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Collecting Data for Fetal and Infant Mortality Reviews Dani Noell ARNP/RNC Christine E. Lynn College of Nursing Florida Atlantic University.

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Presentation on theme: "Collecting Data for Fetal and Infant Mortality Reviews Dani Noell ARNP/RNC Christine E. Lynn College of Nursing Florida Atlantic University."— Presentation transcript:

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2 Collecting Data for Fetal and Infant Mortality Reviews Dani Noell ARNP/RNC Christine E. Lynn College of Nursing Florida Atlantic University

3 Program Description Collecting Data for Fetal and Infant Mortality Reviews (FIMR) was developed as a final graduate project for the masters degree of nursing at Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida by Danielle Noell, ARNP/RNC, under the direction of Marilyn Parker, PhD, RN, FAAN, Project Advisor and Kathleen Buckley, CNM/MSN, Project Chair.

4 Dani Noell is a neonatal nurse practitioner with over a decade of experiences abstracting records for fetal, infant, child and maternal mortality review projects. She has been a nurse for 30 years and believes very strongly in the Fetal and Infant Mortality Review (FIMR) process as a way to improve systems of care for communities. Ms. Noell has abstracted hundreds of cases, provided training to FIMR data abstractors in Florida, presented at national FIMR conferences regarding data abstraction and has traveled to several states to provide data abstraction training to new FIMR projects. Ms. Noell wrote the chapter on data abstraction in the National Fetal and Infant Mortality Review Manual (NFIMR): A Guide for Communities and was a coauthor for FIMR: A Guide for Home Interviewers. Dani Noell is a neonatal nurse practitioner with over a decade of experiences abstracting records for fetal, infant, child and maternal mortality review projects. She has been a nurse for 30 years and believes very strongly in the Fetal and Infant Mortality Review (FIMR) process as a way to improve systems of care for communities. Ms. Noell has abstracted hundreds of cases, provided training to FIMR data abstractors in Florida, presented at national FIMR conferences regarding data abstraction and has traveled to several states to provide data abstraction training to new FIMR projects. Ms. Noell wrote the chapter on data abstraction in the National Fetal and Infant Mortality Review Manual (NFIMR): A Guide for Communities and was a coauthor for FIMR: A Guide for Home Interviewers.

5 Fetal and Infant Mortality Review Fetal and Infant and Mortality Review (FIMR) projects are community based efforts to learn more about the factors and issues associated with fetal and infant deaths and to make recommendations and take action to improve system of care. The National Fetal and Infant Mortality Review Program (NFIMR) is a collaborative effort between the American College of Obstetricians and Gynecologists and the Maternal and Child Health Bureau, Health Resources and Service Administration. Beginning in the 1980’s with under 10 projects, today there are over 200 nationwide, with more starting each year. There is also international interest in starting these review projects.

6 Who is this training for? This training is for beginning FIMR abstractors and project coordinators who are interested in learning more about how data is collected for the FIMR review process.

7 Objectives By the end of this presentation the learner will be able to: Discuss ways to organize abstraction materials Discuss ways to organize abstraction materials Describe methods to access data sources Describe methods to access data sources Discuss barriers to abstraction Discuss barriers to abstraction Recall importance maintaining confidentiality protocols Recall importance maintaining confidentiality protocols Identify method to summarize case. Identify method to summarize case. Discuss role of abstractor caring for self. Discuss role of abstractor caring for self.

8 Introductions

9 Entering the Project

10 Resources National Fetal and Infant Mortality Review Program National Fetal and Infant Mortality Review Program Materials: publications, technical assistance, electronic resources Materials: publications, technical assistance, electronic resources FIMR Projects: about 200 in local and state levels FIMR Projects: about 200 in local and state levels

11 FIMR Process

12 Definitions Fetal death: a death prior to delivery if the 20th week of gestation has been reached and fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Fetal death: a death prior to delivery if the 20th week of gestation has been reached and fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Infant death: any death of an infant from birth up to (but not including) one year of age. Infant death: any death of an infant from birth up to (but not including) one year of age. Neonatal: death of a live born infant before 28 days of life. Neonatal: death of a live born infant before 28 days of life. Post neonatal: death of an infant after 28 th day up to (but not including) one year of age. Post neonatal: death of an infant after 28 th day up to (but not including) one year of age.

