Intermittent Auscultation Simulation-Based Education


 

Learn more about PQI's new IA education

 

Why should perinatal practitioners learn intermittent auscultation?

Evidence supports use of intermittent auscultation (IA) instead of continuous electronic fetal monitoring in low-risk labor. IA supports freedom of movement and may help reduce the risk of cesarean or operative vaginal birth. Education and opportunities to practice IA skills are necessary to ensure IA is performed reliably, safely, and consistently.

 

Who is the intended audience for the program?

PQI’s Intermittent Auscultation Simulation-Based Education is appropriate for perinatal nurses, midwives, and physicians who provide intrapartum care, as well as students/clinical learners in these specialties.

 

Is the program designed for hospital birth or is it also appropriate for community settings (freestanding birth center/home)?

The program is appropriate for all birth settings, and includes imagery of IA taking place in hospital, birth center, and home births.

 

Which IA methods and terminology does the program teach, and what is the evidence to support this approach?

There is not strong evidence to recommend any specific method or approach to intermittent auscultation. The PQI program teaches the same approach that is recommended in Fetal Heart Monitoring: Principles and Practice (5th Edition), published by AWHONN. These include:

  • Using a Doppler device, rather than the electronic fetal monitor or a fetoscope, to perform IA
  • Assessing and documenting baseline as a single average rate, by listening for 30-60 seconds between contractions when the fetus is not moving
  • Assessing for and documenting accelerations and decelerations, though not the type of decelerations/decreases detected (e.g. early, variable, late).
  • Categorizing fetal assessment as Category I or Category II based on baseline rate and rhythm and presence or absence of decelerations
  • If Category II based on IA findings, changing maternal position and increasing frequency of auscultation or considering a 20-minute continuous fetal monitoring strip.

AWHONN recommends that facilities determine their own guidelines for frequency of auscultation. The program presents the range of professional guidelines from AWHONN, ACOG, and ACNM: Listening on admission, every 1-2 hours in early/latent labor (if admitted or being observed in birthing facility), every 15-30 minutes in first stage, and every 5-15 minutes in second stage.

 

Are there examples of using IA to promote vaginal birth?

 Beth Hennessy's PQI Profile  describes how they expanded the use of intermittent auscultation at Sutter Davis as a key strategy to promote vaginal birth and reduce primary cesareans at their facility. “We realized that our staff did not have the competency or the tools that they needed to perform intermittent fetal monitoring or auscultation.” After the Sutter Davis staff received training, Beth explained, “They do nothing but intermittent monitoring unless they hear something abnormal.”

 

How does the simulation work?

The program includes two didactic sections with comprehension quiz questions and a simulation module with skill check questions. The simulations show a video of an animated laboring woman in a birth room with an audio track of a fetal heart rate. Visual and audio cues are given to help the learner distinguish when the contraction is beginning, peaking, going away, and completely gone. The video includes a full contraction cycle from the beginning of one contraction to just before the beginning of the next. The learner listens and counts the rate, then responds to questions about the baseline, presence or absence of accelerations and decelerations, category (I or II), and plan of care. Case information and instructions are provided to assist the learner to prepare for, perform, and interpret the simulation.

 

Are there discounts for health systems or provider groups?

Yes. Health systems may purchase discounted bundles of 50 licenses at a time through the PQI store. If you are interested in a different number of licenses, would like to discuss custom branding or distribution, or want assistance designing or implementing a QI initiative related to intermittent auscultation, please contact info@perinatalqi.org.

 

Are there student discounts?

PQI does not offer student discounts on individual program licenses. However, education program directors may contact PQI to arrange group pricing for students by emailing info@perinatalqi.org.

 

What devices can be used to access the education module?

The program can be accessed from any browser on a computer. Some users have reported issues with completing quiz questions on iOS devices (iPhone, iPad), so these devices are not recommended.

 

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"We decided to use PQI's simulation-based Intermittent Auscultation (IA) education for all of our midwifery students. The education helps bring home IA in a way that is more powerful than simply reading about it." Cindy Farley, CNM, PhD, FACNM, Nurse-Midwifery/WHNP and WHNP Programs, Georgetown University, Associate Professor

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