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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
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| systematic cervical exam training--retrospective measures | Experimental | Effects of systematic cervical exam training on Labor and Delivery Care The total number of exams per hour of labor or triage stay and exam discrepancy between 2 examiners who performed exams less than 30 minutes apart will be compared between the 6 month time period before the unit wide training and 6 months after completing training |
|
| systematic cervical exam training--prospective measures | Experimental | Effects of systematic cervical exam training on Labor and Delivery care Patient will be approached to obtain consent for them to have 2 cervical exams performed one after the other when an exam is clinically indicated. The discrepancy between the 2 examiners will be compared between the 6 month time period before the unit wide training and 6 months after completion of the training. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| cervical exam training | Behavioral | 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 |
| Measure | Description | Time Frame |
|---|---|---|
| Number of repetitions needed to obtain competence | The number of simulated cervical exams each provider needs to reach a pre-specified level of accuracy. | 3 month training period |
| Number of exams patients receive | Number of exams per hour of labor or triage visit | Six months period before training |
| Number of exams patients receive | Number of exams per hour of labor or triage visit | Six month post training |
| Measure | Description | Time Frame |
|---|---|---|
| Discrepancy between 2 cervical exam assessments--retrospective | 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% | Six months period before training and Six months period post training completion |
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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:
Physicians, nurses and nurse midwives: any gender Patients: pregnant women only
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Joshua F Nitsche, MD | Contact | 336.716.6893 | Joshua.Nitsche@advocatehealth.org | |
| Devin M Fariss | Contact | 336.716.4594 | Devin.Fariss@Advocatehealth.org |
| Name | Affiliation | Role |
|---|---|---|
| Joshua F Nitsche, MD | Wake Forest University Health Sciences | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Wake Forest University Health Sciences | Recruiting | Winston-Salem | North Carolina | 27157 | United States |
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| ID | Term |
|---|---|
| D004420 | Dystocia |
| ID | Term |
|---|---|
| D007744 | Obstetric Labor Complications |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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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
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| Discrepancy between 2 cervical exam assessments--prospective |
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% |
| Six months period before training and Six months period post training completion |