13 FIMR Data Vital statistics Vital statistics Maternal interviews Maternal interviews Medical records Medical records Social services Social services

14 Vital Statistics STRENGTHS Traditional/well established Traditional/well established Availability Availability Community specific/ Community specific/ Population based data Population based data Helps with FIMR focus Helps with FIMR focusWEAKNESS Limitations Limitations Accuracy Accuracy

15 Medical Records STRENGTHS Availability Availability Glimpse system care Glimpse system care Fetal, neonatal and maternal information Fetal, neonatal and maternal information In patient and outpatient records In patient and outpatient recordsWEAKNESS Technical Technical Lack psychosocial data Lack psychosocial data Time consuming Time consuming Poor imaging on computerized records Poor imaging on computerized records

16 Maternal Interview STRENGTHS: Community voice Community voice Powerful information Powerful information Consumer perspective Consumer perspective Bereavement follow up and referrals Bereavement follow up and referrals Cultural focus Cultural focusWEAKNESSES Can be hard to locate Can be hard to locate Conflicting information Conflicting information

17 Social Service Records Referrals Referrals Support services Support services Education Education WIC WIC Case management Case management Other Other

18 Starting the Process Community picks focus Community picks focus Identify data tools Identify data tools Identify FIMR abstractor/interviewer Identify FIMR abstractor/interviewer Identify legal information Identify legal information

19 NFIMR Forms Comprehensive Comprehensive Multi-system Multi-system Free Free Revised Revised History of use History of use

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21 Abstractor Flexible Flexible Knowledge base Knowledge base Transportation Transportation Computer and people skills Computer and people skills Unbiased storyteller Unbiased storyteller

22 FIMR Legal Issues Know your statutes/immunity Know your statutes/immunity Institutional Review Board (IRB) Institutional Review Board (IRB) Health Insurance Portability and Accountability Act (HIPAA) Health Insurance Portability and Accountability Act (HIPAA) Confidentiality protocols Confidentiality protocols Accessing records/limitations Accessing records/limitations Storing information Storing information Child abuse reporting laws Child abuse reporting laws

23 HIPAA Health Insurance Portability and Accountability Act (HIPAA) of 1996: to protect privacy and security of exchange of health information. Health Insurance Portability and Accountability Act (HIPAA) of 1996: to protect privacy and security of exchange of health information. See sample letters in FIMR: HIPAA Privacy Regulations See sample letters in FIMR: HIPAA Privacy Regulations

24 Confidentiality is key.

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26 Abstract (ab.strakt”) v.t. to separate from; remove, summarize; reduce (ab.strakt”) v.t. to separate from; remove, summarize; reduce

27 Access (ak’.ses)n. a coming to the means or way of approach: admission; entrance; attack; fit. (ak’.ses)n. a coming to the means or way of approach: admission; entrance; attack; fit.

28 Traveling from B to A

29 Abstraction Methodology Organization of cases Organization of cases Accessing sources Accessing sources Identification of barriers Identification of barriers Communication skills Communication skills

30 Early Organization Assemble abstracting materials: fetal/infant packet, case identifiers, legal forms Assemble abstracting materials: fetal/infant packet, case identifiers, legal forms Abstracting supplies: pens/pencils, extra abstraction forms Abstracting supplies: pens/pencils, extra abstraction forms Make a list of hospitals and contact persons/phone and secure fax numbers Make a list of hospitals and contact persons/phone and secure fax numbers

31 Abstraction Pathways Identification of Fetal/Infant Death Abstractor notifies Medical Records Of request to Review Is request approved? NO Yes Is education indicated? Yes Provide copies of statutes. letters Abstract hospital record No Communication with Directors/Managers

32 Abstraction Pathways Were providers Identified? YesNo Abstractor contacts providers and requests to abstract Is request approved? Completed data Yes No Abstract records Ask provider to fill out forms Yes No Completed Data Case is summarized including information from maternal interview

33 Abstracting Barriers

34 Provider refusal Provider refusal Lost records, incomplete misfiled Lost records, incomplete misfiled Communication confusion Communication confusion Missing contact person: Always have a back up person Missing contact person: Always have a back up person Traveling Traveling

