Post on 25-Aug-2020
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.