Implementation of the Maternal Fetal TriageIndex Tool for Increased Competency and

Assessment of Obstetric Patients

Kendra Folh, BSN, RNC-OBDanyell Taylor, BSN, RNC-OB

State of Triage at CMHH

• Inconsistent practice of assigning triage acuity

• High census volume and increased waiting room times

• High risk acuity population including fetal center patients

• Lack of triage nurse education and competencies

Why Utilize a Maternal Fetal Triage Index

• Variability in the procedure and assignment of obstetric triage categories

• Lack of a standardized tool to assess acuity

• A clear definition of process time targets was needed

• No method to provide consistent feedback to clinicians compromised patient safety and quality of care

AWHONN's Definition of ObstetricTriage

• Obstetric triage is a brief, thorough and systematic maternal/fetal assessment

• Assessment determines priority for full evaluation

In obstetric triage, the initial, brief nursing assessment of the woman and fetus has traditionally been done on a first-come, first-served basis. One of the problems with this approach is that it does not efficiently identify those women who need urgent or immediate care.AWHONN has developed the Maternal Fetal Triage Index (MFTI), a tool that provides a standardized approach to obstetric triage. The MFTI is a five-level obstetric acuity tool for nurses to use when they triage a woman presenting for care to a birth unit in order to prioritize the woman's urgency for provider evaluation. It is the first obstetric acuity tool developed by a professional society for use across the United States.

Association of Women’s Health Obstetric and Neonatal Nursing

AWHONN’s Triage Initiative

• Redefine “OB Triage”

• Reaffirm obstetric triage as a nursing role

• Improve quality of triage nursing care through standardization of acuity classification

• Improve team communication, action, and efficiency.

• Improve education and competency assessment for triage nurses

• Improve outcomes

Barriers to the Implementation of the Maternal Fetal Triage Index

PLAN

• CMHH joined the AWHONN MFTI Pilot Community February 2016

• A MFTI unit committee was established. The team consisted of Women’s Services leadership, Clinical Nurse Specialist, Quality & Safety Project Manager, and Triage nurse champions

• 3 conference calls approximately 90minutes in length were attended in including monthly work meetings

Plan

• All nurses that perform triage completed the AWHONN 2 hour education module

• Nurse Champions were provided support and strategies to begin implementation of the MFTI in the electronic medical record

• The MFTI committee was given the opportunity to learn from other hospitals and leaders who also began to implement the MFTI in their facilities

Competency• 50 “seats” were purchased for education to

include all licensed personnel working in triage

• All licensed personnel working in triage completed a 2 hour online AWHONN MFTI case study module

• Completion certificates issued

• Reports issued

Initial IntakeWithin 10 minutes patient will be taken to triage for initial intake assessment:

• Obtain subjective assessment of complaint/concern

• Obtain vital signs including pulse oximeter

• Obtain FHTs with Doppler

• Obtain medical history

PDSA WORKSHEET

PLAN:

Briefly describe the test:

Presenting obstetric patients will present to the registrar for initial registration and will be given a priority score after assessment and VS by the triage nurse. Patient will be given a disposition at that time.

How will you know that the change is an improvement?

Presenting obstetric patients will be assessed with a prioritization score within 10 minutes of arrival.

What system impact (driver) does the change?

Patient safety, Timely Access to Care, Patient Centered care

What do you predict will happen? Challenges r/t triage bed availability when multiple Priority 2and 3 patients present to unit

PLAN

List the tasks necessary to complete this test (what)

Person responsible

(who) When Where

1. Register patient

Triage RN Presentation to unit

Triage Room 4

2. Obtain brief assessment and VS

Triage RN Within 10min of arrival

Triage Room 4

3. Assign MFTI prioritization score

Triage RN Within 10min of arrival

Triage Room 4

4.Patient will be taken to triage or waiting room

Triage RN Within 10min of arrival

Triage Room 4

5. Document prioritization score Triage RN Within 10min of arrival

Pink slip

6. Notify charge RN if no triage bed available for stat, urgent, or priority patient

Triage RN Within 10min of arrival

Plan for collection of data: See audit tool

DO: Test the changes.

Was the cycle carried out as planned? Yes No Record data and observations. What did you observe that was not part of our plan?

STUDY:

Did the results match your predictions? Yes No Compare the result of your test to your previous performance: What did you learn?

ACT: Decide to Adopt, Adapt, or Abandon.

Adapt: Improve the change and continue testing plan. Plans/changes for next test:

Adopt: Select changes to implement on a larger scale and develop an implementation plan and plan for sustainability

Abandon: Discard this change idea and try a different one

Organization name(s):

CMHH Women’s Services

Date of test: June 6, 2016

Test Completion Date: June 16th

Lead contact(s) Kendra Folh

Overall organization/project aim: 100% of presenting obstetric patients presenting for evaluation to the triage unit will be given a priority score within 10minutes of arrival.

What is the objective of the test? To establish a sustainable intake prioritization process in the triage unit.

Do

Study Act

Plan

Lessons Learned:

• Executive, administrative and clinical leadership essential for implementation and sustainability

• Frontline team engagement imperative

• Don’t underestimate technological challenges

• Education regarding intermittent auscultation was needed

• Priority still has to be assessed regardless of absence of waiting time

As you create your roadmap for the future, make sure you are part of the

steamroller, not part of the roadSaavik Wilcox-Hamilton

Source of quote: http://slidesha.re/1B6jrZw

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