Document Detail

Electronic fetal monitoring. Are we meeting documentation standards?
MedLine Citation:
PMID:  10360257     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To test whether fetal heart rate documentation requirements for high-risk pregnancies are too stringent to achieve compliance, especially during the second stage of labor. STUDY DESIGN: Random retrospective chart and monitor strip review of deliveries occurring one year earlier were reviewed. Thirty-four low-risk and 34 high-risk pregnancies were selected and assessed for compliance with nationally accepted documentation guidelines. RESULTS: All monitor strips and charts were successfully retrieved from medical records. Charted documentation of the strips met national requirements in the active phase of the first stage of labor in 97% of cases, as did documentation during the second stage. For high-risk pregnancies, compliance during the active phase of the first stage of labor was 65% as compared to 35% in the second stage. All infants had normal five-minute Apgar scores, and none had umbilical arterial acidemia. CONCLUSION: Given current resources, we cannot reliably meet established documentation standards for high-risk pregnancies. Such overly stringent documentation standards pose a significant risk in cases going to litigation. A standard should be developed that is based on outcome data.
G D Hankins; T Leicht; G D Anderson; T F Rowe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of reproductive medicine     Volume:  44     ISSN:  0024-7758     ISO Abbreviation:  J Reprod Med     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-08-30     Completed Date:  1999-08-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0173343     Medline TA:  J Reprod Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  441-4     Citation Subset:  IM    
Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston 77555-0587, USA.
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MeSH Terms
Documentation / standards*
Fetal Monitoring / standards*
Heart Rate, Fetal
Medical Records / standards
Outcome Assessment (Health Care)*
Patient Compliance*
Pregnancy Outcome
Pregnancy, High-Risk
Reference Values
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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