Practices and views on fetal heart monitoring

A structured observation and interview study

S. Altaf, C. Oppenheimer, Rachel L. Shaw, J. Waugh, M. Dixon-Woods

Research output: Contribution to journalArticle

Abstract

Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.

Original languageEnglish
Pages (from-to)409-418
Number of pages10
JournalBJOG
Volume113
Issue number4
DOIs
Publication statusPublished - Apr 2006

Fingerprint

Fetal Monitoring
Fetal Heart
Observation
Interviews
Midwifery
Practice Guidelines
Cardiotocography
Guidelines
Equipment and Supplies
Professional Practice
Teaching Hospitals
Documentation
Software
Maintenance
Outcome Assessment (Health Care)

Keywords

  • fetal monitoring
  • guidelines
  • qualitative
  • quality and safety

Cite this

Altaf, S. ; Oppenheimer, C. ; Shaw, Rachel L. ; Waugh, J. ; Dixon-Woods, M. / Practices and views on fetal heart monitoring : A structured observation and interview study. In: BJOG. 2006 ; Vol. 113, No. 4. pp. 409-418.
@article{eac5766363e84a63984de46559564cd1,
title = "Practices and views on fetal heart monitoring: A structured observation and interview study",
abstract = "Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80{\%}) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. {\circledC} RCOG 2006.",
keywords = "fetal monitoring, guidelines, qualitative, quality and safety",
author = "S. Altaf and C. Oppenheimer and Shaw, {Rachel L.} and J. Waugh and M. Dixon-Woods",
year = "2006",
month = "4",
doi = "10.1111/j.1471-0528.2006.00884.x",
language = "English",
volume = "113",
pages = "409--418",
journal = "BJOG",
issn = "1470-0328",
publisher = "Wiley-Blackwell",
number = "4",

}

Practices and views on fetal heart monitoring : A structured observation and interview study. / Altaf, S.; Oppenheimer, C.; Shaw, Rachel L.; Waugh, J.; Dixon-Woods, M.

In: BJOG, Vol. 113, No. 4, 04.2006, p. 409-418.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Practices and views on fetal heart monitoring

T2 - A structured observation and interview study

AU - Altaf, S.

AU - Oppenheimer, C.

AU - Shaw, Rachel L.

AU - Waugh, J.

AU - Dixon-Woods, M.

PY - 2006/4

Y1 - 2006/4

N2 - Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.

AB - Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.

KW - fetal monitoring

KW - guidelines

KW - qualitative

KW - quality and safety

UR - http://www.scopus.com/inward/record.url?scp=33645223719&partnerID=8YFLogxK

UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2006.00884.x/abstract

U2 - 10.1111/j.1471-0528.2006.00884.x

DO - 10.1111/j.1471-0528.2006.00884.x

M3 - Article

VL - 113

SP - 409

EP - 418

JO - BJOG

JF - BJOG

SN - 1470-0328

IS - 4

ER -