Failure to rescue as a process measure to evaluate fetal safety during labor

Abstract

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.