Decision Support

E-Tools are the OBIX Perinatal Data System's decision support tools. They were designed to provide information that can be used when making critical decisions regarding patient care. The use of E-Tools can improve clinical practices, educate staff, and promote patient safety in electronic fetal monitoring. The products were developed to support OB providers during the assessment of fetal heart rate (FHR) and uterine activity (UA) in labor.

FHR Tools

The FHR Tools assist clinicians with the ability to obtain timely, accurate assistance in the assessment of FHR baseline, variability, accelerations, decelerations, and to apply NICHD definitions with confidence and clarity.

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BASELINE

5 BPM
VARIABLE

25 bpm
VARIABLE

15 x 15
ACCELERATION

10 x 10
ACCELERATION

DECELERATION

Baseline

This tool is a horizontal, red line that is placed over the fetal heart rate to help determine the baseline. Once the baseline is determined, a tool tip appears in the upper left hand corner that displays the date, time, and fetal heart rate in BPM. The BPM is displayed in increments of 5 to follow the NICHD guidelines.

5 BPM

This tool is a horizontal, magenta box 1 minute in length and 5 BPM in height that is hovered over the baseline to differentiate between minimal versus absent variability.

25 BPM

This tool is a horizontal, magenta box 1 minute in length and 25 BPM in height that is hovered over the baseline to differentiate between moderate versus marked variability.

15 x 15

This tool is a horizontal, red line with an equilateral triangle that is 15 BPM in height and 15 seconds in length.

10 x 10

Similar to the 15 x 15 Acceleration Tool, this tool is a horizontal, red line with an equilateral triangle that is 10 BPM in height and 10 seconds in length, allowing accurate assessment of an acceleration in fetuses of less than 32 weeks.

Deceleration

This tool is a horizontal, magenta line 30 seconds in length, that assists clinicians in accurately differentiating between gradual versus abrupt when evaluating onset to nadir, a key determination in the identification of the type of deceleration. A vertical, magenta line assists clinicians in evaluating the onset, nadir, and offset of decelerations as they relate to the onset, peak, and offset of uterine contractions, distinguishing between early and late decelerations.

UA Tool

With patient safety and labor management at the forefront of obstetrics, the UA Tool was developed for clinicians to evaluate uterine activity over time, and to be able to assess frequency, and rule out tachysystole during labor. It will display uterine contraction frequency, intensity, duration, and resting tone based on a 10, 15, 30 or 60 minute segment, as defined by the user, and supports TOCO or IUPC monitoring modes.

The tool allows clinicians to confirm evaluation results or make modifications based on their assessments. The uterine contraction assessment information can be added to the patient chart in a single click. Point of care assessments and documentation allows clinicians to provide the safest and most appropriate labor management for your patients.


E-Tools are available to assit nurses, midwives, and physicians with management of electronic fetal monitoring (EFM) and decisions regarding patient care. Developed in collaboration with Clinical Computer Systems, Inc., the E-Tools suite of products supports application of the standardized NICHD nomenclature for fetal heart rate components, application of the NICHD categories, and evaluation of uterine activity.

-Lisa A. Miller, CNM, JD

FHR Categorization

This documentation feature helps to identify the appropriate Category (I, II, or III) based on a FHR assessment. The patient's clinical assessment is documented into the OBIX system's Intrapartum Charting Module and from the following data charted: baseline, variability, accelerations, decelerations, recurrent variable and/or late, and sinusoidal. The system will automatically assign and display the appropriate Category: I, II, or III based on the data entered above. The FHR Categorization screen will display the last 3 completed assessments and category labels.

UC Evaluation Assessment Trends

The UC evaluation section in the systems notes menu will display the 3 previous (completed) assessments and the following information is able to be documented quickly and easily: mode, frequency, duration, intensity, resting tone, and MVU. An optional field, relax time, is available upon request.