Birth Center Shift Manager/Charge Nurse "P.R.E.G.N.A.N.T." Rounding

Purpose for the program: Prevention of maternal and infant sentinel events is a major focus in the labor and delivery setting.  Rounding with purpose is a key risk reduction strategy.  "P.R.E.G.N.A.N.T.".  rounding was developed as an acronym to guide the shift manager/charge nurse in implementing purposeful rounding each shift. 

Proposed change: A rounding checklist was developed to guide the shift manager/charge nurse in P.R.E.G.N.A.N.T rounding which is required for each shift and as needed.

Implementation, outcomes and evaluation: The nurse manager and clinical educator chose the word P.R.E.G.N.A.N.T. to use as an acronym to develop a powerpoint presentation that described the elements of purposeful rounding in a labor and delivery setting.  The acronym includes:  Purposeful, Rounding, Expectations, Got Your Back, Notification of Provider, Assessment(maternal and fetal), Necessary Interventions and Timely. Salient points while rounding include, but are not limited to, scanning the room for safety issues, ensuring primary RN is keeping provider updated on maternal and fetal status, review of fetal and maternal surveillance, review of complications, seekign out detalied information from primary nurse, primary nurse sharing information with shift manager/charge nurse, discouraging unsafe or unproductive behaviors, responding quickly to observed fetal decelerations and emergent situations, notification of provider regarding changes in maternal and/ or fetal status, assessment of the maternal and fetal well-being, recognizing what necessary interventions are indicated and taking action in a timely manner to result in positive outcomes.  It was introduced at mandatory staff meetings.  Staff provided input and the checklist was revised prior to the implementation date.  The measurement of Perinatal Adverse outcomes includes Maternal Death, Maternal Admission to ICU, Uterine Rupture and Neonatal Death >2500 grams.  Also, being evaluated is shift manager/charge nurse compliance with rounding on their shift.  The checklist is a way to ensure that the shift manager/charge nurse and staff nurse is communicating changes in patient status (maternal and fetal). 

Implications for nursing practice: This rounding checklist was developed to ensure that the standards of care are being upheld in the care of every intrapartum patient in a labor and delivery setting.  It is used as a template for enhancing communication between all patient care providers (RN, MD, CNM).  It serves as a risk reduction strategy for preventing maternal and infant sentinel events. 

Keywords: rounding, charge nurse, outcomes, quality, safety, error reduction