PeriCALM ™ Software for Display and Real-time Analysis of

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PeriCALM ™Software for Display and Real-time Analysis of

Fetal Heart Rates and Uterine Contractions

MKT-PPT-0034, rev. 01.01, 2011-02

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Participants

• Tina Armstrong RN, • Clinical Specialist

• Vicki A. Lucas, RNC, BSN, MNEd, Ph.D. • Chief Nursing Officer

• Emily Hamilton MD, • SVP Clinical Research

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Presentation Outline

• Role of Bedside Software in Electronic Fetal Monitoring and Labor Assessment

• Perspective from clinicians and administrators

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Actions Communicatio

n Recognition

Basic Sequence in Clinical Care

Fix it Say it“I am

concerned” See it

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Probl

em

Li

mitati

on

Sol

uti

on

What is the Relevance? Specialized Pattern Recognition Software

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Key Clinical Objectives PeriCALM Tracings and Patterns

1. Standardize the analysis of EFM tracings Why: Even NICHD/ACOG definitions are open to interpretation

2. Standardize the assessment of labor Why : multiple factors affect labor progress and giving rise to large variation in

clinical assessment

3. Enhance Situational Awareness Why: Fatigue, distractions, inexperience known to impair situational

awareness

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What is PeriCALM Tracings?Specialized Software for Displaying and Storing EFM

1. Collects and Displays Tracings from fetal monitors2. Mechanism for annotating the strip3. Posts Vital signs from the fetal monitor 4. Printing and Archiving capabilities

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What is The PeriCALM Curve?Computerised assessment of labor progression

1. Graphical display of dilation(black) and descent(green) taken from pelvic exam entries

2. Superimposed blue lines show how the expected “average” dilation as well as a range

3. Blue line are adjusted at each exam for 6 factors including changes in contraction frequency, cervical dilation and effacement.

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What is PeriCALM Patterns?Specialized Pattern Recognition Software

1. Analyzes fetal heart rate and uterine contraction records 2. Uses terminology based on NICHD definitions3. Displays both a long-term overview to display trends and a close up detailed view

with pattern measurements4. Does not save markings in the electronic medical record

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• Demonstration

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Perspective from Physicians:PeriCALM Patterns Facilitates Clear Communication and Better Situational Awareness

• Incomplete “handover” and miscommunication about the tracing leads can lead to delayed recognition of a problem and consequently little time for effective intervention.

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Perspective From Nurses: PeriCALM Patterns Helps to Consistently Evaluate Both the Degree of Tracing Abnormality as Well as Trends Over Time

• Inconsistency in tracing assessment must be expected with inexperienced staff, distractions or fatigue.

• Criticism about tracing interpretation “in retrospect when outcome is known ” is often demoralizing and unproductive

• Escalating through a “chain of command” is naturally difficult

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The Perspective from a Patient Safety OfficerPeriCALM Patterns Provides a Safety Net to Complement Clinical Reasoning

Litigation Costs by Clinical Category

• Inappropriate use of medications affecting uterine contractions in 47%

• Delayed recognition and intervention for problem tracings in 40-90%

• Oxytocin misuse is indefensible and avoidable.

• “Safe” medical devices provide users with warnings when unsafe conditions exist.

• PeriCALM Patterns identifies uterine tachysystole when it occurs so that clinicians can intervene early rather than try and explain their inaction after the fact.

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Experience and Perspective From Rural Hospitals:

• Doctors often far from Hospital thus need to anticipate problems before emergencies occur

• Support clinical confidence with lower experience from low volume

• Connectivity so all who need to know can see the tracing

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Common Clinical Questions

1. What does ACOG think about this? No formal opinion, agrees that

computerization can analyze more consistently

2. What if I disagree with PeriCALM patterns? Same thing as when you

disagree with another clinician/nurse today

3. Can a plaintiff lawyer get this application? No, it’s not saved

4. Are there any peer reviewed publications on this application? Yes, 17

5. Will my nurses forget how to read tracings? On the contrary, they

receive continuous feedback, which is the one of the most effective

mechanisms of adult learning.

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Thank you

PeriGenwww.perigen.com

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Overview

Detailed 17-minute view

Compressed 2-hour overview

Movable selecting Slider Window

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FHR Information

Baseline

Accelerations

Labels and Measurements

Decelerations

Window Summary Analysis Controls

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Contraction Information

Contraction detection

Running graph - count/10 min with visual indicators when threshold is

exceeded

Mean Frequency

Mean Montevideo units

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Rapidity of Analysis

● What is the Baseline?● What is the Variability?● Contraction Frequency or count /10 minutes?● Montevideo Units?

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● Mean Contraction Interval: Q1.7 min ● Mean Baseline: 137 bpm● Mean Baseline Variability: 13.3● Mean Montevideo Units: 321 per 10 min

Rapidity of Analysis

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Short-Term Trends

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Long-Term Trends

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Up to 12-Hour Overview