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Fetal Heart Monitoring (fetal_heart + monitoring)
Selected AbstractsIdealized design of perinatal careJOURNAL OF HEALTHCARE RISK MANAGEMENT, Issue S1 2006Faith McLellan PhD Idealized Design of Perinatal Care is an innovation project based on the principles of reliability science and the Institute for Healthcare Improvement's (IHI's) model for applying these principles to improve care.1 The project builds upon similar processes developed for other clinical arenas in three previous IHI Idealized Design projects. The Idealized Design model focuses on comprehensive redesign to enable a care system to perform substantially better in the future than the best it can do at present. The goal of Idealized Design of Perinatal Care is to achieve a new level of safer, more effective care and to minimize some of the risks identified in medical malpractice cases. The model described in this white paper, Idealized Design of Perinatal Care, represents the Institute for Healthcare Improvement's best current assessment of the components of the safest and most reliable system of perinatal care. The four key components of the model are: 1) the development of reliable clinical processes to manage labor and delivery; 2) the use of principles that improve safety (i.e., preventing, detecting, and mitigating errors); 3) the establishment of prepared and activated care teams that communicate effectively with each other and with mothers and families; and 4) a focus on mother and family as the locus of control during labor and delivery. Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims.2 Two perinatal care "bundles", a group of evidence-based interventions related to a disease or care process that, when executed together, result in better outcomes than when implemented individually , are being tested in this Idealized Design project: the Elective Induction Bundle and the Augmentation Bundle. Experience from the use of bundles in other clinical areas, such as care of the ventilated patient, has shown that reliably applying these evidence-based interventions can dramatically improve outcomes.3 The assumption of this innovation work is that the use of bundles in the delivery of perinatal care will have a similar effect. The authors acknowledge that other organizations have also been working on improving perinatal care through the use of simulation training and teamwork and communication training. IHI's model includes elements of these methods. The Idealized Design of Perinatal Care project has two phases. Sixteen perinatal units from hospitals around the US participated in Phase I, from February to August 2005. The goals of Phase I were identifying changes that would make the most impact on improving perinatal care, selecting elements for each of the bundles, learning how to apply IHI's reliability model to improve processes, and improving the culture within a perinatal unit. This white paper provides detail about the Idealized Design process and examines some of the initial work completed by teams. Phase II, which began in September 2005, expands on this work. This phase focuses particularly on managing second stage labor, including common interpretation of fetal heart monitoring, developing a reliable tool to identify harm, and ensuring that patient preferences are known and honored. [source] Practices and views on fetal heart monitoring: a structured observation and interview studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2006S Altaf Objective, To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design, Qualitative study. Setting, Large teaching hospital in the UK. Sample, Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods, Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures, Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results, All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion, Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. [source] | ||||||||||