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*

*I have nothing to disclose

*Objectives for OBEWS:

Define OBEWS

Barriers to effective communication

Goals of OBEWS

Overview of criteria for scoring

Identify the benefits of OB EWS

*Objectives for MFTI:

Define triage

Benefits of standardized approach

Explain the use of MFTI

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*

*

Patient

Medical Staff

Nursing

Any Unit Specific

Staff members

Unit Secretary

Scrub Tech

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*Working Conditions

*Resources

*Team Composition

*

OB EWS Goals

Assist the bedside clinician with recognition of critical signs and

symptoms that a patient’s condition may be deteriorating

Increase escalation of patient’s potential worsening condition

Timely attendance to patient’s needs; theoretically reducing the

need for escalation in the emerging condition

*

A method of using routine physiological

measurements to identify maternal patients

who may be at risk for a decline in condition

or potential emergency and provides a

standards assessment and notification process

that prompts healthcare providers when

action is necessary.

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*Question data more effectively

*Respond with purpose and prepare for crisis

*Trigger tools are designed to encourage staff to

question parameters and critically think at the

bedside

*

*Reduction in clinical incidents

*Reduce patient LOS

*Higher Quality of Care

*Improved Outcomes

*Improved Patient Experience

*Lower nurse turnover

*

*Documentation is

required by nursing

staff every 4 hours or

with change in patient

condition regardless of

patient location.

*OBEWS applies to all

pregnant patients up

to 42 days postpartum.

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*Respiratory rate

*Heart rate

*Systolic BP

*Diastolic BP

*Temperature

*Pulse Oximetry

*LOC

*Urine output

*Fetal Heart rate

*Uterine activity

*Bleeding

*History of cesarean

section

*Gestational age

*

*

*Think and act

to the

situation

rather than

react to it.

the objective analysis and

evaluation of an issue in order to

form a judgment

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*Action plan is a guideline for

caring for your patient

*Action plans are NOT to replace

individual patient assessments

*Do NOT ignore the entire

clinical picture

*

*

*Artificial high scores

*Multiple charting systems

*Compliance of timing

*Other tools worth

evaluating

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* Supports safe clinical practice

* Provide opportunity for prompt response to patient score through

critical thinking

* Prevent further deterioration and delay of care

* Develop effective management plans and communicate effectively

* Reduce overall clinical risk

*

*

* RN evaluates patient, FHT

and calls provider

* Instructions/orders by

phone

* 24/7 physician coverage

* Reduced malpractice risk

* RN satisfaction: reduced turnover

* Provider satisfaction

* Patient satisfaction

* Reduced wait times and physician led care.

*

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Obstetric triage is the brief, thorough and

systematic maternal and fetal assessment

performed when a pregnant woman presents for

care to determine priority for full evaluation.

*

*Antenatal transfer is

associated with improved

neonatal outcomes

compared with neonatal

transfers.

EMTALA requirements relative to obstetric care-

1. Qualified medical person must perform an MSE to determine if the patient has a medical emergency; should include health of the women and the fetus.

2. Stabilize and/or transfer where the benefits outweigh the risk of transfer.

3. When necessary arrange transfer; patient may decline after being informed of risk/benefits of transfer.

4. MSE cannot be delayed to inquire about payment.

*No method to provide

consistent feedback to

clinicians compromised

patient safety and quality of

care

*

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*

Standardization decreases risk for

errors

Track priority levels (acuity)

Track flow and length of stay

Assess RN staffing

Tracking quality and patient

satisfaction

Barriers to Implementation of the Maternal Fetal Triage Index

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o Use the first set of vitals

o FHR by auscultation or electronic fetal

monitoring

o Pulse oximetry

o PAY ATTENTION

All vital signs need to be assessed including

temperature. It has been shown that lack of

attention to abnormal vitals have a higher risk of

maternal death from preventable causes.

*

*With Contractions:

Coping is assessed

rather than using the

pain scale

*Pain unrelated to

contractions:

Use pain scale of 0-10

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*Urgency for assessment is based on relevant

history, high risk situations and need for

transfer

*Cervical exam is not included in the MFTI

*MFTI does not alter infectious disease control

processes for triage

*

*Does the woman or fetus have STAT vitals?

*Does mom or fetus require lifesaving intervention?

*Is birth imminent?

*

*Maternal HR <40 or >130

*Apneic

*SpO2 <93%

*SBP ≥ 160 or DBP ≥ 110 or <60/palpable

*No FHR detected by Doppler (unless previously

diagnosed fetal demise

*FHR <110bpm for >60 seconds

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*Urgent or priority 2 vitals?

*Severe pain w/o contractions?

*High risk situation?

*Will mom or newborn require higher level of care?

