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Obstetric Early Warning SystemConfiguration Ideas to
Improve Patient Outcomes
Andrea Tennison, RNC-OBProject Implementation Manager,
CPNBaptist Health System, San Antonio,
Texas
Conflict of Interest Disclosure
The faculty and planning committee have declared no conflict of interest.
The content of this presentation represents the views of the author and
presenters. GE, the GE Monogram, Centricity and Imagination at Work are trademarks of General Electric
Company.
About Me CPN System Administrator since 2010 Certified in Inpatient Obstetrics Labor & Delivery 16 years MSN in Nursing Informatics in Progress Centricity Perinatal Users Group Board
Member Baptist Health System - 6 Hospital WAN Additionally Supporting 3 Hospitals in
Chicago on 2 Databases
PurposeThe Purpose of this Activity is to
Demonstrate the Basic Principles of the Obstetric Early Warning System and to Enable the CPN System Manager to
Build the Appropriate Automatically Computed Items
and Configurations to Help Improve Patient Outcomes for Patients on the Obstetric Unit
Objectives
Criteria for successful completion include attending the entire session and turning in an evaluation form.
Discuss the Obstetric Early Warning System and How it Can Improve Patient Outcomes
Discuss Principles of the Obstetric Early Warning System and How it is Applied to Current Documentation Practices
Define the Steps Necessary to Incorporate the Obstetric Early Warning System into the Centricity Perinatal Database
What is OB EWS?
911
Many times, obstetric patients exhibit warning signs in the hours before experiencing critical health problems like cardiopulmonary arrest
Subtle changes can go unnoticed, allowing a patient’s condition to deteriorate without interventions, commonly referred to as "failure to rescue“
Between 2004 and 2006, Health Grades reported that "failure to rescue" accounted for 128 deaths out of every 1,000 patients nationally
What is OB EWS? Increased cardiovascular reserves and other
physiological changes in childbearing women can make recognition of impending maternal collapse difficult
A tool that brings attention to these changes can impact the overall outcome of the mother and baby
OB EWS helps the bedside clinician with recognition of critical signs and symptoms that a patient’s condition may be deteriorating, prompting the caregiver to evaluate and intervene
Benefits of OB EWS Assists in Conveying Information
Concisely, Accurately and Efficiently Increases Communication Encourages Initiation of the Chain of
Command Provides Guidance to Nurse Providing
Care Not Designed to Replace the Individual
Patient Assessment Visual notifications on Chalkboards
Provides Quick Reference when Built in Centricity
How Does it Work? Uses Parameters Specific to the Labor and
Delivery Patient to Identify Patients who May be at Risk for a Potential Emergency
Nurse Applies the OB EWS Scoring System Upon Admission Each Assessment Change in Patient Condition
Each Parameter Range is Assigned a Numerical Score
Actions are Implemented on the Total OB EWS Score
Entire Clinical Picture Should be Considered when Making Care Decisions
Parameter Ranges & Numerical Scores
Scoring Parameters Respiratory Rate Heart Rate Blood Pressure Temperature Oxygen Saturation Level of
Consciousness Urine Output Fetal Heart Rate
Tracing Uterine Activity Bleeding
OB EWS
OB EWS Downtime Form
Required Interventions on
Back of Downtime Form
Updated Hourly
Automatically & Can be Manually
Refreshed as Often as
Necessary
Display of All Patient OB EWS Scores
Chalkboard View
OB EWS ~ CPN
Legend to Identify Numeric Value of
the Colors Displayed
Displays Most Recent Data &
Related Numerical Score
Notifications for Outdated or Missing Documentation that
Affect the Total Score
Nurse Can Refresh Calculations on Demand
If Score is Elevated, Nurse Can Easily Review
Parameters & Validate Accuracy
Recommended Interventions are Listed
on Same Screen for Quick Reference
Review ScreenOB EWS ~ CPN
Score Required Interventions
Green (0-1) Continue to monitor and document findings according to AWHONN maternal and fetal monitoring standards
