The value of a teardrop alert system

The value of a teardrop alert system

N Ryan (1), AM Verling (1,2), NE Russell (1,2), K O’Donoghue (1,2,3)

(1) Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland, (2) National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland, (3) The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Ireland

Introduction:
In 2009, a “Teardrop Stillbirth Alert Symbol” was introduced in CUMH. This was placed on the woman’s paper clinical notes when she had previously experienced perinatal loss or perinatal loss was anticipated in her current pregnancy. The function of this symbol was to alert staff to ensure all communication was appropriate and thereby avoid exacerbating patient distress. In 2016, an electronic chart (MN-CMS) was launched in CUMH which aimed to improve patient care by better recording of information. The aims of this study were (i) To assess staff opinion on the use of the pregnancy loss alert symbols (ii) To determine how accessible it is for staff to find information relating to stillbirth on the electronic record (MN-CMS).

Methods:
A survey was distributed to 300 clinical staff in CUMH.

Results:
There was a 52% response rate to the staff survey. The majority of participants (93%) stated that previous use of the teardrop symbol on paper notes had been helpful in their practice. There was significant support (97%) for the introduction of a similar alert symbol on the MN-CMS. When reviewing the MN-CMS charts, only 36% of those where the woman had experienced a previous stillbirth were identifiable or “flagged” with a generic red flag or the word “flagged” on the main maternity view banner. In the majority of these flagged charts (64%), it took more than 20 clicks to identify why the chart was flagged. This made it difficult for staff to identify patients with a previous stillbirth. Worrying, 14% of charts were still open, suggesting that the pregnancy was still ongoing despite the pregnancy ending in a stillbirth.

Conclusion:
While the electronic record is a valuable tool, the introduction of a specific pregnancy loss alert symbol would benefit clinical practice. There is a need for ongoing further education and training in navigating the MN-CMS, so that important information can be easily identified. It is important that we maintain the human essence of a patient chart as we move to an electronic era of information recording.

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