Intrapartum Computer Monitoring

1. Intrapartum Computer Monitoring Presented by Yvette M. Kreitz, RN

2. Objectives • Definitions. • Describe the purpose of intrapartum computer monitoring. • Describe the hardware and software utilized with this technology. • Assess the role and function of the nurse involved with this technology. • Examine related legal and/or ethical issues. • Discuss the advantages and disadvantages from a nursing perspective.

3. Definitions • Electronic fetal monitoring (EFM) • Fetal heart tracing • Fetal monitor • Intrapartum computer monitoring • Intrauterine pressure catheter (IUPC) • Tocodynamometer (“Toco”) (Taber’s, 2005)

4. Examples

5. Purpose of intrapartum computer monitoring • Comprehensive, computerized network consisting of: • Centralized server/network • Bedside stations • Remote access points • Printers

6. Purpose of intrapartum computer monitoring • Diverse access points allow for: • Remote patient surveillance • Increased participation from support staff • Continuous monitoring • Improved continuity of care (Sandelowski, 2000)

7. Purpose of intrapartum computer monitoring • Software advancements enable: • Comprehensive data over a nine-month period • Point-of-care and real-time charting • Immediate alarm features and critical value notifications • Software integrated with evidence-based practices (www.lmsmedical.com, 2009)

8. System hardware • Centralized server/network • Network printers • Main station computers • Bedside stations • Remote access points

9. System hardware • Fetal monitor & belts • Toco or IUPC • Ultrasound transducer or fetal scalp electrode • Blood pressure cuff • Pulse oximeter (Ladewig, London & Davidson, 2006)

10. System hardware

11. System software • Top 5 Windows-based intrapartum software monitoring programs: • Clinical Computer Systems: OBiXPerinatal Systems • GE Healthcare: Centricity Perinatal • Hill-Rom: NaviCareWatchChild Solutions • LMS Medical: CALM Suite • Philips: IntelliVue OB Care (www.klasresearch.com, 2009)

12. System software • Modular design for flexibility and efficiency • Patient-focused surveillance and continuous monitoring • On-line documentation • Alerts and reminders (www.gehealthcare.com, 2009)

13. System software • Archival of data • Functions and communicates with other hospital programs and departments • Maintains patient confidentiality and data security. • Decision support (www.gehealthcare.com, 2009)

14. Software usability evaluation • Users must be an early and continuous focus during interface design. • The design process should be iterative, allowing for evaluation and correction of identified problems. • Formal evaluation should take place using rigorous experimental and/or qualitative methods. (Staggers, 2003), (Effken, 2009)

15. Information System Review • What is an information system? • Information system used for intrapartum computer monitoring, and its function. • Part clinical/part special-purpose • A communication system • A patient care system (McGonigle & Mastrian, 2009)

16. Information System Review • Who uses the information system? • How is the information system configured? • What data standards are used in this system? • What Disease and Procedure Classification System is used?

17. Information System Review • Nursing practice standards • NIC • NOC • AWHONN • NICHD • Recommendation regarding this system

18. Advantages of Intrapartum Computer Monitoring • Nurse-patient interaction • Reporting • Storage • Time Management • Flexibility • Safety (www.obix.net/overview/advantages.asp, 2009)

19. Disadvantages of Intrapartum Computer Monitoring • Critical thinking • System down-time • Responsibility • Cost

20. Ethical and Legal Issues • Privacy, confidentiality • Responsibility • Documentation • System over-reliance

21. Informatics Competencies • Operates Windows applications • Uses instant messaging and e-mail • Knowledge of applicable intrapartum monitoring system – hardware and software • Knows hospital-specific nursing policies for charting, storage & medication administration.

22. Functions and Responsibilities of the Informatics Nurse • Perspective • Theories, principles, concepts • Ergonomics • HCI principles • Social, legal and ethical impacts • Role (McGonigle & Mastrian, 2009)

23. Summary • Purpose • Hardware/software • Role and function of the nurse • Information system review • Advantages/disadvantages • Nursing informatics

24. References • Clinical Computer Systems, Inc. (2009). OBiX Overview. Retrieved from • http://www.obix.net/overview/advantages.asp. • Effken, J. A. (2009). Improving the Human-Technology Interface. Nursing • Informatics. Sudbury, MA: Jones and Bartlett, (p. 65-71). • GE Healthcare, Inc. (2009). Centricity Perinatal Product Technology. Retrieved • from https://www.gehealthcare.com/portal/site/usen/1006e73922.asp. • KLAS Reseach, LLC. (2009). Rating Healthcare Technology. Retrieved from • http://www.klasresearch.com/1106/ob_soft.asp.

25. References • Laedwig, P. A., London, M. L, & Davidson, M. R. (2006). Contemporary • Maternal-Newborn Nursing Care. (6th ed.). Upper Saddle River, NJ: Pearson-Prentice Hall, (p. 432-438). • LMS Medical, Inc. (2009). High reliability in obstetrics. Retrieved from • http://www.lmsmedical.com/4105/print.asp?url=/4105/03_04_02_calm_curve.asp. • McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation • of knowledge. Sudbury, MA: Jones and Bartlett Publishers, (p. 206 - 217).

26. References • Sandelowski, M. (2000, May). Retrofitting technology to nursing: the case of • electronic fetal monitoring. JOGNN: Journal of Obstetric, Gynecologic, & Neonatal Nursing, 29(3), 316-325. Retrieved September 8, 2009, from CINAHL database. • Staggers, N. (2003). Human factors: Imperative concepts for critical care, 14(3), • 310-319. Retrieved October 1, 2009, from CINAHL database. • Taber’s cyclopedic medical dictionary (20th ed.). (2005). Philadelphia, PA: F. A • Davis, 749.