Purpose for the program: The Trinity Health Perinatal Patient Safety Initiative (PPSI) was launched in March 2009 in order to improve safety for mothers and babies.  Trinity Health is a large Catholic health system with 25 hospitals that provide obstetrical services with annual births ranging from 50 to 8,500.  The total number of deliveries for Trinity Health in FY 2010 was 38,656 which is approximately 1% of the nation’s deliveries.  Nationally, one of the most frequent allegations in perinatal malpractice claims is delayed diagnosis of an indeterminate/abnormal fetal heart rate tracing.  An analysis of Trinity’s claims data revealed similar findings.  A primary focus for the PPSI is Electronic Fetal Monitoring (EFM) competency.

Proposed change: In response to claims data and findings from on-site assessments by national experts at each hospital, the PPSI Steering Team adopted the National Institute of Child Health and Human Development (NICHD) terminology for EFM and a plan calling for over 1500 clinicians who interpret fetal monitoring tracings to obtain EFM certification by the National Certification Corporation (NCC).

Implementation, outcomes and evaluation:

To prepare clinicians for the certification examination, Trinity Health was awarded a grant in the amount of $1,170,500 to fund EFM education and the cost associated with each clinician taking the NCC certification examination.  Thirteen 6-hour EFM review courses presented by a national expert were scheduled at seven different locations.  The same course was also presented as three 2-hour webinars and recorded for clinician access on the Trinity intranet.  Additionally, an on-line course in Advance Fetal Monitoring, an EFM review book and selected readings and books related to EFM were made available to clinicians.

Compliance with the EFM policy requiring EFM certification is tied to a fifteen percent hospital professional liability discount.  A plan for requiring EFM Certification for privileges was developed and communicated.  As of July 2011, over 580 clinicians have taken the EFM certification examination with an 87%  pass rate. Medical record audits are conducted to determine appropriate use of NICHD terminology and recognition of tachysystole and indeterminate/abnormal fetal heart rate patterns with appropriate interventions.  Additionally, data is being collected on the number of newly reported obstetrical incidents/claims per month which will be compared to past performance.

Implications for nursing practice: Adoption of a standardized language in EFM improves communication among clinicians and therefore increases patient safety.  Validation of EFM knowledge and competency has been shown to improve outcomes.

Keywords: Electronic Fetal Monitoring (EFM) Certification