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Design of a Novel Electronic Maternal Surveillance System on the Labor and Delivery Unit: Frequency of Automated Pages Based on Modifications to the Maternal Early Warning Criteria
Abstract Number: F-30
Abstract Type: Original Research
The National Partnership for Maternal Safety encourages hospitals to adopt The Maternal Early Warning Criteria (MEWC) to improve early detection of maternal morbidity (1). Ideally, an automated system would continuously collect vital signs and alert clinicians with abnormal values (1). However, little is known about the frequency with which real or spurious vital signs would generate an alert during monitoring. As part of a quality improvement project, our institution designed an electronic maternal surveillance system that uses a paging alert algorithm to notify clinicians of aberrant vital signs. This new algorithm generates less paging alerts when compared to automated alerts meeting MEWC.
Automated paging alerts were created by modifying MEWC to more liberal vital sign triggers via institutional expert consensus (Table 1). Pages were not generated for bradycardia and low SpO2 readings due to the high frequency of artifact. Automated pages were suspended during stage 2 of labor given the common occurrence of tachycardia and hypertension. After a 10-minute delay, the paging system initially notifies the bedside nurse for confirmation and recheck of aberrant values. When severe-range values persist, the pages escalate to clinicians. A record is kept of the pages that are generated. For comparison, a database containing automated vital signs obtained by the bedside monitors was also queried.
The frequency of automated vital signs that met MEWC between 9/29/16 and 12/1/16 across 34 labor and delivery rooms is shown in Table 1. For these 34 rooms, there was an average of 6.16 vital sign triggers per hour. Using a modified paging algorithm reduces these events to 0.48 pages per hour for bedside nurses and 0.22 pages per hour for the obstetrical service.
During a 63 day period, 34 continuously monitored labor and delivery beds triggered an average of 1 vital sign meeting MEWC every 9.7 minutes. These vital signs were automatically collected without nurse confirmation. Modifications to the MEWC, combined with a tiered paging algorithm, would reduce overall paging burden. To our knowledge, there were no patient safety events that were missed using the modified alerting system. While further investigation is needed, it appears this paging algorithm could strike an appropriate balance between recognition of maternal morbidity with prevention of alarm fatigue.
1. Mhyre JM, et al. Obstet Gynecol 2014 Oct;124(4):782-6.