26 Apr

Mary Greeley Medical Center Weighs In

Mary Greeley Medical Center BirthwaysAmy Dagestad, Director of Labor & Delivery at Mary Greeley Medical Center in Ames, Iowa had the following words to say when we asked her what they like about their PeriCALM decision support system:

“Although we don’t use all of the PeriCALM integration features, those we do use make life easier.  The interface is intuitive and the system is easy to use. We value the availability of PeriCALM Patterns too, especially for difficult labor cases.  The users like the system and that’s very important.”

Birthways at Mary Greeley Medical Center serves central Iowa, welcoming more than 1,000 newborns into the world each year.  The center is a convenient, comfortable, soothing place for childbirth.  It’s designated as a Baby-Friendly hospital by Baby-Friendly USA for its quality of care.

Birthway offers patients 22 private rooms, 13 of them equipped as labor/delivery/recovery/postpartum  where mothers and their new babies stay from registration until release.  The hospital also offers a host of amenities to make families comfortable including room service and whirlpool tubs.

14 Apr

We love PeriCALM because…

“We love PeriCALM because it makes it easier.  Easier on the eyes.  Easier to find information.  Easier to get the details we need to do our work.”

We were lucky enough to catch Megan Mcfall this week during a rare moment of calm.  Megan is the Director of Women’s Health Care at Indian River Medical Center serving Vero Beach, Florida.  Megan leads a busy team of labor & delivery nurses that she describes as “small, but extremely dedicated and skilled.” In fact, each of her team share competencies across all three areas of their women’s services, providing a continuity of care that’s both logical and rare.

We took the opportunity to ask Megan what she liked about PeriCALM.  Her prompt answer:  “It’s easy.”

07 Apr

When a labor & delivery nurse actually has time for lunch

Things labor & delivery nurses eat (besides a sandwich) while waiting for the next alert

From our “What would you do with 40 free minutes poll” (see below) most labor & deliver nurses would love to just leave on time to spend time putting their feet up, spending time with family and fun.  But a good many say they’d actually spend the time enjoying lunch.  So here’s a quick list of ideas for lunch-on-the-run, literally:

  • Calzones, warmed in the lunchroom or at home, then wrapped in foil
  • Leftover pizza
  • Quesadillas
  • Bento box of veggies for grab-and-runs
  • Thermos meals — non-chunky soups, dumplings
  • A slice of yummy quiche

Any others?

If there was a way to free up 40 minutes of your time per shift, how would you spend the time? (Choose all that apply)

05 Apr

Annual Obstetric Malpractice Review

MalpracticeEvery year, according to a study published by The New England Journal of Medicine in 2011, just over 11% of obstetricians and the hospitals and clinicians serving them, will be faced with malpractice complaints. The average payout will be approximately $360,000 with significant state-by-state variation.¹

PeriGen’s Annual Review of
Labor & Delivery Malpractice Awards

Following is a summary of 2015 perinatal malpractice awards, settlements and complaints:

