Reducing Risk by Standardizing Fetal Monitoring Competence
- Identify one approach to ensure competence in electronic fetal monitoring.
- Illustrate the success of a multi- hospital standardized approach to ensure fetal monitoring competence.
- Discuss the plan to ensure continued competence in electronic fetal monitoring.
Historically, there have been wide variations in interpretation of fetal heart rate (FHR) tracings among obstetrical providers. In 2004, The Joint Commission Sentinel Event Alert #30 highlighted the need to improve communication between care providers and to standardize interpretation of FHR tracings in order to improve outcomes. Our multi-hospital system implemented standardized education and competence validation in electronic fetal monitoring (EFM) for labor and delivery (L&D) nurses in order to improve safety for our mothers and babies.
Proposed change:
Fiscal and quality comparisons were completed on available EFM educational and certification programs. We concluded that the National Certification Corporation (NCC) offered the most economical and highly regarded option- EFM Certification. All L&D nurses would become EFM certified by NCC by the end of 2012 and maintain their certification while employed within our system.
Implementation, outcomes and evaluation:
A timeline was developed for certification testing of the 325 L&D nurses across nine hospitals by the end of 2012. Guidelines for eligibility to take the exam were established: new employees with experience would have one year to become certified, and new employees without experience would have to have at least one year of full time experience in labor and delivery prior to taking the exam. The test is offered 2-3 times per year at rotating hospitals. The costs for certifying, maintenance, and time spent testing are paid by each facility for their individual associates. The clinical nurse specialists and obstetrical educators from across the system created a review course based on the NCC EFM content outline in order to prepare staff for testing. The review course is offered prior to each exam. Two current, relevant texts were identified for review as part of test preparation. The system will also offer continuing education to maintain the certification once obtained.
Outcomes:
In 2009, 105 candidates took the exam, 93 passed, 12 failed (89% pass rate). In 2010 (year to date), 94 candidates have taken the exam, 75 passed, 19 failed (80% pass rate). Overall, the system attained an 84% pass rate.
Evaluation:
Pass rates were compared to the NCC national average: 2008, 71% and 2009 76% (2010 results are not yet available). Our review course and study materials are effective in attaining higher pass results than the national average.
Implications for nursing practice:
By standardizing the competence level of all nurses within a system, consistency in interpretation and communication of EFM tracings will improve, thereby reducing risk and liability.
Keywords: Electronic fetal monitoring, competence, certification
