A labor nurse reviews the fetal heart rate (FHR) tracing and discusses its interpretation in French with a nurse colleague. The other nurse doesn't speak French well; she usually communicates about FHR patterns in Spanish. Communication with the attending physician is challenging because her first language is Portuguese, although she has some understanding of French when it pertains to FHR patterns. The resident physician has visited France, but he communicates best in Italian. The medical record documentation system is in English. Does this sound like safe practice to you? Yet, a similar situation occurs every day in many labor units in which members of the perinatal team have not decided on which language will be used to communicate about FHR patterns.

There are several languages (or nomenclatures) for electronic fetal monitoring (EFM) including: 1. those described in the Association of Women's Health, Obstetric and Neonatal Nurses (Feinstein, Torgersen, & Atterbury, 2003) Fetal Heart Monitoring Principles and Practices text; 2. the American College of Obstetricians and Gynecologists (ACOG, 1995) Technical Bulletin Fetal Heart Rate Patterns: Monitoring, Interpretation and Management; and 3. the National Institute of Child Health and Human Development (NICHD, 1997) Research Planning Workshop. Each has differences in the terms and descriptions for common FHR patterns, and none have been shown to be more reliable or valid than another. Therefore, the critical issue is for labor units to selectone set of definitions for FHR patterns and consistently use it in all types of professional communication.

The NICHD nomenclature was developed by an interdisciplinary panel of experts, convened by the National Institutes of Health. Thus, it is the result of a workgroup with members not having an affiliation with a specific medical or nursing association. This neutrality may make it more likely to be adopted by all members of the perinatal team. An advantage to the NICHD nomenclature is its simplicity, with objective criteria developed to describe various FHR patterns. Vague terms and overly complex descriptions have been excluded. If the NICHD language is chosen, there is a certification process for both nurses and physicians through the National Certification Corporation (NCC).

All perinatal staff should participate in education about the chosen language together, even though it has not been traditional for nurses and physicians to attend the same EFM classes. Certification in EFM could encourage ongoing education for nurses and physicians as a team. The medical record documentation system should be keyed to the language. All prompts, cues, and free text documentation about EFM should be in sync on both the paper forms and in the electronic system. Physician progress notes should coincide as well.

A common language enhances interdisciplinary communication and, thus, promotes patient safety. The chances of miscommunication, especially during telephone conversations about fetal status, are decreased when everyone speaks and understands the same EFM language. Therefore, timely recognition and clinically appropriate intervention during nonreassuring FHR patterns is more likely. In addition to promoting safe care, if the case is reviewed retrospectively in litigation, the use of a common EFM language leads to a defensible medical record that supports the excellent care that was provided and the clear communication that occurred between professionals.

Electronic Fetal Monitoring Language Guidelines

Choose one language to be used exclusively in all professional communication about EFM.

Educate all members of the perinatal team about the EFM language that has been selected using an interdisciplinary process with nurses and physicians learning together. Support periodic continuing education as science and evidence evolves.

Consider certification in EFM for all members of the perinatal team. Revise all medical record forms and electronic system pick-lists to coincide with this language.

References