Cervix; Pregnancy, Delivery Problem, Pregnancy Related
Conditions
Keywords
vaginal delivery, labor cervical exam, labor and delivery
Brief summary
All physicians, nurses, and nurse midwives working on Labor and Delivery will be required to complete cervical exam simulation training. Data before and after institution of the training will be compared to determine if the training leads to less cervical exams during labor and increases consistency between examiners
Detailed description
The labor cervical exam is the cornerstone of the management of labor as the accurate assessment of cervical dilation and effacement are crucial in recognizing a normal labor from and abnormal one. To enhance accuracy and precision among healthcare providers working on Labor and Delivery we have created a high fidelity cervical exam simulator. All providers working on Labor and Delivery Repetitive will be required to practice on the simulators until a pre-specified level or accuracy is achieved. We will prospectively and retrospectively assess the number of cervical exams a women receives and the discrepancy between exams performed by 2 different providers both before and after the training is instituted.
Interventions
BEHAVIORALcervical exam training
Each nurse will then examine 1 sets of 10 high-fidelity silicone task trainers approximately three per week for a maximum of 20 sessions (200 repetitions total). For each set of 10 exams, the estimates will recorded on an answer sheet. A cumulative summation analysis will be performed on each participant. When an individual nurse achieves competence her training will be suspended
Sponsors
Wake Forest University Health Sciences
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
The total number of exams per hour of labor or triage stay and exam discrepancy between 2 examiners will be compared between the 6 month time period before training and 6 months after all nurses have completed the training
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Healthcare providers: • physicians, midwives, and labor and delivery nurses working on the Labor and Delivery unit within the Wake Forest Baptist Birth Center Patients: • any pregnant women receiving care on the Labor and Delivery unit of Wake Forest Baptist Birth Center
Exclusion criteria
Healthcare providers: • none Patients: * placenta previa * vasa previa * any other contraindication to cervical exam
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of repetitions needed to obtain competence | 3 month training period | The number of simulated cervical exams each provider needs to reach a pre-specified level of accuracy. |
| Number of exams patients receive | Six months period before training | Number of exams per hour of labor or triage visit |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Discrepancy between 2 cervical exam assessments--retrospective | Six months period before training and Six months period post training completion | Discrepancy between 2 exam assessments performed less than 30 minutes apart by 2 different examiners: Cervix Dilation will be reported as 1-10 cm Cervix Effacement will be reported as 0% -100% |
| Discrepancy between 2 cervical exam assessments--prospective | Six months period before training and Six months period post training completion | Discrepancy between 2 exam assessments performed one after the other by 2 different examiners: Cervix Dilation will be reported as 1-10 cm Cervix Effacement will be reported as 0% -100% |
Countries
United States
Contacts
CONTACTJoshua F Nitsche, MD
CONTACTDevin M Fariss
PRINCIPAL_INVESTIGATORJoshua F Nitsche, MD
Wake Forest University Health Sciences
Outcome results
None listed