The Impact of Evidence-Based Guidelines on Utilization of First-Trimester Fetal Ultrasounds Performed by Certified Nurse-Midwives and Advanced Practice Registered Nurses in an Obstetric Triage Setting

Abstract

The scope of practice for Certified Nurse-Midwives (CNMs) and Advanced Practice Registered Nurses (APRNs) has expanded to encompass the performance of obstetrical ultrasounds in a variety of settings, including obstetric triage. The focus of this Doctor of Nursing Practice (DNP) project evaluated the impact of implementation of evidenced-based guidelines on the utilization of first-trimester ultrasound by CNMs and APRNs in an obstetric triage unit. The project took place over a six-month period of time and data collection included three consecutive months of retrospective data prior to implementation of guidelines followed by three consecutive months post-implementation of guidelines. A two-sample test of proportions using Stata 17 (StataCorp, College Station, TX) was performed. The rate of first ultrasounds performed pre-implementation of evidence-based practice guidelines was 8.92% and post-implementation was 8.03%. This difference was not statically significant with p= 0.108 and z=1.240. There was not a statistically significant difference in the rate of first-trimester ultrasounds being performed by CNMs and APRNs pre-implementation versus post-implementation of evidence-based practice guidelines. However, best practices were identified and included improved consistency and accuracy in ultrasound documentation, utilization of first-trimester ultrasounds based on clinical indications, and adoption of the evidenced based protocol by the institution as part of assessing ongoing quality of care. First-trimester ultrasounds within obstetric triage are now being performed based on medical indications outlined by the guidelines that were implemented through this DNP project.