Documentation improvements following multidisciplinary educational program on electronic fetal heart rate tracings

Abstract

Objective. To measure the effectiveness of a multifaceted, multidisciplinary, evidence-based educational program designed to achieve compliance with the National Institute of Child Health and Human Development (NICHD) definitions and three-tier system for electronic fetal heart rate (FHR) monitoring.Methods. This prospective study began with a literature review focusing on creating change within complex systems. Evidence-based elements of program development and implementation were incorporated to promote the adoption of the NICHD guidelines for electronic FHR monitoring. A systematic, stratified random sample of charts was reviewed to evaluate compliance with the NICHD recommendations prior to and following program initiation.Results. Compliance rates for documentation of all components of a FHR tracing and a category in SOAP notes increased from less than 1% to 90%. Of the remaining charts, following program implementation, 70% had all components of the FHR tracing documented. Following the educational intervention, only 1% of SOAP notes lacked a category and at least one component of FHR tracing compared to 39% prior to the program.Conclusions. Incorporating evidence-based strategies for systemic change is an important step in program development in obstetrics. A multifaceted, multi-disciplinary program with frequent audits and feedback can yield high compliance in adoption of guidelines and result in practice change.