie Palmer Hospital at Arnold Palmer Med. Center - Orlando, FLAll Children’s Hospital - St. Petersburg, FLBayfront Medical Center - St. Petersburg, FLSt. Mary’s Medical Center - West Palm Beach, FLBroward General Medical Center - Ft. Lauderdale, FLMemorial Regional Medical Center - Hollywood, FLLee Memorial Health System - Ft. Myers, FL
5 Significant Findings from Pilot Perinatal Record Reviews Lack of communication and consistent documentation between HIV providers, prenatal providers, L&D providers & pediatric providers;EMRs on different operating systems & not available to all providers across disciplines, clinics & hospitals.
6 From Our Reviews: Specific Guidelines Not Being Followed Vaccinations in pregnancy;Tuberculosis screening;Hepatitis testing – A, C in particular;Accurate history of cART use in previous pregnancies;VL done 2-4 weeks after initiating or changing cART;VL at weeks gestation to guide decisions for delivery mode;Documented resistance testing – prior, current, and in patients with elevated VL despite therapy;Accurate documentation in L&D notes of cART used during pregnancy, last dose (date & time) once admitted to L&D;Documentation of whether the mother received a prescription or the actual medication (ZDV) for the infant before discharge.
7 Significant Findings from Pilot Perinatal Record Reviews Little documentation of appropriate standard counseling of risks associated with cART during pregnancy, the impact of poor adherence & risk to sexual partners/neonates, pre-mastication, & follow-up care for mother & newborn.Gaps in communication regarding pertinent data on mother (VL at/prior to delivery, no PNC, etc.) to create a strategic plan for management in L&D & an emergency consultation to pediatrics for evaluation of risk and “does this baby need more than ZDV?”
8 Problems to be Addressed with Non-Compliance with Guidelines Problem- Inappropriate Management Issues Solution- Engage providers & offer education & training through F/C AETC;Problem-Despite education and training, individual providers not willing to accept intervention/education and/or follow guidelines, placing women & neonates at risk;Solution- How can this be addressed appropriately & by whom?
9 Proposed Ideas for the Future Use of a Perinatal Chart Review Tool- Use as a Quality Measure or use components as individual- Performance Measures to review practice and improve performanceTracking- Reporting of HIV positive deliveries at time of delivery or earlier- Reporting and Tracking of HIV exposed infants thru DOHData Management / Exchange / Communication- Standard information to be reported- Electronic record and exchange of information overseen by DOHLocal Perinatal HIV Transmission Prevention Team Best Practices Model- Reproduce the model in each area around the state- Adapt the model to specific issues in different locales
10 Perinatal Chart Review Tool Subject #: Reviewer: Review Date:Demographics - SECTION 11. Mother’s Age at 1st Visit2. Race:1. African American/Black2. White3. Asian4. American Indian/Alaska Native5. Native Hawaiian/ Pacific Islander3. Hispanic, Latino, or Spanish Origin? O Yes O No4. Primary Language:_______ Translator O Yes O No