35 Communication Skills Not burn bridge Not burn bridge Take time to be known Take time to be known Represent your project Represent your project Refusal to participate due to many factors Refusal to participate due to many factors May join with time if decreased threat May join with time if decreased threat Have sensitivity to provider grief Have sensitivity to provider grief

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38 Abstractor Interventions Abstractor not to change system by self Abstractor not to change system by self Key points Key points - Confidentiality - Confidentiality - Ethical decision: system vs. individual - Ethical decision: system vs. individual Omissions/clerical errors Omissions/clerical errors Suspected child abuse Suspected child abuse Copy records for others Copy records for others

39 Additional Information Details back of forms Details back of forms Treatments and follow up Treatments and follow up Answer timing questions Answer timing questions Supportive lab information Supportive lab information CRT helps to evolve type info needed CRT helps to evolve type info needed

40 Abstracting Tips Chronological order events Chronological order events Don’t put in your opinion Don’t put in your opinion OK to present conflicting information OK to present conflicting information Notation on forms if didn’t find information Notation on forms if didn’t find information Keep forms de-identified Keep forms de-identified

41 Basic FIMR Abstracting Rule “If the information about a question is not in the chart it was NOT done.”

42 Summarizing The Story Medical/social and maternal interview Medical/social and maternal interview De-identified De-identified Preserves mothers voice Preserves mothers voice Caution what eliminate/not bias Caution what eliminate/not bias Consistent for CRT deliberation Consistent for CRT deliberation Types: narrative/bulleted/italics Types: narrative/bulleted/italics

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45 Caring For Self

46 Reflections on Abstracting The greater past relationship you have with a provider, the less likely they will give you access to their records. The greater past relationship you have with a provider, the less likely they will give you access to their records. The record you abstract quickly is most likely to be the hardest to summarize. The record you abstract quickly is most likely to be the hardest to summarize. The longer a case is discussed at a CRT meeting, the more certain it is that no one has the faintest idea of what happened. The longer a case is discussed at a CRT meeting, the more certain it is that no one has the faintest idea of what happened. The probability of crying is directly proportional to the number of cases you have abstracted. The probability of crying is directly proportional to the number of cases you have abstracted. If you can’t figure out what steps to do next in an abstraction pathway, call another abstractor. They may not have any idea either but you sure will feel better. If you can’t figure out what steps to do next in an abstraction pathway, call another abstractor. They may not have any idea either but you sure will feel better. The ‘success’ of the project is directly proportional to the community’s response. The ‘success’ of the project is directly proportional to the community’s response.

47 “The best preparation for tomorrow is to do today’s work superbly well.” Sir William Osler

48 References Buckley, K., Koontz, A. & Casey, S. (1998). Fetal and infant mortality review manual: A guide for communities. Washington, DC: American College of Obstetricians and Gynecologists. Harmer, B. (1929). Text-Book of the principles and practice of nursing. New York: The MacMillan Company. Lauterbach, S. & Becker, P. ( 1996) Caring for self: Becoming a self-reflective nurse, Holistic Nursing Practice, 10(7), McNeely, E. (2005). The consequences of job stress for nurses health: Time for a check up. Nursing outlook, 53(6), Pellatt, G. (2003). Ethnography and reflexivity: Emotions and feelings in fieldwork. Nurse Researcher, 10(3) pp Polit, D. & Beck, C. (2004). Nursing research principles and methods. 7 th ed. Philadelphia, PA: Lippincott Williams & Wilkins. Shafer, J., Noell, D., & MCClain, M. (2002) Fetal and infant mortality review: A guide for home interviews. Washington, DC: American College of Obstetricians and Gynecologists. The fetal and infant mortality review process: The hipaa privacy regulations. (2003) Washington, DC: American College of Obstetricians and Gynecologists. Wise, P. & Wulff, L. (1992) A manual for fetal and infant mortality review. Washington, DC: American College of Obstetricians and Gynecologists.

49 Appreciation for Don Noell for the photographs, Mike Noell for emotional and financial support and for Frank Meoni at Christine E. Lynn College of Nursing Florida Atlantic University for technical assistance with this project.


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