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

03 Nov

How much time on charting

How much time could you save on charting if EFM data automatically went into an annotation and your EHR? How does it compare to how much time you could save if you could access your email, apps, and make calls from your watch.

Find out at the Synova Perinatal Leadership Forum, Booth 13 and, while you’re testing the new PeriCALM export feature, be sure to enter to win a free, modern, elegant Pebble Time Round  smart watch. It talks to your phone just like PeriCALM talks to your EHR.

20 Oct

Two cool systems that talk

Pebble Time Round Smart Watch talks to any type of phoneTwo cool systems that seem to talk to other systems, no matter the brand? The Pebble Time Round Smart Watch and PeriCALM Patterns.

That’s not all they have in common now. To prove that PeriCALM takes some of the hassle out of getting EFM data into your EHR, we’re giving away an elegant Pebble Time Round smart watch to the person at the Synova Perinatal Leadership Forum that can use our new Export Feature to update an annotation the fastest.

Up for it? See us at the Synova Perinatal Leadership Forum  Booth 13.

27 Sep

Telemedicine Branching Out to Smallest Patients

By Matthew Sappern, CEO, PeriGen

Remote communication in obstetricsTelemedicine is getting much attention these days as innovative health systems look to increase operational efficiency and patient satisfaction. Leaders such as Stephen Klasko, MD at Thomas Jefferson University Hospital are mandating telemedicine and this top down approach will surely accelerate adoption.

Telemedicine is quickly moving beyond telestroke and the ICU. At least one major EMR company and one of the nation’s leading health systems – fortunately a PeriGen client – are investing significant resources to bring telemedicine to labor and delivery. Complexity, risk and attrition in the ranks of OBs and MFMs make labor and delivery an ideal service line in which to deploy these technologies. PeriGen’s fetal surveillance platform uses Artificial Intelligence to identify troubling patterns and long-term trends in fetal strips. This real time capability is now at the heart of a telemedicine infrastructure which allows a single OB to be alerted to specific cases – showing patterns identified as the most troubling – across an entire health system.

Telemedicine branching out to smallest patients
As a standalone tool or in concert with the above-mentioned EMR module, telemedicine creates a cost-effective way to leverage valuable clinical resources across an enterprise and help safeguard one of a health system’s most risky and most valuable service lines.

27 Sep

My Post-Summer Research Reading List

In The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex published in the Journal of Physiology, Lear et al have written a highly readable and methodical analysis of current evidence about the mechanisms of fetal heart rate decelerations. This is a must read for anyone seriously using fetal monitoring. He challenges long held tenets and presents a simplified coherent approach to the interpretation of heart rate monitoring. Here are two excerpts that may compel you to read further:

“… Despite multiple detailed analyses, there is no consistent FHR marker of fetal compromise …”

“… We believe that it is better to focus on the frequency, depth and total duration of decelerations during labor rather than on timing, shape or supposed aetiology of the specific deceleration.”

In an article published recently in the American Journal of Obstetrics & Gynecology titled Triggers, bundles, protocols, and checklists — what every maternal care provider needs to know, Arora et al define and provide examples of various methods to standardize and streamline clinical care and summarize the evidence supporting their association with improved outcomes. Many examples are provided for obstetrical issues such as hemorrhage, hypertension, oxytocin usage or preop preparation. With burgeoning evidence from diverse medical and non-medical domains, the question is no longer “Do these methods work?“, but rather “How can we get wider adoption and sustain compliance?” In short, how do we actually change established clinical beliefs and behaviors? This article is less informative on these practical issues.

InfluencerThere is abundant data about effective ways to change behavior. In short, behaviors will not change without aligning a critical mass of influential factors. Determination and good intentions alone are insufficient and depending upon them alone is destined to fail. To supplement this review of available obstetrical safety packages we strongly recommend the book- Influencer: The New Science of Leading Change, Second Edition by David Maxfield, Ron McMillan, Al Switzler. (Click here to see a summary of this excellent work)

13 Sep

When two nurses differ in EFM interpretation

Nurse leadership is all about leading a teamSally has worked as a labor & delivery nurse for twelve years. Her team brags that she can interpret a strip from 15 feet away. Today she’s teamed up with Laura, a 3-year veteran, taking care of a high-risk mother in early labor.