    • $8.4 Million Awarded for Hypoxic Ischemic Brain Injury:   Mother was admitted to the a Georgia medical center for delivery of a full-term baby. The labor continued throughout the evening.  Baby was delivered around noon the next day. Her admitting physician was not present at the delivery, but delivery was overseen by a CNM. For several hours prior to the delivery, fetal heart rate was noted as decelerating and variable. Infant was born severely depressed, with low APGAR scores and metabolic acidosis. He was not intubated for 8 minutes, and he continued to deteriorate, a full code ensued, and resuscitation occurred. Ultimately, infant was diagnosed with a hypoxic ischemic brain injury and developed cerebral palsy. Click for details
    • A Michigan court granted the right to appeal for a case stemming from a 2008 delivery outcome.  Mother  was admitted to the hospital with ruptured membranes. She had a lengthy labor – 29 hours – augmented by the drug Pitocin.  The baby failed to descend after two hours of pushing. The mother had developed chorioamnionitis (placental infection) and the doctors noticed the presence of meconium. The labor was terminated with a caesarian section. Records revealed “delivery of a healthy baby boy who weighed 9 lbs 13 oz. However, the infant began to show signs of seizing shortly after his birth and a CT scan revealed an acute left middle cerebral artery ischemic stroke, which was “days to hours old.” The complaint alleged that “[t]he baby was at risk for, and did develop, brain injury from traumatic head compression and regional cerebral ischemia caused by failure to descend, macrosomia (large baby), excessive contractions in the presence of failure of descent as augmented with oxytocin, hypoxia-ischmeia (regional cerebral and/or systemic) caused by uteroplacental insufficiency and by cord compression and head compression.” The complaint alleged that defendants were negligent in administering oxytocin, in failing to properly respond to fetal heart rate changes, and in failing to perform a timely c-section. Click for details
    • A couple in Puerto Rico filed a suit for $27 million against two hospitals as a result of respiratory failure, perinatal asphyxia, and clinical sepsis. After experiencing pelvic pressure and secretions the mother was admitted without contractions or amniotic rupture. The mother underwent induced labor. Upon birth, the newborn was found  to be in critical condition. His skin was blue from poor circulation, and he did not respond to any external stimuli.  The boy was rushed to NICU and hooked up to a mechanical ventilator. He was diagnosed with respiratory failure, perinatal asphyxia, and clinical sepsis. After nearly a month of care, the boy was released from treatment. Then in January 2013 doctors diagnosed him with multicystic leukoencephalopathy and microcephaly, from which stemmed a host of motor, mental, and sensory complications, such as seizures and impaired vision and hearing. Click to review case
    • A New Jersey family realized a $700,000 malpractice settlement as a result of a Erbs palsy brachial plexus injury.  The case contends that the attending physician used excessive traction during  delivery, resulting in stretching and tearing of the brachial plexus. See details
    • Another settlement, this one for $562,500 followed a complaint that the obstetrician and nurse, monitoring a patient in labor, failed to recognize that the infant’s heart rate had slowed when the fetal monitor strips was actually demonstrating the mother’s heart rate. The mother’s uterus had abrupted, causing a lack of blood flow and oxygen to the baby. By the time the error was recognized, the infant had died from lack of oxygen.  Details provided here
    • Hypoxic ischemic encephalopathy (HIE) with extensive brain injury is the subject of a recent medical malpractice claim brought against a military hospital in the District of Columbia. The complaint states that after being admitted to the medical center in the early stages of labor, the plaintiff was given oxytocin to help augment contractions. Subsequent fetal heart monitoring suggested an abnormally high rate of contractions, but augmentation was continued. Following this, medical records indicated an increase in the fetal heart baseline along with intermittent late decelerations. Shortly thereafter, the mother developed a fever and was diagnosed with chorioamnionitis (a bacterial infection of the fetal membranes). After several hours of prolonged labor, the plaintiff was delivered, at which point shoulder dystocia was noted.  Allegedly, a first year resident then unsuccessfully attempted to relieve the shoulder dystocia with downward pressure. Next, a third-year resident tried several maneuvers to free the baby’s shoulder, including the McRoberts maneuver, the Rubin maneuver and others. All were ineffective. At this point, contends the complaint, the attending obstetrician arrived and was able to successfully free the shoulder allowing for a vaginal delivery. Upon delivery, the plaintiff’s little girl was was described as having bruising on the face and scalp, a fractured right clavicle and Erb’s palsy. She was also hypotonic and experienced seizures. About five days after her birth an MRI revealed that the child showed hypoxic ischemic encephalopathy with extensive brain trauma. See more
    • Honolulu based hospital faced with $9,000,000 obstetric settlement:  The mother arrived at the hospital at 35 weeks into her pregnancy, she had severe lower abdominal pain. Because of her previous history of miscarriage and the complicated delivery of her first child, the mother had undergone a procedure to keep her uterus closed until delivery and the pregnancy was under close supervision. However, when she arrived at the hospital, the hospital failed to notify and consult her obstetrician. An emergency C-section was performed, but the complaint contends that the procedure was not performed in time to prevent reduced oxygen flow to the fetal brain, causing brain damage. Click for more information
    • A $5 million suite filed against a military hospital in Kentucky also results from HIE. The suit contends that connected to a fetal heart rate monitor, the healthcare workers failed to properly monitor and interpret the tracings. The plaintiff claims that the medical records indicate her daughter was in respiratory failure for a long period of time. In addition, the complaint states that, despite knowing that the labor was not progressing properly, healthcare providers failed to perform a cesarean section. The newborn was diagnosed with intracerebral hemorrhage and interventricular hemorrhage. Click for details

 

¹Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D. Malpractice Risk According to Physician Specialty N Engl J Med 2011; 365:629-636

24 Mar

Last week’s nurse poll results

Saving nurses time

What nurses would do if they had extra time

Last week, results of our “40 Free Minutes” poll said that 37% of labor & delivery nurses would simply sit down and enjoy lunch. 26% said they’d spend more time with patients.  If there were a way to save 40 minutes during your shift, what would you do with them?

Complete the poll to see this week’s results!

