Implementation of the Maternal Fetal Triage

Index Tool for Increased Competency and

Assessment of Obstetric Patients

Kendra Folh, BSN, RNC-OB

Danyell Taylor, BSN, RNC-OB
 State of Triage at CMHH
• Inconsistent practice of assigning triage acuity

• High census volume and increased waiting room

times

• High risk acuity population including fetal center

patients

• Lack of triage nurse education and competencies

Why Utilize a Maternal Fetal Triage
Index
• Variability in the procedure and assignment of
obstetric triage categories
• Lack of a standardized tool to assess acuity
• A clear definition of process time targets was needed
• No method to provide consistent feedback to
clinicians compromised patient safety and quality of
care
 AWHONN's Definition of Obstetric
Triage

• Obstetric triage is a brief, thorough and systematic

maternal/fetal assessment

• Assessment determines priority for full evaluation

In obstetric triage, the initial, brief nursing assessment of the
woman and fetus has traditionally been done on a first-come,
first-served basis. One of the problems with this approach is that
it does not efficiently identify those women who need urgent or
immediate care.
AWHONN has developed the Maternal Fetal Triage Index (MFTI),
a tool that provides a standardized approach to obstetric triage.
The MFTI is a five-level obstetric acuity tool for nurses to use
when they triage a woman presenting for care to a birth unit in
order to prioritize the woman's urgency for provider evaluation.
It is the first obstetric acuity tool developed by a professional
society for use across the United States.

Association of Women’s Health Obstetric and Neonatal Nursing

 AWHONN’s Triage Initiative
• Redefine “OB Triage”
• Reaffirm obstetric triage as a nursing role
• Improve quality of triage nursing care through
standardization of acuity classification
• Improve team communication, action, and efficiency.
• Improve education and competency assessment for
triage nurses
• Improve outcomes
Barriers to the Implementation of the Maternal Fetal Triage Index
 PLAN
• CMHH joined the AWHONN MFTI Pilot Community
February 2016
• A MFTI unit committee was established. The team
consisted of Women’s Services leadership, Clinical
Nurse Specialist, Quality & Safety Project Manager,
and Triage nurse champions
• 3 conference calls approximately 90minutes in length
were attended in including monthly work meetings
 Plan
• All nurses that perform triage completed the
AWHONN 2 hour education module
• Nurse Champions were provided support and
strategies to begin implementation of the MFTI in
the electronic medical record
• The MFTI committee was given the opportunity to
learn from other hospitals and leaders who also
began to implement the MFTI in their facilities
 Competency
• 50 “seats” were purchased for education to
include all licensed personnel working in
triage
• All licensed personnel working in triage
completed a 2 hour online AWHONN MFTI
case study module
• Completion certificates issued
• Reports issued
 Initial Intake
Within 10 minutes patient will be taken to triage
for initial intake assessment:
• Obtain subjective assessment of
complaint/concern
• Obtain vital signs including pulse oximeter
• Obtain FHTs with Doppler
• Obtain medical history
 Plan Do PDSA WORKSHEET
Organization name(s): Date of test: June 6,
Test Completion Date: June 16th
CMHH Women’s Services 2016
Act Study Lead contact(s) Kendra Folh
Overall organization/project aim: 100% of presenting obstetric patients presenting for evaluation to the triage unit will be given a priority score
within 10minutes of arrival.
What is the objective of the test? To establish a sustainable intake prioritization process in the triage unit.
PLAN: DO: Test the changes.
Briefly describe the test:
Presenting obstetric patients will present to the registrar for initial registration and will be given a Was the cycle carried out as planned?  Yes  No
priority score after assessment and VS by the triage nurse. Patient will be given a disposition at that
time. Record data and observations.
How will you know that the change is an improvement?
Presenting obstetric patients will be assessed with a prioritization score within 10 minutes of arrival.
What system impact (driver) does the change? What did you observe that was not part of our plan?
Patient safety, Timely Access to Care, Patient Centered care
What do you predict will happen?
Challenges r/t triage bed availability when multiple Priority 2and 3 patients present to unit
STUDY:
PLAN Did the results match your predictions?  Yes  No
Person
List the tasks necessary to complete responsible Compare the result of your test to your previous performance:
this test (what) (who) When Where
1. Register patient Triage RN Presentation to Triage Room 4
unit
2. Obtain brief assessment and Triage RN Within 10min Triage Room 4
What did you learn?
VS of arrival
3. Assign MFTI prioritization Triage RN Within 10min Triage Room 4
score of arrival
4.Patient will be taken to triage or Triage RN Within 10min Triage Room 4
waiting room of arrival ACT: Decide to Adopt, Adapt, or Abandon.
5. Document prioritization score Triage RN Within 10min Pink slip Adapt: Improve the change and continue testing plan.
of arrival Plans/changes for next test:
6. Notify charge RN if no triage Triage RN Within 10min
bed available for stat, urgent, of arrival
or priority patient Adopt: Select changes to implement on a larger scale and develop an implementation
plan and plan for sustainability
Plan for collection of data:
See audit tool
Abandon: Discard this change idea and try a different one
 Lessons Learned:
• Executive, administrative and clinical leadership
essential for implementation and sustainability
• Frontline team engagement imperative
• Don’t underestimate technological challenges
• Education regarding intermittent auscultation was
needed
• Priority still has to be assessed regardless of absence
of waiting time
“ As you create your roadmap for the
future, make sure you are part of the “
steamroller, not part of the road
Saavik Wilcox-Hamilton
Source of quote: http://slidesha.re/1B6jrZw