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Maternal Fetal Triage Index

1 Contact Hour
This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Nurse Midwife, Certified Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Registered Nurse (RN), Registered Nurse Practitioner
This course will be updated or discontinued on or before Friday, January 12, 2024

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


Outcomes

Participants will understand what a maternal-fetal triage tool is and how to apply it clinically.

Objectives

After completing this continuing education course, the participant will:

  1. Describe a maternal-fetal triage tool.
  2. Apply a tool to their patients.
  3. Develop a plan of care for their patients based on the tool.
  4. Identify how the tool can improve time to treatment.
  5. Relate the use of a tool to improve patient outcomes.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Kelly LaMonica (DNP(c), MSN, RNC-OB, EFM)

History of Maternal Fetal Triage

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) defines obstetric (OB) triage as "the brief, thorough, and systematic maternal and fetal assessment performed when a pregnant woman presents to care to determine priority for full evaluation (AWH, n.d. )" A maternal fetal triage assessment tool is a tool that can be used for nurses to determine the medical and nursing needs of the pregnant woman who arrives at a triage unit or labor and delivery unit. Not all hospitals have maternal fetal triage units, which may occur in the labor and delivery unit. "OB triage is a multidisciplinary specialty within the labor and delivery unit. It is comparable to an emergency department with an unpredictable census, chief complaints, and unexpected challenges (Quaile, 2018)."

Prior to 2007, a maternal fetal triage assessment tool did not exist. Since then, 3 tools have been created (Quaile, 2018). The newest, evidence-based tool created by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) was developed in 2015 (Killion, 2016). Not all hospitals have adopted a tool for triaging patients.

The Need for Maternal Fetal Triage

Women frequently come to labor and delivery units for triage as a non-pregnant woman would go to the Emergency Department, where triage levels are used. The American College of Obstetricians and Gynecologists (ACOG) has released a committee opinion that supports the use of maternal fetal triage guidelines (Smithson, 2013). ACOG believes that triage guidelines could improve the quality and efficiency of women's care when going to labor and delivery.

Obstetric triage patients can increase the labor and delivery unit volume by 20-50%. As many as 1/3 of all women who present to labor and delivery go home without delivering their baby (CO, 2016). These increased volumes can impact patient care and outcomes. Nurses need a way to evaluate the pregnant woman and determine the level of care needed and the speed at which care must be given.

According to the federal Emergency Medical Treatment and Labor Act (EMTALA), all pregnant women who present to a hospital must receive an initial medical screening exam to determine if a medical emergency exists, regardless of the patient's ability to pay or where the woman usually received care (EMTALA, 2019). Women who are not determined to have an emergency may be transferred if appropriate.

How to use a Maternal Fetal Triage Assessment Tool

Different tools may look different and use slightly different criteria. The tool will have categories into which the patient should be classified (Ruhl, 2015). These categories will also determine when the woman should be treated.

The obstetric triage acuity scale is a 5-category system that determines when women should be admitted and the times within an assessment should occur. This system does not have good data to support its use, but it has been adapted and used to determine patients' acuity (CO, 2016).

The AWHONN maternal fetal triage index has 5 categories. The nurse who sees the patient first (or triages them) would use this tool to determine which category the patient belongs in. For example, a woman who comes to the unit via stretcher and has a seizure would be placed into the first category or stat. A woman with decreased fetal movement or a recent trauma would be placed in the second category, or urgent. A woman ≥ 34 weeks in active labor would be placed in the third category, or prompt. A woman ≥ 37 weeks in early labor would be placed in the fourth category, or non-urgent. A woman scheduled for a non-stress test with no complaints would be placed in the fifth category or scheduled (CO, 2016). Currently, this is the only triage assessment tool that has been validated.

The categories should guide the nurses and providers when the woman will receive treatment. Each case needs to be evaluated using critical thinking, but these are basic criteria to help guide the nurse and provider. A woman brought in after a motor vehicle accident with abdominal trauma should take precedence over a woman who is 37 weeks gestation and comes in because her water broke.

Each hospital should choose a maternal fetal triage assessment tool to guide the care of the woman who arrives at labor and delivery for triage.

Improved Outcomes

A labor and delivery unit is like an Emergency Department, where the next patient is usually unknown. One woman or 5 women may walk in the door at any time. Nursing units are not often staffed for walk-in patients. Triage patients are usually not included in staffing ratios, even though they require nursing time. The number of providers and resources may also be limited depending on the size and area of the hospital. At any time, a woman or her fetus may be in a life or death situation. Having a maternal fetal triage tool in place to guide the care and timeliness may improve the outcome for the mother, fetus, or both. Women in labor and delivery units should not receive care in the order of arrival. They must be cared for in order of priority (CO, 2016). A process to evaluate maternal and fetal status in a triage setting is important to ensure the best outcomes for the woman and her baby.

Case Study

Two pregnant women arrive in a busy labor and delivery unit for triage. All nurses had patient assignments when these 2 women arrived. Both women go into evaluation rooms. A nurse goes into each room. One woman is 35 weeks with heavy bleeding. The other woman is 41 weeks in early labor. Using a triage tool, the RN knows that she must triage the bleeding woman first.

Intervention/Strategies

Using a maternal fetal triage tool, the RN will first determine which patient needs to receive medical treatment.

Discussion of Outcomes

With a triage tool, the RN will see the bleeding woman first because a placental abruption could put the woman or fetus at risk.

Strengths and Weaknesses of the Approach Used in the Case Study

An RN with experience may already know that a bleeding pregnant woman is at higher risk of a complication, but a new nurse may think that the 35-week woman is too early to deliver and choose to see the early labor patient first. Using this tool will also enable the nurse to determine that this patient needs care urgently.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

References

  • Association of Women's Health, Obstetric and Neonatal Nurses. Women's Health Perinatal Nursing Care Quality Measures Accessed November 20, 2019. Visit Source.
  • Committee Opinion No. 667 Summary. Obstetrics & Gynecology. 2016;128(1):228. doi:10.1097/aog.0000000000001522.
  • Emergency Medical Treatment & Labor Act (EMTALA). CMS. Accessed November 20, 2019. Visit Source.
  • Killion MM. The Maternal Fetal Triage Index. MCN, The American Journal of Maternal/Child Nursing. 2016;41(6):372. doi:10.1097/nmc.0000000000000280.
  • Quaile H. Implementing an Obstetrics-Specific Triage Acuity Tool to Increase Nurses' Knowledge and Improve Timeliness of Care. Nursing for Womens Health. 2018;22(4):293-301. doi:10.1016/j.nwh.2018.05.002.
  • Ruhl C, Scheich B, Onokpise B, Bingham D. Content Validity Testing of the Maternal Fetal Triage Index. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2015;44(6):701-709. doi:10.1111/1552-6909.12763.
  • Smithson DS, Twohey R, Rice T, Watts N, Fernandes CM, Gratton RJ. Implementing an obstetric triage acuity scale: interrater reliability and patient flow analysis. American Journal of Obstetrics and Gynecology. 2013;209(4):287-293. doi:10.1016/j.ajog.2013.03.031.