Yellow (2-3)Review patient status with Shift Supervisor/Charge NurseIf intervention is required, primary RN will complete interventions, notify provider of concern & completed interventions, and continue to monitor
Orange (4-5)
Immediately review patient status with Shift Supervisor/Charge Nurse and notify providerIncrease monitoring frequency to every 5 to 15 minutes until score is 3 or lessOnce score is 3 or less, continue to monitor and document findings according to AWHONN maternal and fetal monitoring standards
Red (> 5) Call provider IMMEDIATELY and prepare for imminent delivery or maternal rescueBlack (> 99) Documentation missing or outdated…. Correct deficiencies and update score
InterventionsBased on Total Score from Tool
CONFIGURATIONS
Steps to Create OB EWS in CPN 1. Evaluate Documentation
Components2. Create Computed Items
… Lots & Lots of Them3. Develop Documentation
Reminders4. Create Review Summary Screens5. Create notification Alerts on
Chalkboards6. Validate Data & Ensuring
Accuracy7. Provide Education to Staff
Evaluate Documentation
Components
CONFIGURATIONS
AutoRecord Vital Signs
HR Resp Temperature NBPSYS NBPDIA SPO2
EGA Cesareans Urine Output
BHS Urine Output Total Q4
BHS Urine Output ml OR Urine Output
LOC Assessment Fetal Assessment
NICHD Decelerations Fetus A FHR Category Fetus A
Contraction Pattern Cesareans Bleeding
OB Hemorrhage Protocol
Induction Agents Cervical Ripening Agents Induction Agents Oxytocin
Infant Delivery Date Baby A
Documentation Components
CONFIGURATIONS
Cervical Ripening Agents0 Not Applicable1 Cervidil2 Foley Balloon3 Prepidil4 Cytotec5 Other
Oxytocin1 N/A2 Induction3 Augmentation
Induction Agents1 Pitocin Increased milliunits/min @2 Pitocin Decreased milliunits/min @ 3 Pitocin Restarted milliunits/min @ 4 Pitocin Started milliunits/min @5 Pitocin Discontinued
Documentation Components
LOC Assessment0 Alert1 Agitation or Confusion2 New Onset of Agitation or Confusion
3 Drowsy4 Drifts Off During Conversation- Responds to
Verbal Commands5 Somnolent- Responds to Painful Stimuli6 Non- Responsive to Painful Stimuli
NICHD Decelerations Fetus A1 None2 Early3 Late4 Variable5 Prolonged
FHR Category Fetus A1 Category I2 Category II3 Category III
CONFIGURATIONS
Documentation Components Contraction Pattern
1 Normal: < 5 Ctxs in 10 Minutes (Averaged over 30 mins)2 Tachysystole: > 5 Ctxs in 10 Minutes (Averaged over 30 mins)3 Irritability4 Preterm/Ante: < 5 Ctxs in an Hour5 Preterm/Ante: > 5 Ctxs in an Hour
Bleeding OBH Activate Checklist (Date Time Item)
Vaginal Delivery with EBL >500 Cesarean Section with EBL >1000
OBH Activate Stage II (Date Time Item) Delivery with EBL <1500 Continued Bleeding or Vital Sign Instability
OBH Activate Stage III (Date Time Item) Delivery with EBL >1500 > 2PRBCs Given, Vital Signs Unstable, Suspicion of DIC
CONFIGURATIONS
Added Options to Existing CPN Item. More Information to
Follow
Added Options to Existing CPN Item Will Discuss This Later On
Urine Output Urine Output ml (Ours is Named BHS Urine Output ml)
Numeric Item
OR Urine Output Numeric Item
BHS Urine Output Total Q4? %EXISTS ( Infant Birthdate and Time @ 0. ) \ %FAIL \\ ? %EXISTS ( AutoRecord ) & ( ~ %EXISTS ( BHS Urine Output ml @ 3.98 ) & ~ %EXISTS ( OR Urine Output @ 3.98 ) ) \ 0. \\ ? %EXISTS ( AutoRecord ) & ( ~ %EXISTS ( BHS Urine Output ml @ 3.98 ) & %EXISTS ( OR Urine Output @ 3.98 ) ) \ %SUM ( OR Urine Output @ 3.98 ) \\ ? %EXISTS ( AutoRecord ) & ( %EXISTS ( BHS Urine Output ml @ 3.98 ) & ~ %EXISTS ( OR Urine Output @ 3.98 ) ) \ %SUM ( BHS Urine Output ml @ 3.98 ) \\ %SUM ( BHS Urine Output ml @ 3.98 ) + %SUM ( OR Urine Output @ 3.98 )
We have this fail on all our maternal computes… will
exclude for rest of presentation for ease of viewing
Documentation Components
CONFIGURATIONS
Triggers & Computes
CONFIGURATIONS
AutoRecord Create a Numeric Item Called
AutoRecordOn the Server that Runs PtDs: Open Notepad
Document ||AutoRecord|||||1
Save File as AutoRecord.txt in d:\qs
Usually AutoRecord is created without write permissions. Write permissions are needed to refresh OB EWS on demand.
