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Continuous intrapartum electronic fetal monitoring – impact of the introduction of new practices
  1. A Atkins1,
  2. B Ghosh2,
  3. J C Gillham2,
  4. C L Tower1,2
  1. 1University of Manchester, Manchester, UK
  2. 2St Mary's Hospital, Manchester, UK

Abstract

Background Electronic fetal monitoring (EFM) is recommended in high risk pregnancies during labour, aiming to improve perinatal outcome. Previous studies indicate poor interpretation is associated with significant perinatal complications. To reduce the incidence of misinterpretation, three new practices were introduced: the ‘Buddy’ system, a structured sticker to simplify documentation and the ‘Traffic light system’.

Objective To assess whether EFM interpretation, management and documentation have improved following the introduction of new practices.

Methods Eighty postnatal notes were reviewed over 6 weeks (17 May 2010–26 June 2010) on the postnatal ward in a tertiary referral centre, delivering approximately 6000 babies per annum. Documentation from 374 CTGs were analysed and compared with 232 from a previous review in 2008.

Results The new practices resulted in significantly more traces being classified according to NICE guidelines: 91% (342/374) compared to 77% (179/232) in 2008, p value <0.0001, Fisher's Exact Test. In particular, the use of the structured sticker improved classification (270/274) compared to handwritten documentation (73/100), p value <0.0001 Fisher's Exact Test. There was a significant increase in documentation of signatures from 33% (76/232) to 99% (369/374), p value <0.0001 Fisher's Exact Test. Documentation of management plans and fetal blood sample results also improved.

Conclusion The introduction the ‘Buddy System’ and traffic light stickers have significantly improved frequency of EFM classification. This study was not powered to show an improvement in neonatal outcomes in association with this, but these systems may act to reduce errors and documentation failures on the labour ward.

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