While Sally’s taking lunch, Laura starts seeing some variable decels. She pulls up a new software program her hospital has provided, reviewing the last four hours of tracing to see if she can see a pattern of variability. Not yet, but she thinks it’s something to keep an eye on.

Before taking her own lunch break, she suggests that Sally keep an eye on the trend line shown in the new tool. Sally’s not sold on the new tool, so she continues to watch the shorter views, noting the decels and baselines with her experienced eyes.

On September 28th, from noon – 12:30 PM ET, learn how even the most experienced clinicians often disagree about the interpretation of FHR tracings and misjudge the duration of abnormality that can be highlighted by modern perinatal technology.

Click to register today

12 Sep

Improvement over Wallpaper

L&D leadershipSix Focuses for a Happy L&D Unit

Take a look at your L&D unit bulletin board and tell us: Is there at least one piece of paper dealing with employee satisfaction?

Let’s face it. When asked to complete questionnaires about how we view our work and our performance, many of us glaze over. Especially when those questions seem standardized and unrelated to what we really do and where we really work.

This certainly is the case as well for nurse managers using tools such as Gallup’s Q12 to assess their team’s engagement and work satisfaction. This applies even more so for high-stress units such as labor & delivery where the intrinsic life value of helping to bring life is tempered by the demands of patient attention, documentation, and lots of long hours and hard work.

This week Rose Sherman, the editor of the blog Emerging Nurse Leader, summarizes how to put results from employee surveys like Gallup Q12 to effective use. She highlight six (of the way too many) questions for serious focus by managers looking to measure and improve employee satisfaction:

  1. Clearly defined expectations
  2. Necessary tools & equipment
  3. Opportunity to use strengths
  4. Recognition & praise
  5. Empathy with manager
  6. A mentor

Four of these are areas where nurse managers have direct control. #2 and #6 are certainly in a nurse manager’s sphere of influence.

To read Rose’s article click here

27 Aug

The nurse influencers

Christine Burke, VP, Synova AssociatesThe influencers:
How will nurses change the landscape of healthcare?

A guest post by
Christine (Chrissy) Burke
Vice President
Synova Associates, LLC

Here is a short except from a conversation I had recently with Patricia (Pattie) Bondurant, DNP, RN. She has served in numerous executive and front line nursing leadership roles and is particularly passionate about the increasingly important role that nurses play in changing the landscape of healthcare.

Chrissy: You will be the closing speaker at the Perinatal Leadership Forum in November and I know that you are particularly intrigued that nurse leader responsibilities seem to be shifting dramatically from day to day management of the patient care areas to now building systems of care. Perinatal nurse leaders are becoming the primary architect in creating a safe environment. This is a great time to be in healthcare, right?

Pattie: Yes, these are really exciting times. Healthcare is facing unprecedented challenges, and nurses must play a major role in meeting them. We hear so much negative – to quote Gandhi “let’s be a part of the change we want to see.”

Chrissy: How do you propose we seize this opportunity, Pattie?

Pattie: It’s time for us to be accountable and influence healthcare in a meaningful way, tapping in to nurses’ innovation and the unique skills that nurses have to transform care. We have made such great strides by working with our physician colleagues and executive teams together locally, what does our work look like at a regional and national level? We need to keep going and continue to inspire these advances on a larger scale.

Chrissy: So you are talking about personal influence?

Pattie: Influence is the most nuanced – but highest level – leadership skill that we can learn. Kenneth Blanchard, one of the most influential leadership experts in the world says, “The Key to Successful Leadership today is Influence, not Authority.” Nurses are well respected, and we need to develop our influencing skills to be successful in healthcare now. How we connect, lead, and set imperatives as leaders is critical. I see so many talented front line nurses take all different types of initiatives – large, small, challenging, essential – and move them forward to improve outcomes. Let’s also not forget about how this ultimately affects the experience of our patients and families. The ability to influence this work is both critical and extraordinary.

