Evans-Jones R, Dorman E, Barry A, Levy C, Parisaei M · Evans-Jones R, Dorman E, Barry A, Levy C,...
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Introduc)on of a Programme of Standardised Training and Competency Assessment in Intrapartum Electronic Fetal Monitoring for mul)disciplinary staff in a high-risk London maternity unit: a Quality Improvement Project Evans-Jones R, Dorman E, Barry A, Levy C, Parisaei M Homerton University Hospital NHS Founda6on Trust Background Con)nuous electronic fetal monitoring (CEFM) with cardiotocography (CTG) is the most reproducible way of screening for fetal hypoxia during labour. Correct interpreta)on of fetal heart rate paNerns and changes in labour enables: • Timely iden)fica)on of babies who are not gePng enough oxygen to enable appropriate ac)on before the occurrence of injury; and • Reassurance about babies who are adequately oxygenated, in order to avoid unnecessary interven)ons. CTG is, however, an operator dependent tool and its efficacy in improving outcomes is dependent on the skill and competence of those employing it. There have been various systems recommended to aid CTG interpreta)on and varia)ons in nomenclature surrounding classifica)on of traces may lead to confusion about the significance of fetal heart rate changes and the ac)on required. Aim To reduce adverse perinatal outcomes by improving the quality of intrapartum CTG monitoring in our unit Objec)ves To develop a package of interven6ons for mul)disciplinary training and competency assessment in CTG interpreta6on; to standardize the way obstetric and midwifery staff analyse and act on CTG traces; and to establish pathways to support and manage staff not mee6ng competency expecta6ons SePng Homerton maternity unit: - 6000 deliveries - Level 3 Neonatal Unit - ‘Amber’ RAG ra)ng - extended PMR 7.04 deaths/ 1000 births (MBRRACE 2015) References: 1. FIGO Consensus Guidelines on intrapartum fetal monitoring 2015. Interna/onal Journal of Gynecology and Obstetrics 131 (2015) 13-24 2. Homerton Univeristy Hospital ‘Competency in Antenatal and Intrapartum fetal monitoring’ guideline 2016 3. Homerton University Hospital ‘Con)nuous electronic fetal monitoring’ guideline 2016 4. MBRRACE-UK Perinatal Mortality Surveillance report UK Perinatal Deaths for births from Jan to Dec 2013. Supplementary report for UK Trusts Interven)ons: 1. Annual mandatory competency assessment 2. Twice-monthly mul)disciplinary training day • Based on FIGO 2015 Consensus guidelines (2015) • Considers CTG changes in the context of fetal physiology during labour • Emphasizes need to consider cause of changes in the fetal heart rate paNern so that appropriate steps can be taken to reverse any factors contribu)ng to the development or evolu)on of hypoxia 3. New local guideline with detailed discussion about fetal physiology, CTG characteris)cs and algorithms to aid assessment and clinical decision-making, as well as clear pathways for referral and escala)on when CTG concerns arise 4. Weekly informal mul)disciplinary lunch)me review of per)nent CTG traces to inform, share learning and monitor adherence to the classifica)on system recommended in the new guideline Impact: Adherence will be assessed formally by annual audit, with robust data collec6on via our K2 Athena system. Maternity dashboard sta6s6cs and MBRRACE perinatal mortality surveillance data will allow us to assess the impact of this project on our perinatal mortality rate.
Transcript of Evans-Jones R, Dorman E, Barry A, Levy C, Parisaei M · Evans-Jones R, Dorman E, Barry A, Levy C,...
Introduc)onofaProgrammeofStandardisedTrainingandCompetencyAssessmentinIntrapartumElectronicFetalMonitoringformul)disciplinarystaffinahigh-riskLondonmaternityunit:aQualityImprovementProject
Evans-JonesR,DormanE,BarryA,LevyC,ParisaeiM
HomertonUniversityHospitalNHSFounda6onTrust
BackgroundCon)nuous electronic fetal monitoring (CEFM) with cardiotocography (CTG) is the most reproducible way ofscreening for fetalhypoxiaduring labour.Correct interpreta)onof fetalheart ratepaNernsandchanges in labourenables:• Timely iden)fica)on of babies who are not gePng enough oxygen to enable appropriate ac)on before the
occurrenceofinjury;and• Reassuranceaboutbabieswhoareadequatelyoxygenated,inordertoavoidunnecessaryinterven)ons.CTG is,however,anoperatordependenttooland itsefficacy in improvingoutcomes isdependentontheskillandcompetenceofthoseemployingit.There have been various systems recommended to aid CTG interpreta)on and varia)ons in nomenclaturesurroundingclassifica)onoftracesmayleadtoconfusionaboutthesignificanceoffetalheartratechangesandtheac)onrequired.
AimToreduceadverseperinataloutcomesbyimprovingthequalityofintrapartumCTGmonitoringinourunit
Objec)vesTodevelopapackageofinterven6onsformul)disciplinarytrainingandcompetencyassessmentinCTGinterpreta6on;tostandardizethewayobstetricandmidwiferystaffanalyseandactonCTGtraces;andtoestablishpathwaystosupportandmanagestaffnotmee6ngcompetencyexpecta6ons
SePngHomertonmaternityunit:-6000deliveries-Level3NeonatalUnit-‘Amber’RAGra)ng-extendedPMR7.04deaths/1000births(MBRRACE2015)
References:1.FIGOConsensusGuidelinesonintrapartumfetalmonitoring2015.Interna/onalJournalofGynecologyandObstetrics131(2015)13-242.HomertonUniveristyHospital‘CompetencyinAntenatalandIntrapartumfetalmonitoring’guideline20163.HomertonUniversityHospital‘Con)nuouselectronicfetalmonitoring’guideline20164.MBRRACE-UKPerinatalMortalitySurveillancereportUKPerinatalDeathsforbirthsfromJantoDec2013.SupplementaryreportforUKTrusts
Interven)ons:1. Annualmandatorycompetencyassessment2. Twice-monthlymul)disciplinarytrainingday
• BasedonFIGO2015Consensusguidelines(2015)• ConsidersCTGchangesinthecontextoffetalphysiologyduringlabour• EmphasizesneedtoconsidercauseofchangesinthefetalheartratepaNernsothatappropriate
stepscanbetakentoreverseanyfactorscontribu)ngtothedevelopmentorevolu)onofhypoxia3. Newlocalguidelinewithdetaileddiscussionaboutfetalphysiology,CTGcharacteris)csandalgorithmsto
aidassessmentandclinicaldecision-making,aswellasclearpathwaysforreferralandescala)onwhenCTGconcernsarise
4. Weeklyinformalmul)disciplinarylunch)mereviewofper)nentCTGtracestoinform,sharelearningandmonitoradherencetotheclassifica)onsystemrecommendedinthenewguideline
Impact:Adherencewillbeassessedformallybyannualaudit,withrobustdatacollec6onviaourK2Athenasystem.Maternitydashboardsta6s6csandMBRRACEperinatalmortalitysurveillancedatawillallowustoassesstheimpactofthisprojectonourperinatalmortalityrate.
