Do we handle fetal heart Traces correctly? A completed audit cycle

Abstract

INTRODUCTION: Electronic fetal monitoring has become an integral part of modern obstetric practice. Appropriate use and interpretation of CTG is necessary to achieve the expected benefits of electronic fetal monitoring. On the other hand incorrect usage of it can lead to unnecessary interventions. OBJECTIVE: To audit the standards of interpretation of and documentation on intrapartum CTGs. METHOD: An audit was conducted to assess the standard of documentation on the CTG, accuracy of interpretationand the appropriateness of subsequent action taken. Ninety six CTGs taken in July and August 2007 were audited according to standards given in NICE guidelines. The findings of the audit were presented to the team members and a discussion was conducted to improve awareness. A re -audit was conducted during the subsequent week and another 69 CTGs were studied. RESULTS: There were 96 CTGs audited during the first cycle. Patients name, date and time of taking the CTG were mentioned in 79(82.3%), 78(81.3%) and 79(82.3%) of CTGs respectively. Though 78(81.3%) CTGs were signed, the time of seeing the CTG was mentioned only in 19 (19.8%). Although an opinion about the CTG was given in 59 (61.5%), the fetal heart tracing was described only in 13 (13.5%) cases. Most of the interpretations were correct and the subsequent action taken was appropriate. Sixty nine CTGs were audited during the second cycle. Documentation showed a significant improvement with patients name date and time being documented on 64(92.8%), 65(94.2%), 67(97.1%) of CTGs respectively. Majority 56(81.2%) was signed and the time of seeing was noted in 47(68.7%) of CTGs. Comparatively higher proportion (72.5%) of CTGs was described. Second cycle also showed most of the opinions given to be accurate. DISCUSSION: Interpretation of CTGs is fairly satisfactory. Documentation on CTGs is not up to the expected standards. Regular auditing will help to achieve better standards with regard to documentation.