Implementing Enterprise-Wide Electronic Fetal Monitoring Certification for All Perinatal Clinicians


Poster Presentation

Purpose for the Program

The Trinity Health Perinatal Patient Safety Initiative was launched in March 2009 to improve safety for mothers and infants. Trinity Health is a large Catholic health system with 25 hospitals that provides obstetric services, with annual births ranging from 50 to 8,500. The total number of deliveries for Trinity Health in 2010 was 38,656, which is approximately 1% of the nation's deliveries. Nationally, one of the most frequent allegations in perinatal malpractice claims is delayed diagnosis of an indeterminate/abnormal fetal heart rate tracing. An analysis of Trinity's claims data revealed similar findings. A primary focus for the Perinatal Patient Safety Initiative is electronic fetal monitoring competency.

Proposed Change

In response to claims data and findings from on-site assessments by national experts at each hospital, the Perinatal Patient Safety Initiative steering team adopted the National Institute of Child Health and Human Development (NICHD) terminology for electronic fetal monitoring and a plan calling for over 1,500 clinicians who interpret fetal monitoring tracings to obtain electronic fetal monitoring certification by the National Certification Corporation.

Implementation, Outcomes, and Evaluation

To prepare clinicians for the certification examination, Trinity Health was awarded a grant in the amount of $1,170,500 to fund electronic fetal monitoring education and the cost associated with each clinician taking the National Certification Corporation certification examination. Thirteen 6-hour electronic fetal monitoring review courses presented by a national expert were scheduled at seven different locations. The same course also was presented as three 2-hour Web-based seminars and recorded for clinician access on the Trinity intranet. Additionally, an online course in advanced fetal monitoring, an electronic fetal monitoring review book, and selected readings and books related to electronic fetal monitoring were made available to clinicians. Adherence to the electronic fetal monitoring policy requiring electronic fetal monitoring certification is tied to a 15% hospital professional liability discount. A plan for requiring electronic fetal monitoring certification for privileges was developed and communicated. As of July 2011, more than 580 clinicians have taken the electronic fetal monitoring certification examination with an 87% pass rate. Medical record audits are conducted to determine appropriate use of NICHD terminology and recognition of tachysystole and indeterminate/abnormal fetal heart rate patterns with appropriate interventions. Additionally, data are being collected on the number of newly reported obstetric incidents/claims per month, which will be compared to past performance.

Implications for Nursing Practice

Adoption of a standardized language in electronic fetal monitoring improves communication among clinicians and, therefore, increases patient safety. Validation of electronic fetal monitoring knowledge and competency has been shown to improve outcomes.