Chrissy: If I was a nurse director or manager interested in attending this conference, tell me what I will come away with after your closing keynote?

Pattie: Nurse Managers and Directors are on the front line – so the question comes to us: What can we do as nurse leaders to influence changes that are taking place in healthcare? This is really about changing relationships. It’s about understanding that our old ways won’t open new doors for our profession. It’s about raising the bar for accountability for ourselves and within our teams. It is about partnering with our physician colleagues. It’s about understanding measurement of data and how it is threaded through our everyday lives in the hospital so we can make informed decisions. Many of us are doing it now on many different levels. I want to hear about these advances and see the results evolving to bigger things for nurse leaders.

Chrissy: What’s the call to action for perinatal leaders everywhere?

Pattie: We have an opportunity to create and leave a legacy in a very unique way in caring for mothers and babies. Who do we want to be? How can we continue building on our current contributions locally and paint a larger swath of responsibility? As health care incrementally transforms, there will certainly be increased opportunities to place nurses at the center of the conversations, development, and implementation of new roles and new models of care.

Chrissy: What can I do as a leader to make my contribution to the healthcare landscape?

Pattie: This shouldn’t be an added burden to our current roles. We should be doing this instead of what we have always done. This is a positive message that will continue to move nursing and nurse leaders forward. We are moving away from fee-for-service systems and toward paying for improved outcomes, which create opportunities for nurses. Payment changes, based in part on improved patient outcomes—such as with shared savings in accountable care organizations and bundled payments—will allow nursing contributions in the area of wellness, telehealth, and care coordination for patients with chronic conditions. Nursing is asked to architect these systems, across care boundaries and then lead these multi-directional teams. How we can work with our leadership teams to continue to be in belief and alignment with these forward thinking goals to improve the health of our patients and communities? Imagine the future for mothers and babies; healthier communities, healthy pregnancies, safe deliveries, all leading to better outcomes. We are stronger together when we look across the continuum of care.

It’s like Kid President says, “This is your time. This is my time. This is our time! Create something that will make the world awesome!”

Are you seeing these same themes emerge in your facility or community? There are so many nurses ready and able to ‘take this ball and move it down the field’. Are you ready to execute? Join us at the 2016 Perinatal Leadership Forum and let’s see what we can do as a perinatal community. Let’s do this together! See you in San Antonio!

11 Aug

Part 3: Perinatal Nursing & Technology

Rebecca Cypher, PeriGen Chief Nursing OfficerPart 3:
Perinatal Nursing & Technology
Time to Accept & Embrace the Challenge

by Rebecca Cypher, MSN, PNNP
Chief Nursing Officer, PeriGen

I hope you enjoyed the first two excerpts from my recent white paper on technologies in perinatal nursing. This article, done on request by PeriGen (the electronic fetal monitoring software firm for which I serve as Chief Nursing Officer), looks at how technology has evolved in response to changes in perinatal nursing, how we in turn have changed as a result of electronic FHR monitoring, and a view to how we as nursing professionals can influence continued improvement in perinatal technologies.

Below is the final excerpt where we examine the importance of a perinatal nurses view on technology improvements. In case you missed the first two installments, PeriGen has posted the full article as a PDF here.

Why Should Nurses Care?

Between 2008-2012, there were 2.8 million registered nurses (including advanced practice nurses) in the United States workforce making nursing one of the largest health-related professional groups. 24, 29, 30 According to Gallup polls, these professionals are regarded by the public as the most trusted in the United States. Nursing is a caring profession that requires licensure, knowledge and clinical skill. Nursing demonstrates the best side of humanity. Well-designed HIT augments nursing capacity. Nurses must be clear in thinking and understanding the relative strengths and limitations of all parties in order to direct the evolution of these technologies. In turn, nurses can harness these technologies to support the mission of providing high quality patient care that is evidence-based, individualized, efficient and safe.

