Do You See What I See? Using Telemedicine In Obstetrics To Improve Patient Safety
Title: Do You See What I See? Using Telemedicine In Obstetrics To Improve Patient Safety
- Describe how the telemedicine concept can be utilized during remote fetal monitor surveillance to improve obstetrical outcomes
- Identify outcome measures that will determine potential impact on patient safety.
- Discuss the impact of remote fetal monitor surveillance on patient safety outcome measures.
Telemedicine has gained momentum nationally, especially in intensive care settings. Little information is available on remote fetal monitoring. This project aims at testing the use of surveillance fetal heart tracing monitoring using the telemedicine concept. As a result, we will improve birth outcomes, improve patient safety, minimize medical and legal risks and reduce preventable neonatal injuries or death.
Proposed change:
Remote fetal monitoring, with an experienced L&D nurse, will serve as a “second opinion” for bedside clinicians. The use of Telemedicine in the L&D setting is also useful when pregnant patients are admitted to other units, such as the ICU.
Implementation, outcomes and evaluation:
L&D will serve as the pilot for the project. The pilot involves monitoring 20 LDRs and 7 Triage rooms. The use of eCare Mobile Carts (cameras) will be utilized for the visual monitoring of high risk patients. One L&D RN will share space in the eICU and be available 24 hours a day, 7 days a week. Prior to the pilot, data will be obtained on the following outcomes: Babies with arterial cord blood pH ≤ 7.0 or pH 7.01 – 7.09 with base excess ≥ -10.0 with transfer to the NICU; Unanticipated NICU admission; 5 minute APGAR Score ≤ 5. For Category III tracing: time of onset to provider notification, time from notification to decision for C-Section/delivery, time from decision to incision. OBTV Surveillance of all Category II fetal tracings: number of nursing interventions, number of eL&D nurse interventions. Also, management of tachysystole, good catches, response to alerts, staff mentoring and coaching calls, calls to eL&D and differences in clinical interpretation. After implementation of the pilot program, aggregate measures will be reviewed to determine success. A 6 month period of time is necessary in order to determine potential impact on patient safety measures.
Implications for nursing practice:
Through these constant, direct nursing observations and interventions, there will have a positive impact in the number of good catches, significant safety events and fetal outcomes. A supporting goal includes timely and appropriate management of Category III heart rate tracings. It is expected that a decrease from time of onset of this tracing to time of decision to incision will decrease. The pilot program will also be considered successful if either the preventable neonatal injuries or deaths decrease.
Keywords: Patient safety, electronic fetal monitoring, telemedicine,