06 Dec

PeriCALM CheckList nominated for Edison Award

CheckList nominated for 2017 Edison Award for innovation

Protocol Management Tool again

recognized for innovation,

nominated for Edison Award

PeriGen announced today that their protocol management tool, PeriCALM CheckList, has been nominated for a 2017 Edison Award.  The Edison Awards recognize and honor innovation and innovators who make a positive impact in the world.

CheckList also received a Fierce Health Innovation Award earlier this year.

The Edison Awards are named after Thomas Alva Edison (1847-1931) who developed 1,093 patented new products, including the incandescent electric light and the system we still use today to generate electrical power.  His other products include the telephone transmitter, the phonograph, the first storage battery, and a motion-picture camera.

Edison Awards nominees are evaluated not only on their impact, but also the method of conceptualization, product value (advantages and differentiation), and marketing delivery.

PeriCALM CheckList, a module of the PeriCALM electronic fetal monitoring and analytics software solution, is designed to help bedside perinatal clinicians identify when patient EFM metrics match specific protocol parameters.  Although it is highly customizable, it is most often used by hospital clients to monitor oxytocin protocols.  The automation of protocol management that CheckList offers aims to save labor & delivery providers time by eliminating manual calculations and improve data accuracy.  Published research on obstetric protocols, in addition, have been shown to improve outcomes and lower cesarean section rates.

The module also includes a unique export feature, saving additional time by sending EFM data to the EHR and to annotations after review.

 

10 Nov

Impact of the laborist model on obstetric care

Research Summary:
Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes*

Inventor of PeriGen advanced fetal monitoringBy Emily Hamilton, MD CM, Senior Vice President of Clinical Research

This study, published in the August 13th issue of the American Journal of Obstetrics & Gynecology, examines outcomes before and after the introduction of a laborist model of care. Surprisingly, very few differences were noted when comparing changes over time in the hospitals with laborists to changes over the same period of time in the matched hospitals without laborists. This paper describes an interesting methodology to try and tease apart the effect of various factors on obstetrical outcomes. This is relevant because most quality improvement initiatives are studied in a before-and-after fashion and not in a prospective randomized trial.

The study is discharge summary data to NPIC between 1998 and 2011. Results from three hospitals where laborists were introduced were compared to six control hospitals matched for delivery volume, geographical area, teaching hospital status and level of neonatal nursery.

Once adjustment was made for several patient-related factors, no differences were observed in the odds ratio (OR) for any of the neonatal outcomes or for cesarean rates. The OR was reduced only for induction of labor (0.85 95%CI 0.71-0.99) and for Preterm Birth (0.83 95%CI 0.72-0.96). Although the OR for Preterm Birth was reduced this was not accompanied by a change in the OR for the birth of babies weighing

In short, the introduction of laborists was associated with a change in medical behavior (Induction of labor) and some change in actual outcome (preterm births), but not in low-birth-weight babies. A question that springs to mind immediately is the role of unmeasured factors such as policies to curtail elective induction of labor prior to 39 weeks that became common during this timeframe and were not adopted by all hospitals at the same time. Evidently the desire to improve is alive and well in many hospitals and there is no single solution for all.

Reference:
*Srinivas SK, Small DS, Macheras M, Hsu JY, Caldwell D, Lorch S. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. Am J Obstet Gynecol. 2016 Aug 13. https://www.ncbi.nlm.nih.gov/pubmed/27530491

09 Nov

How L&D Teams Use Protocols

What do you think? Is that a late?It’s hard to believe it’s been nine years, almost ten, since Steven Clark et al published “Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes.” Their study found that the use of a checklist-based protocol for oxytocin administration could reduce maximum infusion rates without lengthening labor or increasing operative intervention. In fact, cesareans decreased as a result of the use of the protocol.