Include Write Permissions for Staff
Score Calculation Trigger CONFIGURATIONS
AutoRecord Create a Separate PtD Job for Every
Hour
Select the Units for OB EWS to Run
Select Active Patients
Remember to Cycle PtD
Enter File Named:\qs\AutoRecord.txt
-OR-
\\Servername\qs\AutoRecord.txt
Score Calculation Trigger CONFIGURATIONS
Score Calculation Computes
CONFIGURATIONS Complex Computes
OB EWS FHR OB EWS OBH OB EWS EGA Preterm Trigger OB EWS CS Trigger OB EWS UA Aug Trigger OB EWS UA Preterm OB EWS UA Preterm CS
OB EWS UA Term OB EWS UA Term CS OB EWS Total
Simple Range Computes OB EWS HR OB EWS LOC OB EWS NBPDIA OB EWS NBPSYS
OB EWS Resp OB EWS SPO2 OB EWS Temperature OB EWS Urine Output
OB EWS HR
? %EXISTS ( AutoRecord ) & ~ %EXISTS ( HR @ 4. ) \ 99. \\
? ( HR >= 130. ) \ 3. \\ ? ( HR >= 111. ) & ( HR <= 129. ) \ 2. \\ ? ( HR >= 101. ) & ( HR <= 110. ) \ 1. \\ ? ( HR >= 60. ) & ( HR <= 100. ) \ 0. \\ ? ( HR >= 41. ) & ( HR <= 59. ) \ 2. \\ ? ( HR <= 40. ) \ 3. \\ 0.
* Value of 99 is for Documentation Reminder Computes
Values Assigned to Ranges According to the OB EWS Tool
Simple Range Computes
CONFIGURATIONS
OB EWS FHR? %EXISTS ( AutoRecord ) & %EXISTS ( Infant Delivery Date Baby A @ 0. ) \ 0. \\
? %EXISTS ( AutoRecord ) & ~ %EXISTS ( FHR Category Fetus A @ 4. ) \ 99. \\
? ( FHR Category Fetus A = 1. ) \ 0. \\ ? ( FHR Category Fetus A = 2. ) & ( NICHD Decelerations Fetus A > 2. ) \ 2. \\ ? ( FHR Category Fetus A = 2. ) \ 1. \\ ? ( FHR Category Fetus A = 3. ) \ 3. \\ 0.
* Value of 99 is for Documentation Reminder Computes
* Value of “0” after Delivery to Continue Tool Postpartum
Why 2 Items if OB EWS is Calculated on Category? Category I = 0 Category II without Decelerations = 1 Category II with Decelerations = 2 Category III = 3
* Category II has two separate values depending on whether
there are decelerations present
Multiple Item ComputesCONFIGURATIONS
Here is Where it Gets Tricky…
Primarily Focuses on these Contraction Patterns Normal Uterine Activity Irritability Tachysystole < 5 Contractions in an hour > 5 Contractions in an hour
Multiple Item ComputesCONFIGURATIONS Next Parameter Addresses Varying Degrees of Uterine
Activity
Multiple Item ComputesCONFIGURATIONS
Term, Preterm, Laboring, Antepartum, Previous Cesarean, Augmentation
What About All the Other Variables?
Break it Down Into Small Computes First
…..Then Add Them All Together
Multiple Item ComputesCONFIGURATIONSTerm, Preterm, Laboring, Antepartum, Previous Cesarean, Augmentation
“Laboring or Antepartum” Difficult to Create into a Compute Tried to Avoid Adding Item to Current Nursing
Documentation Discussed Options with Nursing Staff Decision Made to Add Options to Existing Item
Contraction Pattern1 Normal: < 5 Ctxs in 10 Minutes (Averaged over 30 mins)2 Tachysystole: > 5 Ctxs in 10 Minutes (Averaged over 30 mins)3 Irritability4 Preterm/Ante: < 5 Ctxs in an Hour5 Preterm/Ante: > 5 Ctxs in an Hour
Multiple Item ComputesCONFIGURATIONSTerm, Preterm, Laboring, Antepartum, Previous Cesarean, Augmentation
OB EWS EGA Preterm Trigger? %EXISTS ( Infant Delivery Date Baby A @ 0. ) \ 0. \\ ? ( %EXISTS ( EGA based on EGA in 7th EWS ) ) & ( ( EGA based on EGA in 7th EWS ) < 37. ) \ 1. \\ 0.
