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Maternal Fetal Triage Index

1 Contact Hour
This peer reviewed course is applicable for the following professions:
Advanced Registered Nurse Practitioner (ARNP), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Registered Nurse (RN)
This course will be updated or discontinued on or before Wednesday, January 12, 2022
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. did not endorse any product, or receive any commercial support or sponsorship for this course. The Planning Committee and Authors do not have any conflict of interest.

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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.1” 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, so this 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 unpredictable census, chief complaints, and unexpected challenges.2

Prior to 2007, a maternal fetal triage assessment tool did not exist. Since that time, 3 tools have been created.2 The newest, evidence-based tool created by the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) was developed in 2015.3 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.4 ACOG believes that triage guidelines could improve the quality and efficiency of care that women receive when going to labor and delivery.

Obstetric triage patients can increase the volume of a labor and delivery unit by 20-50%. As many as 1/3 of all women that present to labor and delivery go home without delivering their baby.5 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 that 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.6 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.7 These categories will also determine the time in which 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 has been adapted and is used to determine acuity of patients.5

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 is having 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 who is scheduled for a non-stress test with no complaints would be placed in the fifth category, or scheduled.5 Currently, this is the only triage assessment tool that has been validated.

The categories should guide the nurses and providers as to 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 who is 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 given time. Nursing units are not often staffed for the 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 of care 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.5 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 have patient assignments when these 2 women arrive. 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 determine which patient needs to receive medical treatment first.

Discussion of Outcomes

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

Strengths and Weaknesses of the Approach Used in the Case Study

A 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

  1. Women's Health Perinatal Nursing Care Quality Measures - Association of Women's Health, Obstetric and Neonatal Nurses.Accessed November 20, 2019. Visit Source.
  2. 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.
  3. Killion MM. The Maternal Fetal Triage Index. MCN, The American Journal of Maternal/Child Nursing. 2016;41(6):372. doi:10.1097/nmc.0000000000000280.
  4. 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.
  5. Committee Opinion No. 667 Summary. Obstetrics & Gynecology. 2016;128(1):228. doi:10.1097/aog.0000000000001522.
  6. Emergency Medical Treatment & Labor Act (EMTALA). CMS. Accessed November 20, 2019. Visit Source.
  7. 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.