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New Hampshire Alliance for Innovation on Maternal Health (AIM) & ERASE Maternal Mortality Projects

For questions or additional information regarding these initiatives, please feel free to contact us: NNEPQIN@hitchcock.org or 603-653-6898

Table of contents

   

Alliance for Innovation on Maternal Health (AIM)

  • National data-driven maternal safety and quality improvement initiative
  • Works to reduce preventable maternal mortality and severe morbidity
  • AIM works to promote respectful care for all birthing persons, and eliminate disparities in perinatal outcomes

AIM aligns national, state and hospital level improvement efforts

  • AIM works with state health departments, Perinatal Quality Collaboratives, hospitals, community-based teams and patient representatives to address the key drivers of maternal mortality and SMM.
  • AIM utilizes patient safety bundles as core building blocks to improve outcomes

AIM uses data to drive improvement strategies

  • Timely data drives hospital and perinatal quality collaborative QI activities
  • Collaboration with state health departments provides data through vital statistics records and all-payer administrative databases
  • AIM defines standard process and outcome measures for members, to increase opportunities for learning

NH AIM FOCUS

New Hampshire AIM Patient Safety Bundles Focus

AIM relies on critical collaborations between State Perinatal Quality Collaboratives (PQCs) and Maternal Mortality Review Committees

New Hampshire AIM will address two core patient safety bundles in 2021

  • Opioid overdose is the leading cause of pregnancy associated death in New Hampshire
  • Maternal and neonatal outcomes in New Hampshire show the same racial and ethnic disparities which exist nationally

NH-AIM has identified five key initiatives to drive reduction in Substance-related Maternal Mortality and SMM in New Hampshire

NH AIM/ERASE Maternal Mortality & Morbidity Webinars: 

FLYER FOR JANUARY – JUNE 2024 NH AIM/ERASE MM WEBINARS: 2024 NH AIM Webinars Flyer_FINAL

ERASE Webinars:

January 12, 2023 Webinar

Slides: 1.12.23 NH AIM ERASE MM Webinar Handout

Recording: January+2023+NH+AIMERASE+Maternal+Mortality+Webinar

March 9, 2023 Webinar

Slides: 3.9.2023 NH AIM Webinar Handout

Recording: March+2023+NH+AIM+ERASE+MM+Webinar

April 13, 2023 Webinar

Slides: NH AIM ERASE MM April 2023 Webinar Handout

Recording: April+NH+AIM+ERASE+Maternal+Mortality+Monthly+Webinar-2023

May 11, 2023 Webinar

Slides:May 2023 NH AIM ERASE Maternal Mortality Handout

Recording: May+2023+NH+AIMERASE+Maternal+Mortality+Monthly+Webinar+-+Naloxboxes

July 18, 2023 Webinar

Slides: July 2023 NH AIM ERASE MM Webinar Handout

Recording: July+NH+AIMERASE+Maternal+Mortality+Webinar+-+Plan+of+Safe+Care-20230713

August 10, 2023 Webinar

Slides: Aug 2023 NH AIM ERASE MM Webinar Handout

Recording: August+2023+NH+AIMERASE+Maternal+Mortality+Webinar+-+Antenatalperipartum+Drug+Testing+Policies

September 14, 2023 Webinar

Slides:  Sept 2023 NH AIM ERASE MM Handout

Recording: Sept 2023 NH AIM Webinar Recording

October 12, 2023 Webinar

Slides:  Oct 2023 NH AIM ERASE MM Handout

Recording: Oct 2023 NH AIM Webinar Recording

November 9, 2023 Webinar

Slides:  Nov 2023 NH AIM ERASE MM Handout

Recording: Nov 2023 NH AIM Webinar Recording

December 14, 2023 Webinar

Slides: Dec 2023 NH AIM Webinar Handout 12.5.23

Recording: Dec 2023 NH AIM Webinar Recording

January 11, 2024 Webinar

Slides: Jan 2024 NH AIM ERASE MM Webinar Handout

Recording: Jan 2024 NH AIM Webinar Recording

ERASE Maternal Mortality

 

 

CDC ERASE Maternal Mortality Project
Enhancing Reviews and Surveillance to Eliminate Maternal Mortality

 

The Maternal & Child Health Division of DHHS is working in partnership with NNEPQIN and other state teams and health systems to align national, state, and hospital level quality improvement efforts.  Together we will utilize AIM’s framework and structure to improve maternal care and outcomes.  The implementation of AIM bundles is central to our work on ERASE MM.

  • This funding directly supports agencies and organizations that coordinate and manage Maternal Mortality Review Committees to identify, review, and characterize maternal deaths; and identify prevention opportunities
  • Facilitate an understanding of the drivers of maternal mortality and complications of pregnancy and better understand the associated disparities.
  • Determine what interventions at patient, provider, facility, system, and community levels will have the most effect.
  • Inform the implementation of initiatives in the right places for families and communities who need them most.