“Term or Preterm” Is the Patient Preterm? … Yes or
No
“Term or Preterm” Is the Patient Preterm? … Yes or
No
“Previous Cesarean” Is the Patient a Previous Cesarean Section? …
Yes or No
Multiple Item ComputesCONFIGURATIONSTerm, Preterm, Laboring, Antepartum, Previous Cesarean, Augmentation
OB EWS EGA Preterm Trigger
OB EWS CS Trigger
? %EXISTS ( Infant Delivery Date Baby A @ 0. ) \ 0. \\ ? ( %EXISTS ( EGA based on EGA in 7th EWS ) ) & ( ( EGA based on EGA in 7th EWS ) < 37. ) \ 1. \\ 0.
? ( Cesareans @ 0. ) > 0. \ 1. \\ 0.
“Augmentation” Is the Patient Being Induced or Augmented? …
Yes or No Several Medication Items in CPN
Multiple Item ComputesCONFIGURATIONSTerm, Preterm, Laboring, Antepartum, Previous Cesarean, Augmentation
OB EWS Aug Trigger? ~ %EXISTS ( AutoRecord ) \ %FAIL \\ ? ( Cervical Ripening Agents @ 0. ) = 1. \ 1. \\ ? ( Cervical Ripening Agents @ 0. ) = 3. \ 1. \\ ? ( Cervical Ripening Agents @ 0. ) = 4. \ 1. \\ ? ( Oxytocin @ 0. ) > 0. \ 1. \\ ? ( Induction Agents @ 0. ) = 1. \ 1. \\ ? ( Induction Agents @ 0. ) = 2. \ 1. \\ ? ( Induction Agents @ 0. ) = 3. \ 1. \\ ? ( Induction Agents @ 0. ) = 4. \ 1. \\ 0.
CONFIGURATIONS Multiple Item Computes
Too Many Variables to Capture All Variations in One Compute
Create 4 Separate Patient Type Computes
Only One of These Will Yield Answer Remaining Three will Fail with Zero
All Computes Need to Have Numeric Answers for CPN to %SUM Final Score
Instead of %FAIL Use a Zero in these Formulas All 4 Will be Included in Final Total Compute Calculation
No History of CS Previous CS
Term OB EWS UA Term OB EWS UA Term CS
Preterm
OB EWS UA Preterm
OB EWS UA Preterm CS
Term, Preterm, Laboring, Antepartum, Previous Cesarean, Augmentation
…Let’s Take a Look at OB EWS UA Term
OB EWS UA Term One of Four Patient Types
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
…Don’t Panic, Let’s Break It Down
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Did the Patient Already Deliver? Yes… It Stops and Provides a Result of 0 No… It Looks at the Next Variable
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Is the Patient Preterm? Yes… It Stops and Provides a Result of 0 No… It Looks at the Next Variable
…Remember, This Formula is Looking for a TERM Patient Only
We Have a Separate Compute for Preterm Patients
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Is the Patient a Previous Cesarean? Yes… It Stops and Provides a Result of 0 No… It Looks at the Next Variable
…Remember, This Formula is Looking for a Patient that has not had a CSWe Have a Separate Compute for Previous CS Patients
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Did the Nurse Document on Contractions in the Last 4 Hours? No… It Stops and Provides a Result of 99 Yes… It Looks at the Next Variable
OB EWS is Calculated on Current Documentation OnlyThe Result of 99 will Trigger a Documentation Reminder on the Review Screen
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Does the Patient Have Tachysystole? Yes… It Stops and Provides Score of 3 No… It Looks at the Next Variable
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Is the Patient Being Induced or Augmented for Labor ? Yes… It Stops and Provides Score of 1 No… It Looks at the Next Variable
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Is the Patient Experiencing Uterine Irritability? Yes… It Stops and Provides Score of 1 No… It Looks at the Next Variable
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
Remaining Values for Contraction Pattern Have No Score Value for Term Patients and Result in 0
OB EWS UA Term
? %EXISTS (AutoRecord) & %EXISTS (Infant Delivery Date Baby A @ 0.)\ 0.\\ ? (%EXISTS (OB EWS EGA Preterm Trigger @ 0.) & (OB EWS EGA Preterm Trigger @ 0.) = 1.)\ 0.\\? (%EXISTS (OB EWS CS Trigger @ 0.) & (OB EWS CS Trigger @ 0.) = 1.)\ 0.\\ ? %EXISTS (AutoRecord) & ~ %EXISTS (Contraction Pattern @ 4.)\ 99.\\ ? (Contraction Pattern) = 2.\ 3.\\ ? (%EXISTS (OB EWS UA Aug Trigger @ 0.) = 1.) & (%EXISTS (Contraction Pattern))\ 1.\\ ? (Contraction Pattern @ 0.) = 3.\ 1.\\ ? (Contraction Pattern @ 0.) = 1.\ 0.\\ ? (Contraction Pattern @ 0.) = 5.\ 0.\\ ? (Contraction Pattern @ 0.) = 4.\ 0.\\ 99.
