NDPQC Initiatives
The North Dakota Perinatal Quality Collaborative manages a series of healthcare initiatives concerning maternal well-being.
Identifying Severe Hypertension in Pregnancy/Postpartum
The incidences of hypertensive disorders of pregnancy (HDP) and resulting severe maternal morbidities (SMM) have been increasing in recent years in the United States and are considered a significant concern in both North and South Dakota. Hypertensive conditions in pregnancy account for approximately 17% of cases of maternal mortality in the United States. Approximately sixty percent of hypertension related mortalities are preventable and SMMs are preventable if caught and treated appropriately.
Although protocols exist to improve identification and treatment of hypertension in pregnancy and postpartum, their use in North and South Dakota facilities has not been standardized. Increasing patient knowledge of warning signs both during pregnancy and during the postpartum time period, as well as standardizing early follow-up visits for postpartum patients with hypertension or hypertension risks can help to improve timely identification and treatment. Further, inaccurate blood pressure readings can lead to either a delay in diagnosis or misdiagnosis of hypertension in pregnancy.
Please note: this project was part of a larger, grant-funded effort to improve hypertension identification and treatment in pregnant and postpartum American Indian women in North Dakota. This was a primary focus of the NDPQC's work in 2022.
Aim: Improve Identification and Treatment of Severe Hypertension and Preeclampsia in Pregnancy and Postpartum
Proper blood pressure training > NDDoH blood pressure protocol training, followed up with random BP observations using BP checklist
Review current education, update with most recent best practice education > Look into tear pads, providing education in other languages
Review when education is given > Education given at 24 week visit, postpartum handout, and automated MyChart reminder 3 days after discharge
Build in follow-up times in EMR > Add follow-up suggestions to EMR, train all staff on new drop down options
Ensure patients keep follow up appointments > Check for patient attendance at follow-up appointments
Perinatal Mental Health Conditions
According to the North Dakota Maternal Mortality Review Committee data, approximately 33% of all cases of maternal mortality were attributable to mental health conditions. Untreated perinatal mental health conditions can lead to poor adherence to medical care, worsening of pre-existing medical conditions, loss of interpersonal connections and resources, substance abuse, and suicide.
Supporting maternal mental health during pregnancy and postpartum, the NDPQC PMHC project recognizes that a mentally healthy mother is better able to care for their children, resulting in improved family dynamics. The initiative sets ambitious goals, including educating at least 75% of healthcare staff and providers on best practices for screening, diagnosing, and treating PMHC, fostering healthier developmental outcomes.
Aim: Screening, Education and Training Treatment, and Proper Referral Resources Related to PMHC
Screening tool > Develop PMHC Workflow for hospitals and establish screening tools
Education for providers & patient > Stigma and bias in clinical education for physicians and nurses
Development of communication pathways > Patient centered communications strategy using resource mapping for treatment referral
Establish prenatal screening for anxiety and depression > Using recommended screening tool for diagnosis of PMHC
Adaption / development of patient-centered response protocol > Shared decision making and develop care pathways
Initiate pharmacotherapy / psychotherapy > Follow evidence-based response protocol
Respectful maternity care > Provide care that respects patient dignity, privacy, and cultural values
Awareness / education > Racial disparity
Substance Use Disorder (SUD)
By June 2025, participating facilities will improve care for pregnant and postpartum people with substance use disorder (SUD) by increasing early identification and intervention through enhanced screening, comprehensive discharge planning, and promoting non-pharmacologic care for substance-exposed dyads. This will be achieved by implementing evidence-based patient safety bundles, optimizing care coordination between healthcare and community support services, and ensuring respectful, equitable, and supportive care for all patients.
Substance use disorder (SUD) during pregnancy significantly impacts both maternal and infant health outcomes. Recognizing this, the North Dakota Perinatal Quality Collaborative (NDPQC) launched the "Care for Pregnant and Postpartum People with Substance Use Disorder" initiative in 2022. The initiative is designed to improve care for substance-exposed dyads through comprehensive strategies, including targeted education, universal screening, non-pharmacologic care interventions, and collaborative discharge planning that connects patients with community-based resources.
The initiative sets ambitious goals, including educating at least 75% of healthcare staff and providers on best practices for treating substance-exposed dyads, increasing the use of verbal screening for SUD at admission, and ensuring that at least 50% of affected infants and birth parents receive a tailored, comprehensive discharge plan. Additionally, the initiative aims to expand non-pharmacologic care models, such as the Eat Sleep Console (ESC) method, for substance-exposed newborns, fostering healthier developmental outcomes.
By engaging a range of facilities across North Dakota and fostering collaboration with community services, this initiative is building a solid foundation for data-driven improvements, patient-centered care, and long-term support for vulnerable mothers and their infants.
By June 2027, participating NDPQC Facilities Will
- Have at least 75% of staff and providers educated on the identification, care, and treatment of dyads affected by substance use.
- Provide at least 50% of infants and birth parents affected by substance use with a comprehensive discharge plan.
- Increase the number of substance exposed newborns receiving non-pharmacologic care.
- Increase verbal screening for substance use disorder at admission to labor and delivery using validated questionnaire.
Annual Education for All Unit Staff and Providers
- Mandatory reporting laws
- Stigma and bias
- Harm reduction (e.g. naloxone)
- Screening tools
- Transparent, honest, trauma-informed discussions
- Comprehensive discharge planning
Updated Hospital Policies and Procedures
- Pain management during and after labor
- Testing and screening policies consistent with best practice
Have Education for Pregnant and Postpartum People Available
- Substance use disorder (SUDs)
- Naloxone use
- Harm reduction
- Care of the substance exposed newborn
- Relevant community resources
- Engage a care team approach for dyad
- Establish care pathways with providers, including primary care and specialists
- Provide harm reduction counseling
- Standardize use of non-pharmacological interventions for all infants
- Family planning counseling
Promote safe discharge through coordinated care approach
Plans of safe care / discharge plan / coordinated care plan.
Systems and processes that encourage partnership with Families, caregivers, social services, and community resources.
Establish care pathways with Tribal health sites.
Provide education for pregnant and postpartum people
- Substance use disorder (SUDs)
- Naloxone use
- Harm reduction
- Care of the substance exposed newborn