Failure to rescue as a process measure to evaluate fetal safety during labor.
ABSTRACT To evaluate a perinatal team's clinical responses to the key components of the failure to rescue process.
This retrospective descriptive study involved a review of medical records and their accompanying fetal monitoring strips for 53 women who had a cesarean birth at term for a nonreassuring fetal heart rate pattern. The instrument was the Fetal Safety Failure to Rescue Process Tool based on the Agency for Healthcare Research and Quality's Failure to Rescue Patient Safety Indicator adapted for perinatal care processes. This tool measured four process measures: careful surveillance, timely identification of complications, appropriate interventions, and activating a team response. A mean total score was computed to determine quality of care based on all four of the process measures.
The perinatal team's mean total score was 6.6 (SD = 1.0, range 3-8); the highest possible score was 8. The lowest score was found in the team's response with appropriate interventions (lateral positioning, intravenous fluid bolus, discontinuation of oxytocin, oxygen administration, amnioinfusion, administration of Terbutaline) based on fetal heart rate pattern. Interrater reliability of the tool was 90%.
This study provided information that may be useful in evaluating processes of care to ensure quality care for mothers and babies during labor. The findings formed the basis for implementing unit-specific educational programs, including (a) certification, continuing education, and documented competence in electronic fetal monitoring education to promote consistency in language and understanding of abnormal fetal heart rate patterns; (b) review of appropriate documentation of nonreassuring fetal heart rate patterns; (c) review and revision, if necessary, of established institutional standards and guidelines for appropriate interventions for nonreassuring fetal heart rate patterns; (d) changes in standardized forms to include times for notification of team members and improved communication, and (e) mechanisms for identifying system failures.
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ABSTRACT: Aim To reconceptualize the concept of failure to rescue, distinguishing it from its current scientific usage as a surveillance strategy to recognize physiologic decline. Background Failure to rescue has been consistently defined as a failure to save a patient's life after development of complications. The term however, carries a richer connotation when viewed within a midwifery context. Midwives have historically believed themselves to be the vanguards of normal, physiologic processes, including birth. This philosophy mandates careful consideration of what it means to promote normal birth and the consequences of failure to rescue women from processes which challenge that outcome. Data Sources The Medline, CINAHL, PsycINFO, PubMED, Web of Science and Google Scholar databases were searched from the period of 1992 to 2014 using the key terms of concept analysis, failure-to-rescue, childbirth, midwifery outcomes, obstetrical outcomes, suboptimal care, and patient outcomes. English language reports were used exclusively. The search yielded 45 articles which were reviewed in this paper. Review Method A critical analysis of the published literature was undertaken as a means of determining the adequacy of the concept for midwifery practice and to detail how it relates to other concepts important in development of a conceptual framework promoting normal birth processes. Results Failure to rescue within the context of the midwifery model of care requires robust attention to a midwifery managed setting and surveillance based on a caring presence, patient protection, and midwifery partnership with patient. Conclusion Clarifying the definition of failure to rescue in childbirth and defining its attributes can help inform midwifery providers throughout the world of the ethical importance of considering failure to rescue in clinical practice. Relevance to midwifery care mandates use of failure to rescue as both a process and outcome measure.Midwifery 06/2014; · 1.12 Impact Factor
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ABSTRACT: To reach consensus for words used by nurses to document elements of a perinatal failure to rescue process measurement tool. Exploratory study with mixed methods. Virtual. Participants were recruited through an online perinatal nursing discussion list and completed Internet-based electronic surveys. Twenty-nine (29) labor and delivery nurses with at least 5 years of bedside nursing experience and additional expertise in fetal heart monitoring. Modified Delphi study with three rounds. Qualitative methods were used to analyze study results for round one. Rounds 2 and 3 were analyzed quantitatively with a desired level of consensus of 75%. Twenty-seven of 29 participants completed all three study rounds. Seventy-six distinct data elements related to careful monitoring, timely identification of problems, appropriate intervention, and activation of a team response were defined by consensus. Because classification of maternal and fetal risk determines assessment frequency in labor, specific criteria for classifying a woman or fetus as high risk or low risk were included in the definitions for which participants reached consensus. Achieving consensus about the actual words used to document perinatal nursing elements provides the foundation for incorporating paper-based process measurement tools, such as perinatal failure to rescue (P-FTR) into electronic documentation systems. Standardizing the words perinatal nurses use in documentation facilitates data retrieval and analysis and increases the usefulness of process measurement tools such as perinatal failure to rescue. Further, building process measurement tools into electronic systems may facilitate real-time rather than retrospective recognition of process deficiencies and improve perinatal outcomes.Journal of Obstetric Gynecologic & Neonatal Nursing 01/2014; 43(1):13-24. · 1.03 Impact Factor
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ABSTRACT: Doctor of Nursing Practice (DNP) graduates are expected to contribute to nursing knowledge through empirically based studies and testing the effectiveness of practice approaches that ultimately benefit patients and health care systems. This article describes publication practices of DNP graduates in the scholarly literature. Published studies (2005 to 2012) with at least one author with a DNP degree were identified. The search yielded 300 articles in 59 journals; 175 met the inclusion criteria and were included in this study. A codebook, consisting of 15 major categories, was used to extract relevant information. Original clinical investigations were the most frequent, followed by practice-focused patient and provider studies. The number of studies published in peer-reviewed journals with DNP-prepared authors increased over time. We recommend greater integration of translational science models into DNP curricula to achieve the goal of publishing scholarly products that use evidence to improve either practice or patient outcomes. [J Nurs Educ. 2013;52(x):xxx-xxx.].Journal of Nursing Education 07/2013; · 0.76 Impact Factor