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.