CONFIGURATIONS Multiple Item Computes
…Same Process for all 4 Patient Types
OB EWS Total
? %EXISTS ( AutoRecord ) \ ( OB EWS LOC @ 12.) + ( OB EWS HR @ 12.) +( OB EWS NBPSYS @ 12.)+ ( OB EWS NBPDIA @ 12.) + ( OB EWS Resp @ 12.) +( OB EWS FHR @ 12.) + ( OB EWS Temperature @ 12.) + ( OB EWS SPO2 @ 12.) + ( OB EWS OBH @ 12.) + ( OB EWS Urine Output @ 12.) + ( OB EWS UA Term @ 12.) + ( OB EWS UA Term CS @ 12.) + ( OB EWS UA Preterm @ 12.) + ( OB EWS UA Preterm CS @ 12.) \\ 1000.
…And Now You Have an OB EWS Score
CONFIGURATIONSScore Calculation Computes
Documentation Reminders
& Review Screens
CONFIGURATIONS
Documentation Reminders
OB EWS CS Document OB EWS FHR Document OB EWS HR Document OB EWS LOC Document OB EWS NBPDIA Document OB EWS NBPSYS Document OB EWS Resp Document OB EWS Temp Document OB EWS UA Document OB EWS Urine Output Document
CONFIGURATIONS
CONFIGURATIONS OB EWS FHR
Document
Documentation Reminders
Formula is Item Name as OB EWS Items Already Contains Compute to Capture Missing
Documentation (*99)
Create Computed Text Item Reminders Range & Text:
0-10 Documented 99-100 FHR Category Documentation Missing or Outdated
Create For Each Required Item for Score Calculation
Create Documentation Review Summary Form Normal Form - Not Date/Time Form Read Only, No Write Permissions on Items
OB EWS Review
Place Form on Quick Keys for Easy Access
CONFIGURATIONS Summary Screens
Add Documentation Components as “Read Only” … HR Create Info Boxes Next to Each Item for Documentation
Reminder Compute … OB EWS HR Document
Use Info Boxes to Display Reminders in Color Add Items Individual Scores for Staff Reference… OB EWS
HR
CONFIGURATIONS Summary Screens
Item from Charting
Documentation Reminder Compute
Score Assigned to Value of Item
CONFIGURATIONS Summary Screens
Documentation Complete and Within Previous Four Hours
Score Within Normal Limits
What the Nurse Sees…
CONFIGURATIONS Summary Screens
Documentation Needs Updating
Score Outside Range
What the Nurse Sees…
CONFIGURATIONS Summary Screens
Missing or Outdated Documentation Individual Item Scores will Display “99” Documentation Missing will Display in Red in the Info Box Staff Returns and Corrects Deficiencies in Chart
Since OB EWS Score Only Automatically Updates Hourly, Will Need to Create Ability to Manually Trigger the Score to Update Once Deficiencies are Corrected
Add Push Button to OB EWS Review Form Set to Prompt for New Form Each Time
Opened
CONFIGURATIONS Summary Screens
Create an Additional Form to Trigger OB EWS Score
Create a Date/Time Form OB EWS Update AutoRecord Item
Created Earlier
Include “New Button” & “Ok Button” on Form Properties
Add AutoRecord Item on Form Add Text Box with Instructions to Staff
Chalkboard Notifications
CONFIGURATIONS
CONFIGURATIONS Create Visual Alerts by Adding to Unit
ChalkboardsProvides Centralized View of All Patients on the Unit
Add Item OB EWS Total to {{DS PatientData}}
Cycle PDSS Add to Beds on Chalkboard
Insert as “LED” for Color Alert Display
Patient Name OB EWS
CONFIGURATIONS Assign LED Colors for Ranges
Note Colors Used in Color Assignment for Legend
Select Style then Color Assignment
Note: Ranges are “Inclusive” on Chalkboards
Create Legend at Bottom of Chalkboard
Cycle CDSS and PDATS on All Workstations
Select Style then Color Assignment
To Update Colors, Delete
Color Assignment
OB EWS Chalkboard
Staff Education Flyers
QUESTIONS?
Thank You
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