ERASE Webinars:

FLYER FOR JANUARY – JUNE 2024 NH AIM/ERASE MM WEBINARS: 2024 NH AIM Webinars Flyer_FINAL

January 12, 2023 Webinar

Slides: 1.12.23 NH AIM ERASE MM Webinar Handout

Recording: January+2023+NH+AIMERASE+Maternal+Mortality+Webinar

March 9, 2023 Webinar

Slides: 3.9.2023 NH AIM Webinar Handout

Recording: March+2023+NH+AIM+ERASE+MM+Webinar

April 13, 2023 Webinar

Slides: NH AIM ERASE MM April 2023 Webinar Handout

Recording: April+NH+AIM+ERASE+Maternal+Mortality+Monthly+Webinar-2023

May 11, 2023 Webinar

Slides:May 2023 NH AIM ERASE Maternal Mortality Handout

Recording: May+2023+NH+AIMERASE+Maternal+Mortality+Monthly+Webinar+-+Naloxboxes

July 18, 2023 Webinar

Slides: July 2023 NH AIM ERASE MM Webinar Handout

Recording: July+NH+AIMERASE+Maternal+Mortality+Webinar+-+Plan+of+Safe+Care-20230713

August 10, 2023 Webinar

Slides: Aug 2023 NH AIM ERASE MM Webinar Handout

Recording: August+2023+NH+AIMERASE+Maternal+Mortality+Webinar+-+Antenatalperipartum+Drug+Testing+Policies

September 14, 2023 Webinar

Slides:  Sept 2023 NH AIM ERASE MM Handout

Recording: Sept 2023 NH AIM Webinar Recording

October 12, 2023 Webinar

Slides:  Oct 2023 NH AIM ERASE MM Handout

Recording: Oct 2023 NH AIM Webinar Recording

November 9, 2023 Webinar

Slides:  Nov 2023 NH AIM ERASE MM Handout

Recording: Nov 2023 NH AIM Webinar Recording

December 14, 2023 Webinar

Slides: Dec 2023 NH AIM Webinar Handout 12.5.23

Recording: Dec 2023 NH AIM Webinar Recording

January 11, 2024 Webinar

Slides: Jan 2024 NH AIM ERASE MM Webinar Handout

Recording: Jan 2024 NH AIM Webinar Recording

New Hampshire Maternal Mortality Review Process

Link to NH POSC Website Resources: NH Plans of Safe Care check out the Pregnant and Parenting Services and Supports link and map.

NH Review to Action: https://reviewtoaction.org/content/new-hampshire

New Hampshire Maternal Mortality Legislation (Enacted in January 2010, Section 132:29):  NH Maternal Mortality Legislation

To Report a NH Maternal Death: Maternal Mortality Initial Report Letter & Form

2023 Annual MM report to NH DHHS Legislative Oversight Committee:

2023 Annual Report on Maternal Mortality_Revised

2022 Annual MM report to NH DHHS Legislative Oversight Committee:

2022 Annual New Hampshire Report on Maternal Mortality FINAL

2021 Annual MM report to NH DHHS Legislative Oversight Committee:

2021 Annual New Hampshire Report on Maternal Mortality FINAL

2020 Annual MM report to NH DHHS Legislative Oversight Committee:

2020 Annual New Hampshire Report on Maternal Mortality FINAL 10 21 2020

NH MMRC Infographics:

Overview of NH MMRC Infographic 9-27-22 (003)

SUD MM Infographic 9-27-22

Suicide MM Infographic 9-27-22

Cardiac MM Infographic 9-27-22

NH MMRC Recommendations:

2018 Case Recommendations

Recommendations -Women of Childbearing Age:

  • Enhance outreach to homeless individuals, prioritizing access to women’s services
  • Promote standard management of patients with warning signs for substance misuse (ex- early refills), including face to face assessment, screening for presence of substance use disorders, and linkage to SUD treatment services

Recommendations -Prenatal and Post-Partum Care:

  • Provide education to healthcare teams to reduce stigma against people who use substances
  • Develop statewide provider education materials about hazards of co-prescribing benzodiazepines and opioid agonist medications
  • Promote warm handoff from PCP to OB to facilitate engagement in prenatal care

 Recommendations- Education for Providers

  • Introduce assessment of social determinants needs, case management, and linkage to services directly from ED for patients with substance use disorder (SUD)-related complaints
  • Standardize perinatal education for women with OUD about increased risk for overdose after period of abstinence
  • Provide naloxone kits at discharge from inpatient stay; standardize postpartum discharge instructions

Past Recommendations Relevant to 2018 Cases

Recommendations – Pregnant Women with History of Substance Use Disorder:

  • Harm reduction education for all pregnant patients with a substance use disorder
  • Provider education on SHOUT as used in the “Zero Suicide” approach.
  • Social workers/ medical personnel utilize immediate access to treatment for SUD using 211
  • Provider and patient education about benzodiazepine/ opioid interaction.

