Implementing an Obstetric Triage Nurse Competency Program
Title: Implementing an Obstetric Triage Nurse Competency Program
- Identify the training and requirements necessary for the obstetric triage nurse at U.C. Davis Medical Center, Sacramento.
- Discuss the methods and tools for establishing and validating OB Triage nurse competency at UCDMC.
- Categorize obstetric patients who present to the L&D Triage unit within the framework of the 5-tiered Emergency Severity Index (ESI) acuity system.
The need for a method to validate the competency of the U.C. Davis Medical Center L&D Triage nurses was identified during a visit by the DHHS. Deficiencies in EMTALA compliance were noted in both the Emergency Room and the Labor and Delivery Triage unit, and there was no documentation of training specific to Triage for the L&D nurses. Additionally, the unit lacked a consistent method of assigning acuity as patients presented for care. Our project involved the creation and implementation of both an OB-specific acuity system, and a program to establish and validate the competency of the L&D Triage nurses.
Proposed change:
A multidisciplinary committee was established and tasked with the development of a comprehensive program for the orientation, training, and on-going competency validation of the L&D Triage nurses. The L&D managers of other area hospitals were queried about their Triage Nurse Competency validation tools and methods, and many quickly responded. We worked with the Emergency Room staff to develop an OB acuity system compatible with the program already in use by the ER, the Emergency Severity Index.
The basic education and training requirements for the L&D Triage RN’s were delineated, and some audit tools developed: a Medical Screening Exam Competency Assessment Tool, and an Annual Chart Audit form. A Standardized Procedure for the Medical Screening Exam, performed by the Labor and Delivery Triage nurse, in compliance with EMTALA regulations, was written and approved. A spreadsheet was developed to verify the current status of the training of each of the L&D Triage nurses.
Implementation, outcomes and evaluation:
Core L&D RN’s attended the Emergency Department’s ESI training, and became the trainers for the L&D staff. A Power Point presentation was developed, courses were scheduled, and all L&D Triage staff attended a two-hour training session in the utilization of the newly-developed “Emergency Severity Index for OB.” Each RN was then checked off by one of the trainers in Medical Screening Exam competency, using the aforementioned Competency Validation Tool.
An AWHONN Intermediate Fetal Monitoring Course was scheduled and all OB Triage nurses who had not previously attended were enrolled. The new, 5-tiered OB ESI acuity system was put into practice. These changes have allowed us to more efficiently triage and care for OB patients, and improve documentation of the competency of our OB Triage nurses.
Implications for nursing practice:
The education and on-going competency evaluation of Obstetric Triage nurses should be well-documented. A standardized Medical Screening Exam procedure and OB Acuity system will enable OB Triage nurses to improve patient flow and outcomes.
Keywords: Obstetric triage acuity competency