A Multimethod Improvement Project to Strengthen Intermittent Auscultation Practice Among Nurse-Midwives and Nurses

Area of Science:

• Perinatal Care
• Quality Improvement in Healthcare
• Obstetric Nursing

Background:

• Intermittent auscultation (IA) is the standard for intrapartum fetal assessment in low-risk individuals and birth centers.
• Conflicting national guidelines and minimal formal training lead to variable IA skills among perinatal care providers.
• This study addresses the need to strengthen IA skills in nurse-midwives and nurses.

Purpose of the Study:

• To design, implement, and evaluate a quality improvement program to enhance intermittent auscultation (IA) skills.
• To improve the consistency of IA practice and documentation among nurse-midwives and nurses.
• To address deficits in IA training and skill application in clinical settings.

Main Methods:

• Implementation in a multisite network of freestanding birth centers.
• Development of clinical practice guidelines for IA.
• Utilized simulation-based training, audit and feedback, in-person training, and electronic health record configuration.

Main Results:

• Training led to self-reported increases in knowledge across all assessed areas.
• The quality improvement initiative significantly improved the consistency of IA practice.
• Documentation consistency also showed substantial improvements following the program.

Conclusions:

• Policy changes alone are insufficient to improve the nuanced skill of IA.
• Comprehensive training strategies, including simulation and feedback, are crucial for skill enhancement.
• Integrating policy with robust training and supportive electronic health record systems improves clinical practice.