The Computer Assisted Labor Monitoring Suite for Obstetrics (CALM) Tracy Whitman

Objectives  Describe CALM Suite  Describe Hardware  List, Describe, and Evaluate software  Describe and review the information system  Describe advantages and disadvantages  Examine related ethical/legal issues  Describe the technology-related competencies of the professional nurse working with CALM Suite  Describe the functions of the informatics nurse working with CALM Suite

CALM Suite Description CALM Suite is a base fetal monitor surveillance and archival system that:  Allows nurses to view patients from different locations  Electronically documents patient data and capture vital signs  Contains embedded clinical decision support tools that identify and label fetal monitor patterns (LMS Medical, 2005)

CALM Suite Description  CALM Suite provides for the consistent and objective management of obstetrical units  CALM Suite includes: Central fetal surveillance and alerts Central fetal surveillance and alerts Maternal – fetal charting Maternal – fetal charting Aggregated reporting Aggregated reporting Archiving Archiving Remote access Remote access (LMS Medical)

Hardware   Monitors 1. 1.Corometrics 116, Corometrics 118, Corometrics Series 120 models 2. 2.Hewlett Packard Models HP50XM, HP501P 3. 3.Toitu MT430

Hardware description Corometrics 120 Series Maternal Fetal Monitors Records:   Dual fetal heart rates   Uterine activity   Maternal vital signs   Fetal pulse oximetry (Wipro GE Healthcare, 2003)

Software   CALM Curve   CALM Patterns   CALM Shoulder Screen

Software description CALM Patterns:   Provides impartial tracing analysis (of fetal heart rate) while highlighting significant trends (LMS Medical)

Software description cont. Key Features: CALM Patterns Tracing:   Labels and measures standard fetal heart rate   Accelerations   Decelerations   Late, Early, Variable typical, Variable atypical   Patterns are marked with:   Color, letters, icons   Beginning and ending date   Time range CALM Patterns Contractility:   Detection of uterine contractions from the monitor (LMS Medical)

Software description cont. Key Benefits   Brings American College of Obstetricians and Gynecologists (ACOG) definitions to the bedside   Numeric values for easy review   Improves communication   Constant educational reinforcement   Automatic data input   2 hours of tracings for trend identification (LMS Medical)

Usability of the software “Train the Trainer” approach:   Trained super users, administrators and basic users   First line of clinical support nearby   Complete user guide   Access to “how to” section for in-depth explanation Your Current IT investment:   Works with monitors, PC’s, servers, networks and software already in place. Ensure Team Acceptance and Usage of the System:   Easy to use interface   Configured based on OB teams preferences and work methods CALM ensures usability by:   Being highly accessible   Users can see patient data from the bedside, workstation, lounge or remotely I hope this is easy to use!! (LMS Medical)

Usability of the software cont.   Provide ease of interoperability   HL7 interface   Enable’s data sharing between other obstetrical information systems   Fulfill the departments current needs while considering the future   Ensure system performance and ease of installation (LMS Medical)

Description of Information System LMS Medical Systems is a healthcare technology company specializing in computer software for obstetrical management. The CALM Clinical Information System (CIS) houses intelligent tools in specialized software. CALM CIS Includes:   Central fetal surveillance and alerts   Maternal-fetal charting   Aggregate reporting   Archiving   Remote access (LMS Medical)

Description of Information System cont. The Calm suite comprises many modules CALM Curve (analysis of labor progression) 2. 2.CALM Patterns (helps to identify the fetus at risk for brain injury from oxygen deprivation) 3. 3.CALM Shoulder Screen (estimates the risk for shoulder dystocia) (LMS Medical)

Information System Review Summary   CALM Clinical Information System   Used by doctors and nurses   Functions   Electronic medical record keeping   Surveillance   Alerts and archiving   Display of fetal monitoring records   Web accessibility   Decision support modules   Accessibility   At the bedside   Central monitoring   Workstations   Remotely from home or the physicians office   Health Level 7 (HL7) (LMS Medical)

Advantages   Optimizes patient safety   Three tiered security   Improves communication between physicians and nurses   Long-term data storage   Fetal and maternal surveillance and alerts (LMS Medical)

Advantages cont.   Central monitoring   Improving outcomes and reducing errors in obstetrics   Uses evidence-based approach to obstetrics (LMS Medical)

Disadvantages Adapting to new software Troubleshooting problems Staff opposition to change Financial

Ethical Issues   Neonatal brain injury   Birth asphyxia (Bracci, Perrone, & Buonocove, 2006)

Legal Issues 50% of all malpractice cases with damages over 1 million dollars are in obstetrics.   Most involve birth-related brain injury Medical errors play a role in 30-50% of cases. Teams are held accountable even if antepartum conditions contributed to the injury. (LMS Medical)

Informatics Competencies   Uses computerized patient monitoring systems   Identifies the basic components of a computer system   Recognized that a computer program has limitations   Defines the impact of computerized information management   Applies monitoring system appropriately   Performs basic troubleshooting (McGonigle & Mastrian, 2009)

Functions and Responsibilities   Demonstrates fluency in informatics and nursing technologies   Implements and evaluates application/system training programs for users   Determines projected impacts to users and organizations   Applies human factors and ergonomics to the design of the hardware and software (McGonigle & Mastrian)

Summary Prevent birth related injuries by:   Recognizing   Anticipating   Communicating   Intervening With regards to:   Abnormal fetal heart rate tracings   Prolonged labor   Shoulder dystocia (LMS Medical)

References LMS Medical (2005).. Retrieved January 25, 2009, from LMS Medical (2005). The CALM Suite for Obstetrics. Retrieved January 25, 2009, from Wipro GE Healthcare (2003). Monitoring Systems. Retrieved February 21, 2009, from McGonigle, D., & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, MA: Jones and Bartlett Publishers. Rodolfo Bracci, Serafina Perrone, Giuseppe Buonocore. "The Timing of Neonatal Brain Damage. " Biology of the Neonate 90.3 (2006): Health Module. ProQuest. University Park, PA. 23 Feb. 2009