Documentation improvements following multidisciplinary educational program on electronic fetal heart rate tracings.
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.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mvadnais@bidmc.harvard.edu
Mary A
MA
Vadnais
Toni H
TH
Golen
D004282:Documentation; D004496:Education, Continuing; D005260:Female; D005323:Fetal Monitoring / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006340:Heart Rate, Fetal; D006801:Humans; D054582:National Institute of Child Health and Human Development (U.S.); D011247:Pregnancy; D011446:Prospective Studies; D014481:United States