          Example: Reference information in the Greater Manchester Mental Health brochure

  • Promote use of the Northern New England Perinatal Quality Improvement Network’s (NNEPQIN) Substance Use Guidelines.

          Example: Consider echocardiogram for patients with injection drug related infection

  • Pregnant women who are incarcerated received Medicated Assisted Treatment (MAT)
  • Planning and collaboration between prison and community providers for pregnant patients around post- release treatment transition

Recommendations –Women in Recovery in Postpartum Period

  • Prioritize keeping mother and baby together in safe environment for both, rather than separation/foster placement.
  • Provide access to residential treatment which accepts children as an alternative to separation/foster placement for vulnerable women with complex dual diagnosis
  • Provide access to higher level of care (residential care which accepts children) for women who are struggling with complex co-occurring disorders

Recommendations –Public Education

  • Provide public education re: importance of prenatal care especially for women who use substances
  • Provide public education re: importance of engaging in treatment for SUD for pregnant women

NH Maternal Mortality Review Committee

Member Organization
Alison Palmer Women’s Health OBGYN and Psychiatric-Mental Health Nurse Practitioner
Carol Whitman NH DHHS Perinatal Nurse Coordinator & MMRC Coordinator
Carolyn Nyamasege NH MCH Epidemiologist
Cheri Breyer Public Member with Lived Experience & Recovery Coach/CRSW
Colleen Whatley DH Senior Quality and Safety Specialist & MMRC Recommendations Facilitator
Daisy Goodman CNM & Director of the DH Perinatal Addiction Treatment Program
DaNae Belt Nurse Manager, Labor & Delivery Unit, Elliot Hospital
David Laflamme NNEPQIN, Epidemiologist
Diane Proulx Chair, NH AWHONN & Clinical Quality & Safety at Wentworth Douglass Hospital
Elaine de Mello National Alliance on Mental Illness, NH Chapter, Expert on Suicide
Emily Baker DH Maternal Fetal Medicine Specialist
Erica Tenney NH DHHS Clinical Services Program Administrator
Jess Bacon Chair, NH ACNM & Nursing Practice Specialist Wentworth Douglass Hospital
Jessica Bates NH MCH, DHHS, Administrative Support
Julia Frew DH, Psychiatrist and Addiction Medicine Physician
Kerry Norton Director, Hope on Haven Hill
Kiera Latham New England High Intensity Drug Trafficking Area (HIDTA), Overdose Response Strategist
Kimberly Koschek Perinatal Social Worker, Catholic Medical Center
Kris Hering NH Foundation for Healthy Communities, Vice President of Quality Improvement
Kristen Kraunelis Mental Health Center of Greater Manchester
Kristine Nikitas NH Bureau of Drug and Alcohol Services, NH DHHS
Lauren Lessard Chair of the NH Chapter of ACOG & Obstetrician/ Gynecologist Concord Hospital
Lissa Sirois NH Bureau of Population Health and Community Services, NH DHHS, Interim Bureau Chief, Expert in Nutrition, WIC and Breastfeeding
Margaret Minnock Executive Director DH NNEPQIN
Meagan Smith NH AWHONN Member at Large & Director of Nursing, Speare Memorial Hospital
Pam Doubleday Concord Hospital, Labor and Delivery Nurse
Rhonda Siegel NH MCH, DHHS Maternal and Child Health Section/Title V Director
Suzanne LaMontagne NH Division of Program Quality and Integrity, DHHS Sentinel Review Committee
Tim Fisher DH NNEPQIN Medical Director & Obstetrician/Gynecologist
Victoria Flanagan MMRC Case Abstractor & DH NNEPQIN Director of Operations

For questions or additional information, please feel free to contact us:

NNEPQIN@hitchcock.org or 603-653-6898

Suicide Prevention Resources:

For suicide loss survivors: https://theconnectprogram.org/find-support/coping-with-suicide-loss/ [theconnectprogram.org]

Free training for physicians to talk with families about firearms and safety in the home:

https://shop.aap.org/calm-for-pediatric-providers-counseling-on-access-to-lethal-means-to-prevent-youth-suicide/ [shop.aap.org]

For additional information and support, please contact:

Amy: aoliva@naminh.org

or Elaine: edemello@naminh.org

at NAMI NH: Home – NAMI NH