Improving Nurses' Management of Uterine Tachysystole.

Abstract

Purpose: To evaluate the incidence of uterine tachysystole and determine if nurses' management of tachysystole using an artificial intelligence-enabled clinical decision support (cEFM-aiCDS) alert system alone and in combination with an education module about tachysystole could be improved.

Study design methods: Phase I involved a pre-post study design comparing the incidence and management of tachysystole in patients having labor induction after implementation of the cEFM-aiCDS alert system. Phase II involved a one-group pre-post quasi-experimental design to evaluate the effect of offering a comprehensive educational module about tachysystole to nurses using the alert system. Outcomes measured included nurses' knowledge, management, and incidence of tachysystole, and duration of the alerts. Data collection used system reporting and medical record reviews that occurred between January 2020 and August 2024.

Results: Phase I found no significant difference in the number of tachysystole events ( p = .626) or management of tachysystole with the decrease or discontinuance of oxytocin after implementation ( p = .603). In phase II, of the 210 labor nurses, 66 participants, representing 31.4% of the potential sample completed the educational module on tachysystole. Phase II found no change in the incidence of tachysystole among all births ( p = .945) and in those patients who experienced a Category II/III fetal heart rate pattern after implementing an educational intervention ( p = .070). The number of prolonged alerts also did not change ( p = .377). Phase II found a significant improvement in the timely management of tachysystole with evidence-based intervention in the presence of Category II/III fetal heart rate pattern ( p < .001). However, Phase II found no change in the incidence of tachysystole among all births ( p = .945) and in those patients who experienced a Category II/III fetal heart rate pattern after implementing an educational intervention ( p = .070). The number of prolonged alerts also did not change ( p = .377).

Clinical implications: Offering a comprehensive educational module about tachysystole combined with a cEFM-aiCDS alert system was associated with an improvement in nurses' management of tachysystole; however, these results should be interpreted with caution as only about one-third of the labor nurses participated in the education module.