Vidant Health is working to bring ongoing fetal monitoring education to all of its birthing facilities. Jennifer Kendrick, the Perinatal Outreach Coordinator and an AWHONN Fetal Monitoring Instructor for Vidant Health, provides email education each month to all labor and delivery staff and providers throughout the Vidant system. Jennifer identifies strips to target specific educational needs, such as tachysystole, abruption and fetal distress, and emails a sample strip along with a case study and a series of questions regarding interpretation and subsequent interventions. When responses are submitted, Jennifer provides corrective guidance as appropriate. Fantastic work by Jennifer and the Vidant system in keeping fetal monitoring education in the forefront of care delivery!
Mission hospital was one of the first PQCNC RPC teams to create a labor algorithm utilizing the criteria found in the ACOG/SMFM CS checklist. Their algorithm was color coded and easy to follow. Through the course of the RPC initiative, Atrium Health built off of Mission’s work and added further detail to their labor algorithm. Atrium Health vetted the algorithm through staff and providers and the final version went live in May 2020. These algorithms are wonderful visual tools to guide decision making in supporting laboring women.
After the last RPC learning session in March 2020 focused on improving knowledge around fetal monitoring, several teams moved to implement different approaches to reviewing monitoring strips with staff and providers. A few teams have begun to review sample fetal monitoring strips at staff meetings while other teams are reviewing strips at shift huddles. The strip review, followed by a brief discussion of the interpretation and interventions to follow, works to ensure that all staff are utilizing appropriate terminology and provides for sharing of ideas about effective ways to respond. Additionally. discussions around appropriate documentation of interventions, both of content and location in the EMR, are important in capturing care provided.
On March 3, 2020 RPC teams gathered face to face for the day to collaborate and brainstorm on how to continue making great strides toward our goal of an overall statewide NTSV cesarean rate of 20% by January 2021. Since the focus over the past year has largely been on following ACOG criteria for failed induction and labor dystocia, the content of the learning session centered on the clinical indication of fetal concern and the impact fetal heart rate (FHR) interpretation has on the decision to perform a surgical birth. Presenters discussed unique educational sessions created for both providers and nurses focused on fetal heart rate interpretation. The sessions were successful in large part due to the short duration of the class to easily fit the busy schedule of obstetricians. Additionally, the unique perspective from a legal nurse expert was part of the discussion as she shared how to minimize risk as a labor nurse when documenting and responding to electronic fetal heart rate tracings. Lastly, large group discussions ensued at the end of the day as actual fetal heart rate strips were shared and interpreted along with resuscitative actions that should follow.
The next learning session for the PQCNC AIM RPC initiative is scheduled for March 3, 2020. Presentations will be offered by several of our wise peers who have honed their craft over time. Chris Westveer, a clinical nurse specialist from Atrium Cabarrus, will be sharing a fetal monitoring update class for providers, Mona Ketner, a legal nurse consultant and nurse educator from Northwest AHEC, will share some legal insights on fetal monitoring and Heather Talley, the Nurse Manager of Labor and Delivery at Duke Regional, will discuss how she has crafted a high level of collaboration between physicians, midwives and nurses to produce outstanding patient outcomes. Dr. Ollendorff will be reviewing RPC data to date and guiding us through the nuances of interpreting and responding to fetal monitoring strips. A day full of collaboration of sharing of wisdom from those who have experienced success.
In order to increase shared decision making between mothers and the medical team, one hospital is extending childbirth education to provider offices. Frieda Norris at CaroMont created a brief class titled “Preparing for Vaginal Birth” that is advertised and conducted at provider offices twice a month. The class gives information for women to consider when preparing for birth and encourages them to register for the more detailed childbirth education classes at CaroMont. Frieda is the friendly face that teaches class at the provider offices and also teaches childbirth education at CaroMont so parents have a familiar contact when attending classes.
Rhonda Lanning DNP, CNM, LCCE, IBCLC, RN from University of North Carolina, Chapel Hill, presented to our PQCNC teams on their success of running a volunteer doula program in October, 2019. This month, she published an evaluation of this volunteer program in the Journal of Obstetric, Gynecologic, & Neonatal Nursing. The article outlines the program and shares how the demand for doulas increased exponentially over a 6-year time-frame. From 2012 to 2018, there was a 315% increase in the number of women supported in an L&D room. The published evaluation of the program underscored the rapid growth of the project, high levels of patient satisfaction with doula care, and nurses noted positive experiences partnering with volunteer doulas. Other PQCNC teams in the state have already begun planning their own volunteer doula program as a result of Rhonda sharing her knowledge and resources aimed at reducing primary cesareans.
The second learning session for the PQCNC AIM Reducing Primary Cesarean delivery initiative was held on October 24, 2019. Gail Tully, the founder of Spinning Babies, was the keynote speaker and provided insight on physiologic labor support. She instructed attendees on positions to support vaginal birth and provided handouts for attendees to take home and share with colleagues.
Amanda Walker, a former NICU parent who experienced a traumatic delivery, shared her experience and provided insights on improvement. Mary Cascio, the Director of Women’s from Mission hospital presented on a new staffing model for labor and delivery units that better allocates resources a times of higher census. Rhonda Lanning shared a pathway and the benefits to implementing a volunteer doula program and Dr. Arthur Ollendorff highlighted multidisciplinary collaborative efforts in performing family centered cesarean deliveries.
See those presentations here
As the North Carolina state leader promoting maternal safety in partnership with the Alliance for Innovation on Maternal Health (AIM), PQCNC is educating teams on best-practice to reduce primary cesarean births. Adhering to the AIM metrics, teams are encouraged to track provider education on the ACOG/SMFM labor management guidelines that include teaching on the Safe Reduction of Primary Cesareans.
Admittedly, tracking education for physicians is not a role many providers have time to commit too. However, one MD did just that in Wilmington, NC. Dr. Jeffery Stinson, the highly engaged physician lead for the PQCNC RPC project at New Hanover Regional Medical Center, took the initiative and created education for their providers focused on evidence provided by The American College of Obstetricians and Gynecologists. Not only did he take the time to create the education, he worked with their internal education department to ensure the education would be mandatory for all providers, including residents, and included a quick post-test to track knowledge and compliance upon completion. By partnering with his nurse leaders to ensure a multi-disciplinary approach is achieved, his commitment and dedication is making a difference in reducing primary cesareans in eastern North Carolina.
As we continue to provide labor support education in every perinatal region across North Carolina, a third class was held in Winston Salem at Novant Forsyth Medical Center. Taught by midwife, Tina Hayes, with assistance from midwives Leigh Anne Smith and Tamara Brothers, nearly 40 nurses were given instruction and advice on how to partner with women to provide labor support to increase vaginal delivery. A highlight of the day was four nurses who previously attended a PQCNC labor support class in Charlotte, NC sharing their experiences of how they recently incorporated support techniques learned during the class. Not only were they successful in achieving vaginal deliveries, they were also able to demonstrate the value of that knowledge to providers who subsequently requested their presence for labor support at additional deliveries. The enthusiasm and feelings of empowerment and gratification demonstrated by the nurses was contagious. Three more labor support classes are scheduled in Raleigh, Wilmington and Asheville, North Carolina.