In 2002 New York State's maternal mortality rate was 12.8 deaths per 100,000 live births, while the rate in New York City was 22.9 per 100,000 live births-both rates exceed the national rate of 8.9 maternal deaths per 100,000 live births and are far above the U.S. Department of Health and Human Service's Healthy People 2010 goal of 3.3 deaths per 100,000.
In response, the New York State Department of Health and the American College of Obstetricians and Gynecologists District II-New York initiated the Safe Motherhood Initiative, which investigated cases of maternal death voluntarily reported by hospitals between August 2003 and June 2005. Each multidisciplinary team included a nurse and examined data from several sources, including medical records, death certificates, and autopsy reports. Teams found that interviews with the clinicians involved in each woman's care gave them the best picture of the events preceding each death, especially in identifying where communication broke down. Maternal death is a rare, catastrophic event, and these professionals welcomed the opportunity to talk about it and make recommendations.
The most common direct causes of maternal death were pulmonary embolism (24%), pregnancy-induced hypertension (24%), hemorrhage (15%), and infection (15%). According to the authors, no one cause was responsible for any particular death.
The Safe Motherhood Initiative's top five recommendations call for
* availability of complete documentation, beginning with prenatal care, including written accounts of discussions between professionals.
* better communication and collaboration among providers.
* greater timeliness and accuracy in the assessment of high-risk patients.
* guidelines and continuing education on appropriate therapies.
* better management of obstetric emergencies, particularly hemorrhage, by developing protocols, conducting drills, and ensuring adequate availability of blood-replacement products.
The rate is probably even higher because of the underreporting of maternal deaths in New York State, the incomplete medical records and death certificates, a lack of autopsy reports, and clinicians' fears that reporting the deaths might violate confidentiality. The need for complete, nonpunitive reporting of maternal deaths is clear. Such information is crucial to implementing changes to legislation and policy that will lower the rate of maternal deaths in the state. Read the report at http://mail.ny.acog.org/website/SafeMotherhoodrev.pdf.
Mennick, BSN, RN
NewsCAP
The shortage of nursing faculty has not abated; in fact, it's worse. A report released in July by the National League for Nursing, Nurse Educators 2006: A Report of the Faculty Census Survey of RN and Graduate Programs, states that the vacancy rate for budgeted, full-time faculty in baccalaureate and higher-degree programs is 7.9%, representing a 32% increase since 2002. Among associate's degree programs, the vacancy rate is 5.6%, representing a 10% increase since 2002. Less than half of current nursing faculty hold doctorates; in addition, two-thirds are likely to retire within the next five to 15 years. To purchase the report, go to http://www.nln.org/Research/Reports/nurseeducators/index.htm.