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Failure to Rescue as a Process Measure to Evaluate Fetal Safety During Labor

Beaulieu, Michele J. DNP, NNP-BC

MCN: The American Journal of Maternal/Child Nursing: January-February 2009 - Volume 34 - Issue 1 - p 18–23
doi: 10.1097/01.NMC.0000343861.64614.c9
Original Article

Purpose To evaluate a perinatal team's clinical responses to the key components of the failure to rescue process.

Methods This retrospective descriptive study involved a review of medical records and their accompanying fetal monitoring strips for 53 women who had a cesarean birth at term for a nonreassuring fetal heart rate pattern. The instrument was the Fetal Safety Failure to Rescue Process Tool based on the Agency for Healthcare Research and Quality's Failure to Rescue Patient Safety Indicator adapted for perinatal care processes. This tool measured four process measures: careful surveillance, timely identification of complications, appropriate interventions, and activating a team response. A mean total score was computed to determine quality of care based on all four of the process measures.

Results The perinatal team's mean total score was 6.6 (SD = 1.0, range 3–8); the highest possible score was 8. The lowest score was found in the team's response with appropriate interventions (lateral positioning, intravenous fluid bolus, discontinuation of oxytocin, oxygen administration, amnioinfusion, administration of Terbutaline) based on fetal heart rate pattern. Interrater reliability of the tool was 90%.

Clinical Implications This study provided information that may be useful in evaluating processes of care to ensure quality care for mothers and babies during labor. The findings formed the basis for implementing unit-specific educational programs, including (a) certification, continuing education, and documented competence in electronic fetal monitoring education to promote consistency in language and understanding of abnormal fetal heart rate patterns; (b) review of appropriate documentation of nonreassuring fetal heart rate patterns; (c) review and revision, if necessary, of established institutional standards and guidelines for appropriate interventions for nonreassuring fetal heart rate patterns; (d) changes in standardized forms to include times for notification of team members and improved communication, and (e) mechanisms for identifying system failures.

Research about perinatal safety is sorely needed. Dr. Beaulieu provides us with a new way to measure safety during labor.

Michele J. Beaulieu is a neonatal nurse practitioner at Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH. She can be reached via e-mail at

Acknowledgments: Special thanks to Dr. Kathleen Rice Simpson for the inspiration to conduct this research. I am grateful for the guidance and support of my research committee Dr. Donna Dowling, Dr. Judith Maloni, and Dr. Elizabeth Damato.

There are no conflicts of interest related to this article.

© 2009 Lippincott Williams & Wilkins, Inc.