Standardizing Electronic Fetal Monitor Training in the Ambulatory Care Setting

Purpose: Antepartum electronic fetal monitoring (EFM) is an essential skill for the outpatient OBGYN nurse to perform on pregnant women to help guide clinical care for the mother and fetus (ACOG, 2021). NICDH (National Institute of Child Health and Human Development) has developed guidelines and standard terminology for EFM to communicate fetal heart rate (FHR) patterns. It is critical for nurses to know this terminology so they can accurately communicate, escalate, respond, and intervene (Cypher, 2018). In our search for training materials, all education offered by nationally recognized OBGYN organizations were centered on inpatient EFM, which is outside of an ambulatory care nurse’s needs. Similarly, the inpatient fetal monitoring training at our organization was too extensive for ambulatory care nurses. This gap made it difficult to train new hires especially staff with limited to no fetal monitoring experience. The purpose of this project was to formalize the ambulatory care nurse training process for EFM to ensure staff are knowledgeable of NICDH terminology and utilize this terminology when interpreting and communicating results to help prevent adverse fetal outcomes.

Description: Over the last year, we have developed an online module and an in-person class for interpreting EFM for the ambulatory care nurse. Our online module was designed as a refresher for the experienced nurse and as an initial introduction of terms and content for the novice. Our current training plan consists of all new hires taking the online module and completing the quiz, then depending on experience level and quiz score, they may be required to attend an in-person fetal monitoring class prior to demonstrating competency.

The online module consists of a one-hour lesson plan that breaks down each component of EFM. Participants get practice interpreting fetal heart rate patterns with different clinical scenarios commonly seen in the outpatient setting. There is an EFM interpretation quiz at the end of the module to ensure understanding of the content. If the nurse is a novice, or did not score a 100% on the quiz, they would be required to attend the in-person fetal monitoring class.

The in-person class shares similar content to the module but breaks down the topics further and has more of a focus on interpretation. This class is designed to be interactive and allow the learners to ask questions and be more involved in the lesson. We created clinical scenarios to accompany fetal heart rate patterns. The learners use all the information to properly interpret the fetal heart rate pattern and to discuss appropriate interventions.

Evaluation/outcome: The learners are required to complete a quiz at the end of the online module and in person class, as well as a fetal monitoring competency we developed which they must be signed off by their preceptor with the outcome of increasing competence in EFM.