To understand how protocols are handled today, PeriGen has launched an ongoing research survey. So far, 129 clinicians have participated. Here is a summary of results so far:

  • 96.7% of respondents use protocols to improve patient safety
  • The top three most commonly used protocols are for obstetric hemorrhage (8.2%), induction/oxytocin (7.6%) and pre-eclampsia (6.8%).
  • Most protocols (56.06%) are managed via a combination of EHR forms, paper forms and separate electronic forms. Few (6.1%) are actually integrated with the EFM.
  • Despite published research indicating induction protocol compliance was 40%, the mean estimate for protocol compliance among respondents is 90%.
  • Most respondents (53.85%) indicate that their teams spend about 1-3 hours a month on training, including initial training, for the protocols they use.
  • Respondents (47.7%) also say they meet as needed to analyze and generate ideas about increasing the effectiveness of the protocols they use, although 21.5% schedule monthly meetings.

To view an infographic of the survey results, please click here. To participate, click here.

08 Nov

Recommended Reading: A Profile of Friedman

Recommended Reading A Profile of Emanuel A. Friedman*

Dr. Emanuel A. Friedman, father of the labor curveEvery practitioner and student of obstetrics owes much to the landmark works of Emmanuel A Friedman. Recently, Dr. Romero, Editor in Chief of the American Journal of Obstetrics and Gynecology, interviewed Dr. Friedman and has chronicled his remarkable story for us. As with many discoveries or inventions, Dr. Friedman’s creative journey was triggered by happenstance and adversity.

While we may debate the merits and shortcomings of the mathematical techniques available in that era, especially when compared with the mathematical methods available today, no one can question how Dr. Friedman raised the level of thinking about labor by a quantum leap. I treasure an autographed copy of his 1955 publication entitled Primigravid Labor; a graphicostatistical analysis.

I highly recommend Dr. Romero’s essay on one of our great obstetrical thinkers.

Reference:
*Romero R. A profile of Emanuel A. Friedman, MD, DMedSci. Am J Obstet Gynecol. 2016 Oct;215(4):413-4. doi: 10.1016/j.ajog.2016.07.034. Epub 2016 Aug 3.
http://www.ajog.org/article/S0002-9378(16)30469-0/abstract?cc=y=

07 Nov

Back from the honeymoon

Shaping the Future of Perinatal CareBy Matthew Sappern, CEO

Well, it’s been five weeks since we announced the combination of PeriGen and WatchChild and by any and all accounts…so far so good! Of course, most honeymoons are great. Now we start the hard work; the work to continue delighting our customers.

If you have had the opportunity to interact with the WatchChild or PeriGen teams in the last four weeks, you’ve probably noticed – no difference! The personnel you turned to for support, training, implementation services and account management are all the same. The development team remains the same as well and is continuing to enhance the  platform. In fact, we are all focused on the next WatchChild release, which we anticipate making generally available in the January timeframe. But we did not bring these two companies together to maintain the status quo. On the contrary, we are looking to accelerate innovation and in early 2017 bring to all of you more tools designed to benefit both clinicians and the IT teams that support them.

In the last few weeks, I have had the pleasure of meeting with both WatchChild and PeriCALM customers to hear firsthand about the customer experience and I look forward to meeting many more over the coming months. In the last few weeks, I have also spent quite a bit of time with the entire WatchChild and PeriGen team. I am very impressed. I have reinforced their existing commitment to customer service and made it clear that customer satisfaction is a critical goal company-wide and one for which everyone is empowered and everyone plays a part. I am confident that in the coming months you will find that the commitment to your satisfaction continues unwavering.

Matthew Sappern is PeriGen's Chief Executive OfficerThough it will take a bit of time, I look forward to meeting you. In the meantime, please feel free to reach out to me and, of course, the familiar WatchChild and PeriGen faces if there is anything that we can do for you. I hope that you are excited by the merger of these two great companies and knowing that you now have more people and resources focused on maternal and fetal safety and on developing innovative solutions for you.

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)

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

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