of the Executive Medical Director and the Clinical

Nurse Specialist formed to review reasons for

delays and evaluate the work£ow for unscheduled

Cesarean delivery. The team created a new

work£ow that included additional resources, delin-

eation of roles, clari¢cation of communication,

and streamlined procedures. The team provided

education on the new work£ow to medical and

nursing sta¡, and the change was implemented.

The new work£ow was practiced and reinforced

for approximately 3 weeks before data collection

resumed.

Ourgoal is to achieve a decision-to-incision interval

of 30 minutes or fewer for all unscheduled Cesar-

ean deliveries. As we move forward with this project

we are collecting feedback, identifying unforeseen

issues, and revising the work£ow as necessary. Ini-

tial data collection (including only 2 weeks of

deliveries) revealed improvement in the frequency

of meeting the 30-minute standard for all unsched-

uled Cesarean deliveries (33%, previously at 26%)

and for cases of nonreassuring fetal status (64%).

We are committed to continuing to monitor and re-

¢ne this project as needed to meet our goal.

Another Set of Eyes: Remote Fetal

Monitoring Surveillance Aids the Busy

Labor and Delivery Unit

Poster Presentation

Remember those days on labor and delivery

when patients were coming out of the walls?

Often it was a struggle to take a bathroom break

much less take a lunch break.Wouldn’t it have been

great to have another nurse there to watch your fe-

tal monitoring strip for 1minute? This is exactly what

ANGELS at the University of Arkansas for Medical

Sciences did for their nurses on labor and delivery.

The innovative new program is called ANGELShield.

ANGEL Shield is housed in the ANGELS Call Center

which provides 24/7 phone consultation, triage,

and transport facilitation to providers and patients

throughout Arkansas. A section of the call center

houses a computer with multiple screens where the

fetal monitoring tracings from labor and delivery are

transmitted. Experienced labor and delivery nurses

remotely monitor the fetal monitoring tracings. Pro-

tocols were developed collaboratively between the

nurses on labor and delivery and the ANGEL Shield

nurses. The protocols specify when the ANGEL

Shield nurse is to contact the nurse on laborand de-

livery and who to call when the nurse is unavailable.

As with any program, there are growing pains. The

protocols are revised and improved as the program

develops. ANGEL Shield plans to expand its pro-

gram out to rural hospitals and providers. In small

town Arkansas, often there are only two labor and

delivery nurses on a unit at a time. They must man-

age all of the care for the patients on labor and

delivery and postpartum. The ANGEL Shield pro-

gram can provide them the support they need in

emergent situations. ANGEL Shield helps watch

the back of busy labor and delivery nurses.

Donna Williams, ADN, RN,

ANGELS Program, University

of Arkansas for Medical Sci-

ences, Little Rock, AR

Tesa Ivey, MSN, Maternal/

Infant Division, University of

Arkansas for Medical

Sciences, Little Rock, AR

Tina Benton, BSN, RN,

ANGELS Program, University

of Arkansas for Medical

Sciences, Little Rock, AR

Sarah Rhoads, DNP, APN,

ANGELS Program and the

College of Nursing, University

of Arkansas for Medical

Sciences, Little Rock, AR

Childbearing

JOGNN 2010; Vol. 39, Supplement 1 S41

Williams, D., Ivey, T., Benton, T. and Rhoads, S. I N N O V A T I V E P R O G R A M S

Proceedings of the 2010 AWHONN Annual Convention