Purpose for the Program
The need for a method to validate the competency of the U.C. Davis Medical Center's labor and delivery (L&D) triage nurses was identified during a visit by the United States Department of Health and Human Services (DHHS). Deficiencies in Emergency Medical Treatment and Active Labor Act (EMTALA) compliance were noted in both the emergency room and the L&D triage unit, and there was no documentation of training specific to triage for the L&D nurses. Additionally, the unit lacked a consistent method of assigning acuity as patients presented for care. Our project involved the creation and implementation of both an obstetric (OB)-specific acuity system, and a program to establish and validate the competency of the nurses from the L&D triage unit.
A multidisciplinary committee was established and tasked with the development of a comprehensive program for the orientation, training, and ongoing competency validation of the L&D triage nurses. The L&D managers of other area hospitals were queried about their triage nurse competency validation tools and methods, and many quickly responded. We worked with the emergency room staff to develop an OB acuity system compatible with the Emergency Severity Index (ESI), a program already in use by the emergency room.
The basic education and training requirements for the L&D triage registered nurses (RN) were delineated and some audit tools were developed: a medical screening exam competency assessment tool and an annual chart audit form. A standardized procedure for the medical screening examination, performed by the L&D triage nurse, in compliance with EMTALA regulations, was written and approved. A spreadsheet was developed to verify the current status of the training of each of the L&D triage nurses.
Implementation, Outcomes, and Evaluation
Core L&D RNs attended the emergency department's ESI training and became the trainers for the L&D staff. A PowerPoint presentation was developed, courses were scheduled, and all L&D triage staff attended a 2-hour training session on the use of the newly developed “Emergency Severity Index for OB.” Using the aforementioned competency validation tool, a trainer then tested each RN in his or her competency of a medical screening examination.
An Intermediate Fetal Monitoring course of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) was scheduled. All OB triage nurses who had not previously attended were enrolled. The new, five-tiered OB ESI acuity system was put into practice. These changes have allowed us to more efficiently triage and care for OB patients and improve documentation of the competency of our OB triage nurses.
Implications for Nursing Practice
The education and ongoing competency evaluation of OB triage nurses should be well documented. A standardized medical screening examination procedure and OB acuity system will enable OB triage nurses to improve patient flow and outcomes.