An innovative telemedicine program connects obstetrical nurses with inmates facing difficult pregnancies in Arkansas.  Approximately 6% of incarcerated women are pregnant and many stem from backgrounds that encouraged high-risk behaviors, including drug abuse, smoking, and alcohol use. Traditionally, pregnant inmates are transported for each prenatal visit and procedure to outside providers and hospitals. Through this new initiative, the Arkansas Department of Corrections and the Antenatal & Neonatal Guidelines, Education and Learning System (ANGELS) have partnered to launch a telemedicine program that delivers comprehensive prenatal care for inmates at Arkansas’ Wrightsville Prison. This innovative program extends the expertise of obstetrical nurses at the state’s only academic medical center to provide an innovative blend of training, in-person guidance, remote subspecialty consultation, and around-the-clock triage support.

Implementation followed a series of steps.  First, prison personnel were trained by ANGELS’ nurses to provide basic obstetrical care, routine lab tests, common obstetrical medications, and technical skills in using a telemedicine-based fetal monitor and cervical exam. Next, the prison clinic was launched weekly, as nurse practitioner traveled to the prison site to partner with onsite, prison personnel in administering routine prenatal care.  Utilizing real-time telemedicine, remote obstetrical nurses, Maternal-Fetal Medicine subspecialists, genetic counselors, and other specialists collaborate with prison personnel to consult and review ultrasounds and fetal-monitoring strips.  In support, a 24/7, nurse-staffed call center is available for prison personnel and pregnant inmates to triage pregnancy-related complaints and concerns.  For urgent concerns, the call center facilitates on-the-spot consultation with a chief obstetrical resident to the caller by connecting them through interactive telemedicine. 

Nurses directing the implementation of this project gained valuable lessons learned needed to improve future replication of obstetrical telemedicine programs, as detailed below.      Strict and cumbersome firewalls: Because of the restricted nature of a prison, exchange of information can be difficult using technology lines.  An intensive collaboration between ANGELS and prison technologists worked to alleviate these barriers.      High staff turnover: One series of training sessions is simply not enough, as ongoing training accommodates the high turnover experienced at prisons.  Consistent and frequent obstetrical and technology training is necessary.      Inmate & staff psychologies: Inmates and staff were concerned that their images were being transmitted to areas of the Internet that may be accessible by others, making all parties nervous to participate.  Patient and staff pre-consultation education helps ease these worries, with careful emphasis of telemedicine security and HIPPA rights.

These initial barriers were overcome, and this obstetrical nursing telemedicine program thrived with these strong outcomes to date:       Served 41 pregnant inmates
      Conducted 224 inmates visits
      Facilitated 20 inmate deliveries
      Accepted 133 inmate triage calls
      Coordinated 77 maternal transports to the tertiary care facility

The described innovative obstetrical nurse and prison staff collaboration immediately reduced transports for routine care, saving money for the Department of Corrections.  The high-risk obstetrical care of inmates can be efficiently managed through obstetrical nursing support through telemedicine.  This program increases access to the specialty obstetrical nursing care needed by high-risk pregnant, incarcerated women, better ensuring their future outcomes for mother and baby.