WDH 2020-2021 Nursing Report - Flipbook - Page 21
Nurses in the offices have
completed the AWHONN Basic
Fetal Monitoring class and most
have completed/are working on
the Intermediate Fetal Monitoring
class. New hires have these
courses outlined in their new
hire competencies to ensure
consistency of training of all RNs
in the offices. This has offloaded
this from the Midwives plates, to
allow both midwives and RNs to
function to the top of their scope.
Picture left to right: Jordan Quale, clinical lead;
Annie Cox; Adeline Bouras (sitting); Donna
Taylor; Melissa Hanscom
Women’s Health Center Outpatient NSTs
Obstetric patient needs
fetal non-stress test (NST)
AWHONN Basic Fetal Monitoring
class or AWHONN antepartum
fetal assessment online module
Has RN had
introductory EFM
training?
No
NST Tips:
Yes
WHP Nursing Competency
completed
AWHONN Intermediate Fetal
Monitoring class or current
NCC EFM certification
Criteria for Reactive NST:
• Greater than 32 weeks: presence
of two accelerations peaking at
least 15 bpm above baseline and
lasting 15 seconds from beginning
to end acceleration
• The peak of amplitude does not
have to be sustained at 15 bpm
above baseline; rather the total
duration of FHR increase must be
at least 15 seconds
• Less than 32 weeks: Accelerations
are abrupt increases peaking at
least 10 bpm above the baseline
and lasting at least 10 seconds
• Patient in side-lying or semi-Flowers position (avoid supine
position with head lower than 30 degrees)
• Assess fetal position and apply fetal monitor over fetal back
• Continuously monitor FHR and uterine activity for duration
• Monitoring period can be extended for 40 minutes to
accommodate normal fetal sleep-wake cycles
• Vibroacoustic stimulation may help generate acceleration
Perform NST
(Must have provider
in office)
Has RN had
additional EFM
training?
Do not perform NST
No
Review NST with OB
provider or RN who
has completed
intermediate course.
Document NST results and name
of person who reviewed. Route
to OB provider for co-signature.
No
Report results to OB
provider and discuss
plan of care (POC).
Document NST results, provider
communication and POC. Route
to OB provider for co-signature.
Yes
Is NST reactive?
Yes
Document NST results.
Route to OB provider
for co-signature.
Discharge patient home.
2020–2021 Nursing Annual Report
21