Government agencies expect a 21% increase in demand for nurses nationwide by 2025 though considerable variation of supply and demand at the state level is anticipated. Nursing employment will continue to be affected by factors including population growth, a shift in demographics as the median age increases, economic conditions, employment and retirement of nursing personnel and changes in health care reimbursement. Workforce projection models demonstrate that the rapidly changing health care delivery system, which includes HIT, is shifting how patient care is delivered and the specific role the nursing workforce plays in these changes. 31

Perinatal nurses are using technology in conjunction with clinical knowledge that has been accumulated through hands on experience and education. This combination assists in improving care and facilitates multidisciplinary communication. Technology allows nurses to ask the right questions at the right time, perform streamlined nursing assessments, accurately determine a correct diagnosis from a multidisciplinary approach, and perform appropriate tasks and intervention on the front and back end of decision-making processes. 32

Conclusion

In this modern era, technology is commonplace whether it’s embedded in households, communication methods, modes of transportation or healthcare. In these areas technology continues to be created, refined and updated on a regular basis. Advances in technology, whether it’s a new cellular phone model or component of medical equipment, are requisite in order to provide and improve efficiency, convenience, accessibility and safety. As nurses provide day to day quality patient care in the perinatal setting, technology will continue to influence many facets of the nursing process framework. In today’s healthcare environment, few perinatal nurses can envision delivering patient care without assistance from some form of technology, whether that technology be an automatic blood pressure machine or fetal surveillance with an electronic fetal monitor. Nursing is what we as individuals do best and nurses working in conjunction with HIT is clearly an investment in optimizing efficiency, perinatal outcomes and patient safety. Throughout time women in labor have sought assistance from others with experience and skills. Clearly nurses will continue to fill that essential role backed by increasingly complex technology as HIT evolves.

To continue reading this article or review the references, please click here

04 Aug

Part 2: Perinatal Nursing & Technology

Rebecca Cypher, PeriGen Chief Nursing OfficerPart 2: Perinatal Nursing & Technology
Time to Accept & Embrace the Challenge

by Rebecca Cypher, MSN, PNNP
Chief Nursing Officer, PeriGen

You may remember that I shared the first part of my recent white paper with you not too long ago. It examined how healthcare technology as evolved as a result of perinatal nursing needs and changes in standards. Now it’s time to look at the flip side: How nursing as changed as a result of technology, specifically systems that help us monitor FHR.

PeriGen has also made the full article available as a PDF here.

Clinical Acumen and Care

While the fundamental technology in standard fetal monitoring equipment has changed little in recent decades, clinical behavior in response to FHR monitoring has changed considerably. Clearly defined nomenclature, 10, 11 standardized clinical guidelines, 12-16 and structured communication techniques are now part of obstetric care. Moreover, published nursing position statements and other resources have highlighted that skilled clinicians are essential to ensure maternal and fetal well-being when fetal monitoring is utilized. Additional publications focus on HIT’s vital healthcare role in terms of enhancing opportunities for reducing error in perinatal settings. 3, 11, 17, 18

There is increased awareness that environmental and human factors can impair clinical judgment resulting in delayed intervention and birth-related injury. To address some of these issues healthcare professionals have:

  • Legislation that limits working hours
  • Updated recommendations on nurse-patient ratios
  • Stricter and more frequent credentialing
  • Chain of command procedures
  • In-house coverage rather than on-call at home

Despite these measures, assessing a clinical situation is still challenging. Nurses must often project what will happen in the future. Furthermore, these same nurses prefer to avoid allowing patients to deteriorate to a suboptimal status because, once changes have occurred, safe recovery may be impossible. To make decisions, the clinical mind must focus on what is important and disregard the irrelevant. The human brain is vulnerable to well described biases in this task.

