07 Mar

Change of instructor

Free Continuing Education

Register for the last few spots for

tomorrow’s free CE webinar

There are still a couple of spots open for tomorrow’s free online continuing education session covering uterine activity management.

Unfortunately, Rebecca Cypher, MSN, PNNP, PeriGen’s Chief Nursing Officer, originally scheduled to present tomorrow’s CE webinar, will not be able to make it.  Michelle Flowers R, an AWHONN-certified continuing education instructor, will be leading the session instead supported by Dr. Emily Hamilton, PeriGen’s Senior Vice President of Clinical Research.  They will be covering the nomenclature and definitions related to uterine activity, the etiology of uterine tachysystole (UT) and UT’s impact on FHR.

Registration is required.  Click here

27 Feb

MEWS…MEWT…MEOWS

PeriNews, PeriGen's take on what matters in obstetrics
The “cat’s whiskers” behind a

key concept of obstetrical safety

by Emily Hamilton, MD CM

No, we have not taken to caring for cats or declining Latin verbs. Yes, we are “over the top” on the concepts behind these acronyms and their contributions to obstetrical safety. MEWS1,MEWT2, MEOWS3 refer to examples of Maternal Early Warning Systems that operate in addition to usual clinical care. They have been proposed to facilitate timely recognition, diagnosis and treatment of patients developing critical illness. This assistance is relevant today because delayed recognition and intervention remain contributory factors in about half of births with maternal deaths or neonatal encephalopathy.4, 5

MEWS, MEWT and MEOWS are scoring systems based on a short checklist of key criteria, Maternal Early Warning Systemprimarily vital signs. Some variants add factors such as persistence, level of consciousness, urine output, lab tests or fetal condition. Some use color coding or weighting for different levels of abnormality. Important characteristics of successful warning systems are:

  1. Assessments are routine and repeated periodically, e.g. on admission and at frequent intervals
  2. Specific scores are tied to specific actions e.g. physician assessment, calling a rapid response team or initiating a specific investigation or therapy.

In obstetrics, early warning scores on ICU admission were strongly related to maternal mortality.6 A large “Before and After” study in the US found very significant reductions in severe maternal morbidity in the group where an early warning system was implemented and no changes in these rates in the control group without a warning system.7 A survey of 130 maternity units in 2013 in the UK indicated that 100% had implemented a formal early warning system, up from 19% in 2007.8

We are still learning the impact of Early Warning Systems in obstetrics and how to optimize them to improve efficiency. Nursing effort and alarm fatigue are important considerations.

But wait…. software could reduce that nursing effort by using information already recorded in the electronic medical record. In addition it could track how often and how early a particular trigger appears. We could use statistical techniques to determine exactly what clusters of parameters are most useful.

Stay tuned … the best is yet to come. Look for more information on this topic later this year.

References
1 Mhyre JM, DʼOria R, Hameed AB, Lappen JR, Holley SL, Hunter SK, Jones RL, King JC, DʼAlton ME. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol. 2014 Oct;124(4):782-6.

2 Hedriana HL, Wiesner S, Downs BG, Pelletreau B, Shields LE.
Baseline assessment of a hospital-specific early warning trigger system for reducing maternal morbidity. Int J Gynaecol Obstet. 2016 Mar;132(3):337-41.

3 Singh S , McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia. 2012 Jan;67(1):12-8.

4 Main EK, McCain CL, Morton CH, Holtby S, Lawton ES. Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol. 2015 Apr;125(4):938-47.

5 Sadler LC, Farquhar CM, Masson VL, Battin MR. Contributory factors and potentially avoidable neonatal encephalopathy associated with perinatal asphyxia. Am J Obstet Gynecol. 2016 Jun;214(6):747.e1-8.

6 Carle C, Alexander P, Columb M, Johal J. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Anaesthesia. 2013 Apr;68(4):354-67.

7 Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Use of Maternal Early Warning Trigger tool reduces maternal morbidity. Am J Obstet Gynecol. 2016 Apr;214(4):527.e1-6.

8 Isaacs, RA, Wee MYK, Bick DE, et al. (2015) A national survey of obstetric early warning surveys in the United Kingdom: five years on. Anaesthesia2014;69:687-9

24 Feb

The promise of spring

A new, more powerful

fetal surveillance system

Last year, when we announced that PeriGen and WatchChild had joined forces you may have noticed a promise. We indicated that we would be working to bring together the strengths inherent in each system to provide an even more powerful set of fetal surveillance solutions.

That promise wasn’t an empty one. This spring we will introduce you to an array of modules designed to incorporate the best of both PeriCALM and WatchChild. A system that incorporates your suggestions and ideas for solving your biggest clinical, integration, and technical challenges.

We can’t wait and we hope you’ll stay tuned for the big announcement this spring. In the meantime, don’t hesitate to contact your PeriGen Client Executive or visit the PeriGen website for ongoing updates.

24 Feb

Coming soon! PeriGen’s EFM Scholarship Program

PeriNews, PeriGen's take on what matters in obstetrics

One small contribution to

helping clinicians get better

and make more

PeriGen has announced the introduction of a continuing education program for labor & delivery clinicians that includes funding to cover the cost of taking the EFM credentialing exam through The Perinatal Quality Foundation (PQF).

Applications for the program will be available at the AWHONN National Conference in New Orleans and, after the event, on PeriGen’s website.

EFM credentialing is viewed by many labor & delivery professionals as one of the key components of effective obstetric patient safety programs. The PQF exam, developed by both physicians and nurses recognized as EFM experts, tests for knowledge and judgment. The exam is available online and preparation – one of the objectives of PeriGen’s free continuing education modules – is considered key to passing.

