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The Fetal Heart Rate Collaborative Practice Project: Situational Awareness in Electronic Fetal Monitoring—A Kaiser Permanente Perinatal Patient Safety Program Initiative

MacEachin, S. Rachel BSN, RN, PHN; Lopez, Connie M. MSN, RNC-OB, CNS; Powell, Kimberly J. MSN, NPC, CNM, RN; Corbett, Nancy L. BSN, RN, MHA

The Journal of Perinatal & Neonatal Nursing: October-December 2009 - Volume 23 - Issue 4 - p 314–323
doi: 10.1097/JPN.0b013e3181a1bf07

Background Electronic fetal monitoring has historically been interpreted with wide variation between and within disciplines on the obstetric healthcare team. This leads to inconsistent decision making in response to tracing interpretation.

Purpose To implement a multidisciplinary electronic fetal monitoring training program, utilizing the best evidence available, enabling standardization of fetal heart rate interpretation to promote patient safety.

Methods Local multidisciplinary expertise along with an outside consultant collaborated over a series of meetings to create a multimedia instructional electronic fetal monitoring training program. After production was complete, a series of conferences attended by nurses, certified nurse midwives, and physician champions, from each hospital, attended to learn how to facilitate training at their own perinatal units. All healthcare personnel across the Kaiser Permanente perinatal program were trained in NICHD nomenclature, emergency response, interpretation guidelines, and how to create local collaborative practice agreements. Metrics for program effectiveness were measured through program evaluations from attendees, the Safety Attitudes Questionnaire.

Results Program evaluations rendered very positive scores from both physicians and clinicians. Comparing baseline to 4 years later, the perception of safety from the staff has increased over 10% in 5 out of the 6 factors analyzed.

Summary Active participation from all disciplines in this training series has highlighted the importance of teamwork and communication. The Fetal Heart Rate Collaborative Practice Project continues to evolve utilizing other educational modalities, such as online EFM education and unit-based interdisciplinary tracing reviews.

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc, Rockville, Maryland (Ms MacEachin); and Kaiser Permanente National Risk Management (Ms Lopez) and Kaiser Permanente Northern California Regional Risk Management (Mss Powell and Corbett), Oakland, California.

Corresponding Author: Connie M. Lopez, MSN, RNC-OB, CNS, Kaiser Permanente National Risk Management, One Kaiser Plaza, Ste 18B, Oakland, CA 94612 (

The authors have disclosed that they have no financial relationships related to this article.

Submitted for publication: January 16, 2008

Accepted for publication: February 19, 2009

© 2009 Lippincott Williams & Wilkins, Inc.