Purpose for the program: Electronic Fetal Monitoring has recently been the subject of many perinatal patient safety initiatives.  The American College of Obstetricians and Gynecologists (ACOG) released a Practice Bulletin in 2009 addressing EFM terminology updates, interpretation and management. Evidence indicates that fetal monitoring is often a factor in obstetric lawsuits.  A review of the literature also shows that poor communication is a primary factor in sentinel events.  Therefore, our facility initiated a protocol to ensure appropriate interpretation and management of fetal monitor tracings.

Proposed change: The facility instituted a new protocol that all nurses and physicians caring for fetal monitoring patients would be required to pass the National Certification Corporation (NCC) EFM exam. 

Implementation, outcomes and evaluation: The Obstetric Collaborative Team, a group of obstetrician champions, perinatal educators, nurse managers, and quality specialists met to create an implementation plan.  A fetal monitoring expert taught a review course at our facility with physicians and nurses in the same class.  The course was repeated two days in a row to allow as many nurses and physicians as possible to attend.  The review course was also videotaped and offered as a webinar on the facility’s library website. This option was available for those who were unable to attend the live version and/or for review purposes.  The NCC EFM exam was offered immediately after the review course and at various times over the following two week period.  Approximately, 165 nurses and 103 physicians took the exam and 92% have passed to date.  Both nurses and physicians have reported improved collaboration in caring for EFM patients.  In addition, the medical record has shown improved compliance in interpretation and management of fetal tracings in the two months after education and completion of the exam.  Indeterminate/Abnormal EFM tracings were identified 97% of the time, and managed appropriately 92% of the time. 

Implications for nursing practice: Nurses and physicians have an increased responsibility for professional accountability.  Facility requirements include team training drills, collaborative EFM strip reviews, and case studies.  In addition, continuing EFM education is required.  Because of this collaborative approach to fetal monitoring, both nurses and physicians have reported improved confidence in caring for EFM patients, thereby, improving patient safety and maternal/neonatal outcomes.   

Keywords: fetal monitoring, NCC EFM certification