For more information on the PQF credentialing exam, click here to access an article in Contemporary OB/GYN or visit the Perinatal Quality Foundation’s website.

24 Feb

An appetite for change & cheesecake

PeriNews, PeriGen's take on what matters in obstetrics
An introduction leads to some important

reminders about standardization

by Matthew Sappern, CEO

A new acquaintance recently reintroduced to me an article authored by Dr. Atul Gawande that piqued my appetite for change – and cheesecake!How healthcare standardization is like the art of making good cheesecake

In “Big Med,” published in the August 13, 2012 issue of The New Yorker Gawande touched on one of my favorite topics – standardization. His lightning bolt came while dining at The Cheesecake Factory. His guests ordered a wide variety of dishes from a seemingly endless menu – the food was uniformly presented and immensely satisfying. So, he went back in to the kitchen and learned how The Cheesecake Factory has struck an effective balance between universally applied standards and the tacit knowledge of the chefs, which I liken to “freedom at the grill.”

Today’s growing “super-regional” health systems are moving to PeriGen because they need to find ways to ensure this balance for the sake of quality care.

It is virtually impossible to ensure consistency in how individual L&D nurses across a health system will assess potentially disturbing trends; that lack of consistency will always limit the efficacy of even the most well-considered protocols. Alternatively, computer systems designed, trained and deployed to vigilantly identify specific patterns that might be of concern lends some control to the effort. The quest for continuous improvement relies on standardization for the baseline. Once potential issues are consistently identified – the clinicians can consider each case. In other words, they can achieve freedom at the grill.

14 Feb

First CE Webinar Scheduled

Rebecca Cypher, PeriGen Chief Nursing OfficerPeriGen Now Offering Online Continuing Education

PeriGen has provided a date for the first in a series of free online continuing education webinars.  The series, featuring Chief Nursing Officer Rebecca Cypher, MSN, PNNP, will offer educational topics related to fetal monitoring, patient safety, and multidisciplinary care in the perinatal setting. Sessions are intended to assist clinicians in translating and incorporating evidence-based information into daily clinical activities.

The first webinar will cover uterine activity and is scheduled for March 8th, noon – 1:00 PM ET.  Titled “Power & Passenger: Understanding Uterine Activity,” this session is designed to examine nomenclature and definitions associated with uterine activity, etiologic principles of uterine tachysystole and tachysystole’s impact on fetal heart rate.

Registration is now open and, since the event is free and awards continuing education hours, is expected to fill fast

08 Feb

Reserve C-Section / NICU Research

cesarean research

Pick up your copy at
AWHONN CA Convention

PeriGen is proud to be supporting this year’s AWHONN California Section Conference, scheduled for February 17th and 18th at the DoubleTree by Hilton at the Berkeley Marina. Rebecca Cypher, PeriGen’s CNO, will be launching the pre-conference with a presentation on “Advanced Monitoring Concepts for Clinical Practice” and also greeting attendees at the PeriGen table.

We’re also offering a limited number of copies of our clinical research team’s latest work, published by Becker’s Hospital Management, “HIT & Clinical Synergy: A decade of decreasing NICU admissions & stabilizing cesarean rates.” This research summary outlines how one system combined leadership commitment, process improvement strategies and advanced technology to lower NICU rates and extraordinary resuscitation and control c-section rates. The work serves as a blueprint for those systems looking to achieve similar results.

To reserve your copy, for pick up at the PeriGen exhibitor table, please complete the form below:

About the research

“HIT & Clinical Synergy: A decade of decreasing NICU admissions & stabilizing cesarean rates” is co-authored by PeriGen’s Clinical Research leader Emily Hamilton. It appeared in Becker’s Hospital Management earlier this year.

The research uses retrospective analysis of 78,000 singleton births from a health system serving Maryland. The research uses a before-and-after comparison to identify factors leading to a statistically significant reduction in three metrics: NICU admissions, the use of newborn resuscitation, and the rate of cesareans.

04 Jan

Words to live by when leading change

Advice from leading IT transformation and change managers

Five key thoughts for those leading changeFive key thoughts for those leading system change

“People who have low psychological ownership in a system and who vigorously resist its implementation can bring a ‘technically best’ system to its knees.”

Nancy M. Lorenzi, PhD & Robert T. Riley, PhD
Managing Change: An Overview
Journal of the Medical Informatics Association

Practical implications of a study on IS change management: “…management should aim to increase the perceived value of change and organizational support for change to reduce user resistance.”

Hee-Woong Kim & Atreyi Kankanhalli
Investigating User Resistance to Information System Implementation: A Status Quo Bias Perspective
MIS Quarterly, Vol. 33, No 3, Sept 2009

“Lead your organization to a successful outcome, and speed up the process by treating your staff as customers first.”

Claire McCarthy, MA & Douglas Eastman, PhD
Change Management Strategies for an
Effective EMR Implementation

“In his article, “Leading Change: Why Transformation Fails,” John Kotter of Harvard Business School lists the major reasons for the failure of large-scale change initiatives (such as HIT systems): lack of a sense of urgency, no strong coalition, lack of a clear vision, missing frequent, clear communication, dis-empowerment of staff, no creation of short-term ‘wins’ to build momentum, and lack of ‘anchors’ for a change culture.”

Gloria L. Austin, Stephen Klasko, MD & William B. Leaver
The Art of Health IT Transformation

“In other words, recognize that you are not done at go-live; you’ve just started achieving technology adoption and changing behavior to get value from your investment.”

David E. Garets, FHIMSS
Change Management Strategies for an
Effective EMR Implementation