Fetal Monitoring for Non Obstetric Surgery and Procedures: Implementation of a Systemwide Approach to Improve Safety
- Discuss what guidelines currently exist to inform whether electronic fetal monitoring should be considered for nonobstetric surgery or procedures, and share a systemwide policy/procedure.
- Describe the variations in fetal heart tracings that may occur as the result of medications used during nonobstetric surgery and procedures, and suggestions to maximize the fetal condition in utero.
- Discuss the role of the obstetric nurse in planning and doing electronic fetal monitoring during nonobstetric surgery and procedures.
Proposed change: Create and implement an evidence based policy/procedure for electronic fetal monitoring during non obstetric surgery and procedures across a large multihospital health system to improve patient safety and reduce risk.
Implementation, outcomes and evaluation: It was identified that wide variation in practice and opinion existed regarding whether or not to perform electronic fetal monitoring for non obstetric surgery and procedures (and also determining what kind of monitoring), particularly at viable gestations. At the start of the project in 2009, there were not clear guidelines from professional organizations regarding this topic, and there was a need for a multidisciplinary process to ensure safety for mothers and babies. A literature search was performed, and input/feedback was obtained from anesthesiologists, obstetricians, perinatologists, emergency department, surgery department, OB care coordinators, and obstetrical RN’s. A particular challenge for this project after creating a policy/procedure was to inform and engage staff and physicians from many areas of the hospital including the emergency department, surgery, and procedural areas. In late 2010, the policy/procedure was approved and an implementation plan created for 10 metro and regional hospitals. Evaluation is ongoing regarding process and outcomes. Staff and physician feedback has been positive for having a clear policy/procedure, and clinical outcomes and safety have already been positively impacted.
Implications for nursing practice: Obstetric nurses are in a unique position to effect safety in the high risk situation of non obstetric surgery during pregnancy by helping to ensure a consistent, intentional approach to maternal and fetal monitoring, especially at viable gestations. The process created for addressing fetal monitoring for non obstetric surgery and procedures could be implemented in any hospital setting.
Keywords: Non obstetric surgery, fetal monitoring, process improvement.
Purpose for the program: To improve safety of mothers undergoing non obstetric surgery or procedures during pregnancy, as well as their babies.
Proposed change: Create and implement an evidence based policy/procedure for electronic fetal monitoring during non obstetric surgery and procedures across a large multihospital health system to improve patient safety and reduce risk.
Implementation, outcomes and evaluation: It was identified that wide variation in practice and opinion existed regarding whether or not to perform electronic fetal monitoring for non obstetric surgery and procedures (and also determining what kind of monitoring), particularly at viable gestations. At the start of the project in 2009, there were not clear guidelines from professional organizations regarding this topic, and there was a need for a multidisciplinary process to ensure safety for mothers and babies. A literature search was performed, and input/feedback was obtained from anesthesiologists, obstetricians, perinatologists, emergency department, surgery department, OB care coordinators, and obstetrical RN’s. A particular challenge for this project after creating a policy/procedure was to inform and engage staff and physicians from many areas of the hospital including the emergency department, surgery, and procedural areas. In late 2010, the policy/procedure was approved and an implementation plan created for 10 metro and regional hospitals. Evaluation is ongoing regarding process and outcomes. Staff and physician feedback has been positive for having a clear policy/procedure, and clinical outcomes and safety have already been positively impacted.
Implications for nursing practice: Obstetric nurses are in a unique position to effect safety in the high risk situation of non obstetric surgery during pregnancy by helping to ensure a consistent, intentional approach to maternal and fetal monitoring, especially at viable gestations. The process created for addressing fetal monitoring for non obstetric surgery and procedures could be implemented in any hospital setting.
Keywords: Non obstetric surgery, fetal monitoring, process improvement.
