Purpose of the tool: This tool describes the key perinatal safety elements that support the use of electronic fetal monitoring (EFM). The key safety elements are presented within the framework of the Comprehensive Unit-based Safety Program (CUSP). Who should use this tool: Nurses, physicians, midwives, and labor and delivery (L&D) unit staff responsible for assessment, interpretation, management, communication, and documentation of fetal heart rate patterns and uterine activity observed through EFM. How to use this tool: Review the key perinatal safety elements with L&D leadership and unit staff to determine how the elements will be implemented on your L&D unit. Consider any existing unit procedures, policies, or processes related to the use of EFM to support implementation. Consider existing policies, standing orders, or processes that refer to EFM findings that may need to be updated. Key Perinatal Safety Elements Standardize When Possible (CUSP Science of Safety) Key Perinatal Safety Elements Examples Use standard terminology to describe and document fetal heart rate (FHR) and uterine contraction pattern assessment for all patients who are receiving continuous EFM. The 2008 National Institute for Child Health and Human Development (NICHD) Workshop developed nomenclature that has been adopted by several professional organizations as the standard nomenclature for describing FHR and uterine contraction patterns. Use of the standard NICHD nomenclature for communicating and documenting EFM findings provides a common language for use among providers and staff to decrease variation and provide accurate communication among caregivers. A complete description of an EFM tracing requires a qualitative and quantitative assessment of the following: uterine contractions, baseline FHR, baseline FHR variability, presence of FHR accelerations, periodic or nonperiodic FHR decelerations, and changes in over time. Standardize When Possible (CUSP Science of Safety) (continued) Key Perinatal Safety Elements Examples
Key Perinatal Safety Elements Examples Debrief and analyze near misses and adverse events and the contribution of EFM use, EFM interpretation, and communication of EFM findings Unit can decide its approach to debriefing events on seriousness of event, expertise available, and data monitoring and tracking capabilities. debriefings by clinical team immediately following event using an approach that does not shame or blame individuals. This allows for understanding of what went well, what could have gone better, and what could be done differently next time. with a multidisciplinary team can help the unit learn from defects and sensemaking using the following tools: Discovery form Root cause analysis Eindhoven model Failure mode and effects analysis Probabilistic risk assessment Causal tree worksheet Interdisciplinary case reviews Have a process in place to review severe maternal or neonatal morbidity and mortality events. Unit can decide its approach to reviewing of severe maternal or neonatal morbidity or mortality. This might include an existing medical peer-review process or review by a perinatal safety or quality committee. A sample process and for a committee review are available at the Council on Patient Safety in Women’s Health Care. . Select “Get SMM menu. Share outcomes or process improvements from the informal (debriefing) and formal analysis with staff to achieve transparency and organizational learning. Sites can decide how often, how much, and with whom this information will be shared and whether this is specified in a unit policy or is handled more informally. Simulation (SPPC Program Pillar) Key Perinatal Safety Elements Examples