If there was a way to free up 40 minutes of your time per shift, how would you spend the time? (Choose all that apply)
23 Mar

HIStalk interviews CEO Matt Sappern

Matthew Sappern is PeriGen's Chief Executive Officer“The Safest Place to
Have a Baby”

PeriGen CEO Matt Sappern shares an anecdote about his time at this year’s HIMMS conference.  Seems that a client CIO made quite an impression on those manning the booth of a major EHR vendor when he proclaimed that PeriGen was helping make his hospital be the safest place to have a baby.

Matt closes the interview with another great story about a cesarean avoided through PeriCALM’s power of delivering the right information in real-time at the bedside

Read the Inteview

17 Mar

How nurses spend their time

How nurses spend time

How nurses spend timeIn the Summer of 2008 issue, The Permanente Journal published the results of a time-and-motion study that looked at how nurses spend their time. At that time, only about one-third of hospitals had implemented EHRs, and patient records were still often kept on paper. The results indicate that documentation, medication administration, and care coordination accounted for 73.1%. Patient care accounted for 19.3%.

Eight years later, the electronic health record (and its many ancillary components) is almost ubiquitous. Has this changed how you spend your time? How?

And what would you do if there were a way to free up 40 minutes for each of your shifts? Click to participate in a poll and see how you compare

15 Mar

Perinatal Webinar Summary for Tomorrow

Better perinatal assessment of fetal heart rate patterns

Here’s a summary of what Emily Hamilton, MDCM will be covering during tomorrow’s free perinatal nursing training webinar designed to help clinicians improve their ability to understand FHR variation and decelerations.

  • What regulates the fetal heart rate
  • Fetal heart rate decelerations
  • Variable decelerations
  • Late decelerations
  • How they affect clinical interpretation of tracings

Perinatal Training Summary:

The clinical goal of electronic fetal monitoring is to identify fetuses with increased risk of hypoxic injury so that intervention can be executed to avoid adverse outcomes without also causing excessive number of interventions.  Understanding the mechanisms of fetal heart rate control is important because it can help us to infer the physiological state of the baby and gauge whether intervention is truly necessary.

Unlike in adult cardiology, where ECG changes are used to diagnose myocardial infarction, labor & delivery clinicians depend upon the heart rate to infer the condition of another organ, namely the fetal brain.  Although the fetal heart rate is related to fetal brain state, is is also affected by a number of other factors.

During tomorrow’s training webinar, Dr. Hamilton will provide an overview of recent perinatal research on these factors.

Registration is still open, but “seats” are filling fast

Register now by completing form below

14 Mar

Discuss EFM data vs clinical information

Are you using just data or rich clinical information to assess labor?

Here’s a definition of data

According to Merriam-Webster’s dictionary, data is the output from a sensing device that includes both useful and relevant or redundant information and must be processed to be meaningful.

Typical perinatal EFM software provides labor data

Here’s a familiar example:
Traditional electronic fetal monitoring systems, developed long before computers made real-time analysis possible in a hospital setting, deliver numeric measurements of fetal heart rate and contractions and presents them in graph form.

Converting this obstetric data to information of actual use is left entirely up to clinicians in their role as human calculators.

Here’s a definition of clinical information

Knowledge obtained from investigation, study, or instruction which justifies change in a plan or theory.

Perinatal Clinical Information fuels better childbirth decision-making

Information-rich decision support tools, illustrated in the PeriCALM® screenshot shown above, convert data into intelligence that make more robust interpretation and decision-making possible.

How many perinatal nurses are limited to just using data to assess labor?

Does your EFM software system deliver data or information?

Which is of more use?  How would having the rich clinical information shown above make a difference with your work?

10 Mar

Ochsner Baptist Celebrates PeriCALM Launch

Ochsner Baptist celebrates launch of PeriCALM

Melanie Williams, Director of Labor & Delivery and Dr. Alfred Robichaux, Ochsner Chairman of Women’s Services are joined by their PeriGen Clinical & Technical Implementation Team during the launch of Ochsner Baptist’s new obstetric patient safety system

Led by Dr. Alfred Robichaux, Chairman of Women’s Services for Ochsner Health, the Ochsner Baptist team just went live with PeriGen’s clinical decision support system, PeriCALM.

Ochsner Baptist is a one-of-a-kind facility serving uptown New Orleans.  Their Women’s Pavilion offers expert care and advanced birthing services, including alternative birthing options such as water births, spa-like services, and state-of-the-art imaging.

The new PeriCALM clinical decision support system is designed to supply Ochsner Baptist with real-time labor analysis while integrating seamlessly with their electronic health record system, so that clinicians spend more time on patient care and less on cumbersome documentation and number-crunching.

 

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