EFM diagnostic error and miscommunication are major causes of perinatal morbidity and mortality, as well as, malpractice claims. Use of the 2008 NICHD terms and guidelines creates a standardized framework for interpretation while reducing errors and omissions. This course is the first lesson of a 3 part series that applies NICHD principles into critical thinking activities to improve retention of key concepts in EFM interpretation.
This video improves identification and diagnosis of fetal acid-base imbalance via electronic fetal monitoring (EFM). This course is the second lesson of a 3 part series that applies NICHD principles into critical thinking activities to improve retention of key concepts in EFM interpretation and management.
Mismanagement of electronic fetal monitoring (EFM) data may result in permanent neurologic injury and malpractice claims. This course is the third lesson of a 3 part series that evaluates the benefits and risks of individual interventions, applies ACOG intrapartum management algorithms to various case studies, and examines risks associated with EFM mismanagement.
The most frequent OB malpractice allegation, delay in the treatment of fetal distress, involves interpretation and management errors of fetal heart rate patterns (FHR). Category II is the largest category with over 128 various FHR patterns and is the most challenging to manage. This monograph compares the 2013 expert clinical opinion recommendations with the current ACOG guidelines and offers risk management solutions. EFM case studies and critical thinking drills are included to improve clinical decision making and reduce claims in this challenging population.
When interpreting FHR patterns, the presence of decelerations (late, variable, or prolonged) is an abnormal finding. Determining when to intervene once decelerations are observed is difficult. This monograph reviews the past and present science of various deceleration severity scales and offers a simple 60-Rules option to improve clinical decision making. EFM critical thinking drills are included.
Differences in clinical opinions regarding the interpretation of EFM data or other clinical factors between two perinatal practitioners can and will happen. Choosing not to share your clinical opinion when indicated or refusing to take into consideration another’s opinion into a patient’s care plan can increase malpractice risk. This monograph defines and outlines the Chain-of-Authority process; EFM critical thinking drills are included.
Fetal triage is not a new skill but has a significant impact on malpractice claims. Triaging EFM data to establish a course of action for the fetus happens a lot in clinical care. Our monograph provides a resource for perinatal practitioners that provides an EFM Triage model for swift and accurate EFM interpretation when there is no clinical information about the mother or her pregnancy.
Utilization of standardized electronic fetal monitoring (EFM) nomenclature nationwide remains inconsistent between hospital to hospital and practitioner to practitioner. This monograph outlines how to apply standardized EFM nomenclature, 3-Tier FHR Interpretation System and the ACOG intrapartum management algorithms into clinical practice in a case study format. EFM risk management concerns are defined..
Umbilical cord blood sampling is used to determine if the cause of neonatal encephalopathy or cerebral palsy is linked to a peripartum or intrapartum event. Critical values are defined by ACOG & AAP in the second edition of Neonatal Encephalopathy & Neurologic Outcomes (2014). This monograph presents an overview of oxygen delivery, definitions of critical values, and analysis of EFM strips for pH interpretation in a case study format.
Inappropriate, unsafe, or lack of transport when clinically indicated increases medical-legal risk to obstetricians and hospitals. This monograph applies the ACOG & SMFM maternal levels of care and their implications on maternal and/or fetal transport into an electronic fetal monitoring (EFM) case study format.
The over treatment of women with complaints of preterm labor without objective evidence is no longer acceptable and a new care model exists. This monograph applies the ACOG and SMFM PTL management guidelines into an electronic fetal monitoring (EFM) case study format.
Attainment and ongoing maintenance of electronic fetal monitoring (EFM) skills is a requirement of all perinatal practitioners who actively participate in the care of pregnant patients. This video series is divided into six, 30 minute, modules that include didactic discussions on key topics and critical thinking drills that assess the novice learner’s understanding of fundamental EFM skills.
Miscommunication is a primary root cause of perinatal injury and death, as well as, malpractice claims. This monograph outlines miscommunication errors in three EFM case studies; analysis and critical thinking drills are included to improve EFM communication between any two perinatal providers.
Poor interpretation skills can lead to EFM diagnostic inaccuracies that result in over-management, under-management, or mismanagement. This often results from a lack of knowledge regarding NICHD terms and cognitive biases. This monograph evaluates diagnostic error as it applies to EFM interpretation and intervention and the cognitive biases that impact frequency.
New guidelines outlined in the ACOG & AAP Task Force Report on Neonatal Encephalopathy (NE) include scientific updates on specific fetal heart rate patterns, sentinel events, and newborn assessment indicators that may indicate an acute intrapartum hypoxic-ischemic injury that leads to NE or cerebral palsy. This monograph reviews the new guidelines in a case study format to improve application.