Purpose for Program
Obstetric triage often occurs within the perinatal department as opposed to an emergency room. Women presenting to triage may need immediate intervention or require extensive assessment and specialty consultation. It is crucial for obstetric triage nurses to understand and comply with the regulations from the Emergency Medical Treatment and Active Labor Act (EMTALA). Delays in a timely response, improper follow-up to laboratory tests, or failure to communicate a sense of urgency to the physician can jeopardize maternal–fetal safety and increase the liability risk for the nurse. Also of concern, in 2005 the United States estimated cesarean birth rate was 30.2%. According to the National Health Safety Network, the rate of surgical site infection after cesarean birth ranges from 1.5% to 2.6%.
Having readily available staff, well educated, and skilled in the standards established by the Association of periOperative Registered Nurses presents challenges to many perinatal departments. Implementing the triage/scrub role can simultaneously address two safety/quality challenges in obstetric care: timely and thorough triage of childbearing women and compliance with operating room standards. The following describes one hospital's attempt to meet the challenges of triage and scrub duties with specialized staff education and training.
Implementation, Outcomes, and Evaluation
A department decision was made to improve and revise the nurse's triage/scrub role. Duties included answering all triage phone calls, care for arriving triage patients, and surgical scrub availability for cesarean births. Two senior staff nurses agreed to create a program aimed at educating experienced labor and delivery nurses to the revised role. The educators collaborated with the operating room clinical nurse specialists, staff physicians, and equipment/material representatives. A review of triage literature revealed information on EMTALA, standard of care, and liability risks. The reviewed surgical literature included site preparation, sterile technique, and documentation. Class curriculum was based on evidence from literature review and expert opinion. Multiple teaching methods include slide presentation, demonstrations, videos, and hands-on training of trainees. Competency is documented with written examination and verbal evaluation. Only nurses meeting these requirements could function as a triage/scrub nurse.
Implications for Nursing Practice
The creation of triage/scrub has fostered collaborative practice among nurses, physicians, and midwives. Department guidelines and protocols were created to define roles, outline standards, and streamline triage care. Standing orders were created for common obstetric problems. Utilization of nursing staff and department workflow have improved. Surgical site wound infection rates have decreased. Nurses reported improved confidence of knowledge and skills, increased awareness of liability risks, and overall enhanced job satisfaction.