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.