Recent “vivid” experiences affect individual’s perception of risk. The psychological phenomenon of “Tunnel Vision” refers to a tendency to perceive and confirm only the information that aligns with a particular viewpoint and discard contradicting information. 19 Variations of this phenomenon include “Wishful thinking.” For example, a belief that a patient will deliver soon or not deteriorate on a shift can lead to poor FHR tracing assessments which is inconsistent under the best of conditions. Occasionally, humans get tired, distracted, have memory lapses, take risky shortcuts, or get diverted by competing interests. Furthermore, inadequate training or clinical experience can compound problems at the bedside. The objective, unbiased, statistical methods offered by HIT can counter these types of human bias, reduce information overload and assist novice and seasoned nurses to make more confident decisions. 20, 21, 22

Another attractive HIT feature for perinatal leaders is the ability to collect and organize outcome and performance data such as the number of cesarean births or elective inductions. Instead of hand counting data from multiple sources, which takes up valuable nursing time and resources, HIT can collect this data and provide written reports on a regular basis. Performance can be compared over time, to other unit level quality improvement goals or datasets of core measure such as those established by the Joint Commission and the National Perinatal Information Center. Policies and procedures can then be further refined based on benchmarked data in order to provide safer care to patients. 18, 23

The divisions between fetal monitoring technologies, technologies in healthcare information and modern nursing care have been become increasingly blurred. Monitors contain software. Systems in HIT employ clinical algorithms. Clinical algorithms are often based on research using huge datasets derived from HIT systems. Clinicians make decisions on monitoring data and research findings. A brief comparison of strengths and weakness related to computer and human faculties is outlined in Figure 2. Both are fallible but each one has strengths in specific areas. The strengths of one counter weaknesses of the others. Computers crunch numbers well. Let the computers apply that capacity to analyze, organize and display critical information without bias so that nurses can be empowered to use technology and focus on higher order clinical reasoning, collaborative dialogue with colleagues and compassionate quality care. Surely valuable nursing time should not be consumed by the repetitive, manual labor of measuring, counting and calculating. On the other hand, nurses are essential to seek out and integrate information from additional sources, see exceptions to the general rule, cue in to unspoken patient fears, and even make do with missing data. Nurses communicate, reason, educate, encourage and empathize with patients and families. The profession makes a profound difference as hands-on patient contact, visual interpretation at the bedside and having an underlying basic foundation in obstetric care is absolutely necessary to validate HIT information. The perception that technology will take over nursing responsibilities, such as FHR interpretation, leaving all data to be interpreted, documented and managed by artificial intelligence is not only incorrect but illogical. However, given what is known about human error, surely one could not advocate for one approach without the other i.e., nurses without equipment or equipment without nurses.

As HIT related to antepartum and intrapartum fetal surveillance techniques evolve, the profession is often concerned with how to integrate them without challenging or devaluing the role of nursing. This is where an understanding of HIT strengths is important so that they can insist on HIT functionality that is truly helpful allowing nurses to have more time with patients. Perinatal nurses must continue to be involved in the design of state-of-the art systems at the bedside that optimize time for hands-on patient care and streamlined workflow and patient safety. 18, 24 Additionally, nurses play an important role in collaboratively developing and utilizing a variety of quality improvement and risk reductions strategies with the aid of HIT to improve patient care, reduce adverse perinatal and neonatal outcomes (e.g. emergent cesarean section or neonatal intensive care unit admission) and potentially reduce liability. 13,25-28 These include but are not limited to

Developing clear fetal monitoring guidelines that include multidisciplinary protocols for interpretation, intervention, and documentation

Educating nurses, residents, nurse midwives, and physicians on fundamentals of fetal monitoring using standardized fetal monitoring nomenclature

Applying HIT to patient care by using high quality up to date decision aids, bundles and toolkits

Implementing peer reviewed evidence based information, such as clinical protocols, checklists (i.e. oxytocin), and guidelines in a high reliability organization to reduce clinician practice variation

To continue reading this article or review the references, please click here