CNS Role In Multidisciplinary Care Planning For An Obstetric Patient With Cardiac Arrythmia

Background: While rare, maternal cardiac arrhythmias can have significant clinical repercussions for both mother and fetus.  Proper preparation is  key to preventing adverse outcomes.  Collaboration of all  potential services that may be involved in care of complex patients can lead to positive patient outcomes.  By remaining an advocate for patient and family centered care, the Clinical Nurse Specialist plays a crucial role in assisting staff, patients, families and medical systems to reach these outcomes.

Case: N.C. presented to the Regional Perinatal Clinic for high risk obstetrical care due to her history of a cardiac arrhythmia during a previous pregnancy.  Care management was ccomplicated  by the inability of staff to review the chart from her previous pregnancy.  During her prenatal course the plan of care was flexible and changed several times.  She was seen as an inpatient for her cardiac arrhythmia, followed by  by cardiology as an outpatient. Care was managed by the maternal fetal medicine specialists who consulted multiple disciplines during prenatal care, included multidisciplinary planning meetings and phone conferences and coordinating delivery plans for the team .

Interventions included multidisciplinary meetings attended by cardiac and perinatal case managers, nurse managers, assistant nurse managers, OB patient placement facilitator, MFM, medical director of labor and delivery, anesthesiologist, and cardiac intensivist. Close monitoring of maternal cardiac status before, during and after delivery was maintained. Constant contact with the patient was available through text messaging to the CNS and facilitated prompt response to patient questions. 

The care coordination that included medical specialists, inpatient and outpatient nursing teams led to a healthy mother and baby at discharge, an improved patient and family experience and decreased confusion during the delivery of care.  Additionally, staff understanding of the role of the CNS in direct patient care, as a nurse educator and as a change agent in the organizational sphere of influence was attained.

Conclusion: Evidence based care and multidisciplinary care planning are central to producing positive patient outcomes in complex obstetrical cases.  The APRN role of CNS has impact in three spheres of influence: patient, staff and organization.

Keywords: cardiac arrythmia; CNS; case manager; multidisciplinary; spheres of influence