Objective:  The increased focus on patient safety and quality makes it necessary to identify tools that assist the perinatal nursing specialty to measure and modify processes to improve safety and assess quality. Such a tool is perinatal failure to rescue (P-FTR). Prior use of P-FTR in research noted difficulty in locating the tool’s elements in perinatal documentation. Incorporation of P-FTR into electronic documentation systems may improve the ability to retrieve the elements, equate them to corresponding outcomes, and benchmark one facility’s outcomes against another. However, in order to incorporate P-FTR elements into electronic systems, standard (consensus) definitions for the elements are necessary. The purpose of this study was to identify consensus definitions for the elements of P-FTR.

Design:  Because little was known about the topic, this was an exploratory study, using a modified Delphi technique.

Setting: The setting was virtual, with participants completing Delphi study rounds through a series of online surveys. Participants were recruited through an online perinatal nursing discussion list with over 800 active members.

Patients/Participants: Participants included 29 experienced labor and delivery nurses from a variety of practice settings. Experience was defined as at least 5 years current practice in a labor and delivery setting, as well as completion of an AWHONN intermediate or advanced fetal heart monitoring course, work as an AWHONN fetal heart monitoring instructor and/or certification in fetal heart monitoring.

Methods: The initial online survey asked participants to list the words they used to document various P-FTR elements. Also, since fetal monitoring frequency depends on whether the mother or fetus is considered high risk, participants were asked to identify the maternal and/or fetal characteristics that classified a mother or fetus as either high or low risk. Subsequent rounds (2) summarized responses from the previous rounds with the goal to reach at least 75% consensus for each P-FTR element.

Results:  Of the 70 distinct elements of P-FTR, participants reached at least 75% consensus for 66 (94%).

Conclusion/Implications for nursing practice: This study is foundational and supports the need for further research. Study findings may be used to incorporate P-FTR into electronic systems in a standard format, perhaps even using standard, coded nursing terminologies. Standardizing the use of P-FTR may permit easier correlation of P-FTR to patient outcomes and safer perinatal nursing practice. Findings also suggest a framework for determining risk as such risk relates to the frequency of fetal heart monitoring assessment.

Keywords:  research, Delphi studies, failure to rescue, standard terminologies