*

*Abnormal vital signs

oMaternal HR >120 or <50

oTemperature ≥ 101.0F (38.3C), R>26 or <12, SpO2

<95%,

oSBP ≥ 140 or DBP ≥ 90, symptomatic Or <80/40,

repeated

oFHR >160 bpm for > 60 seconds; decelerations

SEVERE PAIN: (no ctx) ≥ 7 on a 0-10 pain scale

*

- UNSTABLE HIGH RISK MEDICAL CONDITIONS

- DIFFICULTY BREATHING

- ALTERED MENTAL STATUS

- SUICIDAL/HOMICIDAL

- <34 weeks c/o detectable, uterine ctx

- <34 weeks c/o SROM/ leaking/spotting

- Active vaginal bleeding

- c/o decreased fetal movement

- Recent trauma

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-≥ 34 weeks with regular ctx, or SROM/leaking

with any of the following:

- HIV +

- Multiple gestation

- Planned, medically indicated cesarean

- Placenta Previa

- Breech or other malpresentation

- Active herpes

*

*Does the woman have priority 3 vital signs?

oTemperature >100.4F (38.0C)

oSBP ≥ 140 or DBP ≥ 90, asymptomatic

OR

*Does the women require prompt attention

*

*Signs of active labor ≥ 34 weeks

*c/o early labor signs and/or complaints of SROM/leaking 34-36.6 weeks

*≥ 34 weeks with regular ctx and HSV lesion

*≥ 34 weeks planned, elective, repeat cesarean w/ regular ctx

*≥ 34 weeks multiple gestation pregnancy with irregular ctx

*Woman is not coping with labor (per the Coping with Labor Algorithm v2©)

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*A complaint that is non urgent

o≥ 37 weeks early labor and/or SROM/leaking

oNon-urgent symptoms: common discomforts,

vaginal discharge, constipation, ligament pain,

nausea, anxiety

*

*Requesting service: NO COMPLAINT

*Scheduled procedure: NO COMPLAINT

oPrescription refills

oOutpatient service

oAny scheduled event formally or informally

NST

Version

Steroids

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*

Executive, administrative and clinical leadership

essential for implementation and sustainability

• Frontline team engagement imperative

• Don’t underestimate technological challenges

• It’s not all black and white

*

References:

1. American Academy of Pediatrics & American College of Obstetricians and Gynecologists

(2012). Guidelines for perinatal care (7th ed.). Washington, DC: Author.

2. American College of Obstetricians and gynecologists (2009). Intrapartum fetal heart rate

monitoring, nomenclature, interpretation and general management principles (ACOG Practice

Bulletin No. 106) Washington, D.C.

3. Association of Women’s Health Obstetric and Neonatal Nurses. (2009). Fetal heart monitoring

principles and practices (4th

ed.) Washington, DC: Author.

4. Cherouny PH, Federico FA, Haraden C, Leavitt Gullo S, Resar R. Idealized Design of Perinatal

Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement;

2005. (Available on www.IHI.org)

5. Clark SL, Belfort MA, Byrum SL, et al. Improved outcomes, fewer cesarean deliveries, and

reduced litigation: results of a new paradigm in patient safety. American Journal of Obstetricians

and gynecologists, 2008;199:105.e1-105.e7.

6. Doyle, J., Kenny, T. H., Burkett, A. M., & von Gruenigen. (2011). A performance improvement

process to tackle tachysystole. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40, 512–

519.

7. Nolan T, Resar R, Haraden C, Griffin FA. Improving the Reliability of Health Care. IHI

Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004. (Available

on www.IHI.org)

8. Merriel, A. Van der Nelson, H., Merriel, S., Bennett, J., Donald, F., Draycott, T., Siassakos, D.

(2015). Idnetifying deteriorating patients through multidisciplinary team training. American

Journal of Medical Quality.

9. Shields, L.E., Wisener, S., Klein, C., Pelletreau, B., and Hedriana, H.L. (2016). Use of maternal

early warning trigger tool reduces maternal morbidity. American Journal of Obstetricians and

Gynecologists, 2(1): 1-6.

10. Thorpe-Gardner, J., Love, N., Wrightson, J., Walsh, S. and Keeling, A. (2006). The value of

modified early warning score in surgical patients: a prospective observational study. Annals of

the Royal college of Surgeons of England, 88(6): 571-575.

11. The National Institute of Child Health and Human Development Workshop Report on Electronic

Fetal Heart Monitoring: Update on Definitions, Interpretation, and Research Guidelines (2008).

American Journal of Obstetricians and gynecologists, 112 (3), 661-666.

12. The National Institute of Child Health and Human Development Workshop Report on Electronic

Fetal Heart Monitoring: Update on Definitions, Interpretation, and Research Guidelines (2008).

Journal of Obstetrics, Gynecology and Neonatal Nursing. 37, 510-515.

13. Carle C1, Alexander P, Columb M, Johal J. 2013 Design and internal validation of an obstetric

early warning score: secondary analysis of the Intensive Care National Audit and Research

Centre Case Mix Programme database. Anaesthesia. Apr;68(4):354-67

14. Quinn AC1, Meek T, Waldmann C. 2016 Obstetric early warning systems to prevent bad

outcome Current Opinion Anaesthesiology. Jun;29(3):268-72.

15. Isaacs RA1, Wee MY, Bick DE, Beake S, Sheppard ZA, Thomas S, Hundley V, Smith GB, van

Teijlingen E, Thomas PW; Members of the Modified Obstetric Early Warning Systems Research

Group. 2014. A national survey of obstetric early warning systems in the United Kingdom: five

years on. Anaesthesia. Jul;69(7):687-92

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References

American college of obstetricians and gynecologists' committee on obstetric practice . (2016). Hospital-based triage of obstetric patients. Committee Opinion No.667. ACOG.

University of Utah College of Nursing and University of Utah Hospital & Clinics.

(n.d.). Birth tools . Retrieved June 29, 2018, from Coping with labor algorithm v2:

http://www.birthtools.org/birthtools/files/ccLibraryFiles/Filename/000000000067/Co

ping_Algorithm.pdf

Ruhl, C., Scheich, B., Onokpise, B., & Bingham, D. (2015). Content Validity Testing of the Maternal Fetal Triage Index. JOGNN, 701-716.