Wednesday, November 10, 2010

Mobile Solutions Improve Teamwork in Labor and Delivery

Labor and delivery is a great example of a clinical care area where mobility makes a huge difference in teamwork and communication.

In the nurse managed labor model, a registered nurse is responsible for recognizing problems, evaluating labor progress, providing hands-on care, and informing the physician or other team members when needed. [1] Nurses are trained to recognize, interpret and evaluate fetal monitoring data. In addition, they are aware of the autonomous interventions that can be instituted prior to calling the physician and the expected outcome of each. When approved interventions within the scope of nursing practice do not yield acceptable results, the nurse immediately notifies the physician or nurse midwife, who then collaborates in development of a plan of care in the best interest of mother and fetus. [2]

A challenging fact in obstetrics is that communication between the nurse and physician occurs as the nurse is providing direct care to the patient while the physician may be away from the bedside - in the office, another part of the hospital, or on call at home. [3]

In the past, nurses endeavored to describe the concerning fetal tracing via telephone, often a subjective assessment, when what they actually need is validation of their visual finding. Physicians had to try to envision what the nurses were seeing. Mobility solutions today can and must provide virtual viewing of data that is incomparable to verbal description alone.
AirStrip OB is an example of this kind of solution. It allows the physician to be in two places at one time and to actually see what the nurse is seeing. This extends the physicians' ability to make critical decisions based on real-time information that leaves no room for error related to verbal interpretation.

We know that prior to this mobility solution, there were delays in collaborative multidisciplinary assessment of patient data and medical management. There was no way to efficiently escalate differences of opinion via the established chain of command, and teamwork breakdowns and patient safety issues ensued. We have learned that when nurses identify a concerning CTG pattern, they notify midwives and/or physicians who can immediately view the CTG pattern on their smartphone and can discuss the treatment plan in a time sensitive fashion. Disagreements can be escalated up the chain of command immediately, regardless of the location of the providers involved. The net results are safer patient care, improved efficiency, and better relationships among clinicians.

References
1. Murray, M.L. & Huelsmann, G.M. (2009). Labor and delivery nursing: a guide to evidence-based practice. New York: Springer Publishing Company.
2. Simpson, K.R., & Knox, G.E. (2006b). Communication of fetal heart monitoring information. In E.F. Feinstein, K. Torgeren, & J. Atterbury (Eds.), Fetal heart monitoring: principles and practices (2nd ed.) Washington, DC: Association of Women’s Health, Obstetric and Neonatal Nursing.
3. Simpson KR, Knox, GE (2003). Adverse perinatal outcomes: Recognizing, understanding & preventing common accidents. Lifelines: Promoting the Health of Women and Newborns, 7(3), 224-235.

2 comments:

  1. Hi Dr. Powell,

    Firstly congrats on Airstrip.
    Also "A health dose of Mobility" what an apt name for a blog.

    Wish you all success, because I truely believe you folks are on the right track when it comes to providing care outside of the Healthcare settings/walls. I also believe this is two ways - either the patient is external to the system or the provider is mobile.

    I am sure images/video transfer though an issue currently, shouldn't be one as Technology advances.

    It's also great to see you folks provides mobility solution to most PDA not just iPhone/iPad!

    Would love to connect with you and see if we have any synergies.
    Suresh
    +1 603-930-9451 (mobile)
    suresh.d.kumar@comcast.net

    ReplyDelete
  2. Thank you for your comment, and you raise a very important point.

    We do see that, in the absence of a clear workflow with a policy and procedure for effective use, some organizations are missing the mark on ensuring that their mobility solutions are timely and targeted, delivered meaningfully, and used judiciously. Overwhelming clinicians with alerts, alarms and information for information's sake is not helpful. Mobile devices are not designed to be used for continuous bedside monitoring. No clinician can possibly deal with 24/7 patient alerts. We have found that the most successful deployments involve these simple best practices for avoiding alarm fatigue, overuse, and misuse of mobility:

    1. Timely activation - When a clinician situation arises that requires the visual assessment or visual data by a physician, an alert is activated. This may be a phone call or an alert.
    2. Targeted notification - The provider accountable for the care of that patient at that time receives the alert and has a predetermined period of time within which to act. Triage protocols work. Integration with the EHR assures the entire team has the accounting of how the mobile intervention played a role in the patient’s care.
    3. Meaningful delivery - Data transformation is essential. Simply displaying the EHR or a pdf of patient data is not helpful. Provide visual cues through artful display of relevant data, access to an evidence base, and links to other resources to help guide better decision-making.
    4. Judicious use - Establish protocols for expected and effective use of mHealth to support existing workflow to ensure the clinical team is making the best use of their time and technology enablers. Get staff feedback and monitor utilization trends. Discuss usage patterns with clinical staff regularly. Modify workflows and policies accordingly. Thank you!

    ReplyDelete