FHT charting

[LaborRN]

Question:

When charting heart tones you need a 10 minute window to determine baseline and variability.. "There must be 2 minutes of identifiable baseline segments (not necessarily contiguous in any 10 min window" "It may be necessary to refer to the previous 10 minute window for determination of the baseline". Variability is also "determined in a 10 minute window, excluding accels and decels".

So lets just say I'm charting for 6:30-

At my facility we chart based on the previous 10 minute window for all categories (baseline, variability, accels, and decels) so if I have a variable decel at 6:05 and I have no decels from 6:20-6:30 then I would chart absent for my decels. I see how we would look at the previous 10 mins for variability and baseline but I don't see why we only annotate for the 10 mins for decels and accels.

Currently, I chart everything based off the previous 10 mins in our powerchart system. BUT, I always chart my position changes, IVF boluses, 02 and extra provider to the room on my strip which flows into my powerchart. But the way we have been taught is to still chart absent if decels don't occur in that 10 min window (6:20-6:30).

There isn't anything concrete that we can find that you should chart accels and decels off this 10 min window and I feel that most facilities chart off the whole time period (6-6:30).

The only thing we could find so far is from the AWHONN 5th ed. 2015 book FHR monitoring principles and practices book "Accelerations and decelerations are determined in reference to the adjacent baseline FHR." P.S what does this sentence tell you?

What do you guys think?

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[klone, MSN, RN]

I would always chart any decels that occurred between the last time I charted FHTs and the current charting of FHTs. I would probably chart "Variable decel x 1 with nadir of 70 lasting 40 seconds before RTB" or whatever.

Ask yourself this - if you're charting FHTs q hourly, and the patient had repetitive lates, but not in that "10 minute window" of which you're charting, would you just not mention them like they didn't exist?

Decels still exist, and should still be charted, even if they didn't occur in the last 10 minutes.

[LaborRN]

So what I do right now is if I have decels that occur outside of that 10 min window I chart interventions on my strip but I don't say specifically what it was in a nursing note or anything like that. But I'm with you.. I think all decels should be recognized at that 30 minute mark.

[Ilikeletters]

We chart any decels since the last charting - even if it was at 6:01 and is perfect after that. Your "absent" isn't defendable in court.

[keharms0202]

Your charting should reflect the time since you last charted. You need at least 10 min before you can determine baseline and variability, but you can and should look at more than the 10 minutes for your overall charting. If you're doing and charting interventions, your charting should reflect the FHR characteristics that required you to intervene.

[not2bblue]

We chart in 30 minute increments, ie 0600-0630, 0630-0700. I know other places do it differently, but that is what we do here. So, if it occurs in that time frame it is documented in the flow sheet that it existed at all during that time, but not specifically when it happened. I document what I did about it in real time in nursing notes. Since we do it differently, only way I can answer it is that if you are charting for a time frame, chart what happened in that time frame but you can't pretend nothing happened and ignore it simply because it was out of the "10 minutes" you are charting your findings. That would be a separate note in that case, but you have to define your time parameters without simply saying absent and you have to address it somewhere.

[labordude, BSN, RN]

We chart in 30 minute increments, ie 0600-0630, 0630-0700. I know other places do it differently, but that is what we do here. So, if it occurs in that time frame it is documented in the flow sheet that it existed at all during that time, but not specifically when it happened. I document what I did about it in real time in nursing notes. Since we do it differently, only way I can answer it is that if you are charting for a time frame, chart what happened in that time frame but you can't pretend nothing happened and ignore it simply because it was out of the "10 minutes" you are charting your findings. That would be a separate note in that case, but you have to define your time parameters without simply saying absent and you have to address it somewhere.

Does your facility cite AWHONN as their source for any of their other policies? It seems weird to ignore the policy statement on frequency of fetal heart monitoring documentation. Unless you have all low risk non-oxytocin induction patients in which case I say...damn, that must be nice.