Collecting Data for
Fetal and Infant Mortality
Reviews
Dani Noell ARNP/RNC
Christine E. Lynn College of Nursing
Florida Atlantic University
Program Description
Collecting Data for Fetal and Infant Mortality
Reviews (FIMR) was developed as a final
graduate project for the masters degree of
nursing at Christine E. Lynn College of Nursing,
Florida Atlantic University, Boca Raton, Florida
by Danielle Noell, ARNP/RNC, under the
direction of Marilyn Parker, PhD, RN, FAAN,
Project Advisor and Kathleen Buckley,
CNM/MSN, Project Chair.
Dani Noell is a neonatal nurse practitioner with over a decade of
experiences abstracting records for fetal, infant, child and maternal
mortality review projects. She has been a nurse for 30 years and
believes very strongly in the Fetal and Infant Mortality Review
(FIMR) process as a way to improve systems of care for
communities. Ms. Noell has abstracted hundreds of cases, provided
training to FIMR data abstractors in Florida, presented at national
FIMR conferences regarding data abstraction and has traveled to
several states to provide data abstraction training to new FIMR
projects. Ms. Noell wrote the chapter on data abstraction in the
National Fetal and Infant Mortality Review Manual (NFIMR): A Guide
for Communities and was a coauthor for FIMR: A Guide for Home
Interviewers.
Fetal and Infant Mortality Review
Fetal and Infant and Mortality Review (FIMR) projects are
community based efforts to learn more about the factors
and issues associated with fetal and infant deaths and to
make recommendations and take action to improve
system of care. The National Fetal and Infant Mortality
Review Program (NFIMR) is a collaborative effort
between the American College of Obstetricians and
Gynecologists and the Maternal and Child Health Bureau,
Health Resources and Service Administration. Beginning
in the 1980’s with under 10 projects, today there are
over 200 nationwide, with more starting each year.
There is also international interest in starting these
review projects.
Who is this training for?
This training is for beginning FIMR
abstractors and project coordinators who
are interested in learning more about how
data is collected for the FIMR review
process.
Objectives
By the end of this presentation the learner will be
able to:
• Discuss ways to organize abstraction materials
• Describe methods to access data sources
• Discuss barriers to abstraction
• Recall importance maintaining confidentiality
protocols
• Identify method to summarize case.
• Discuss role of abstractor caring for self.
Introductions
Entering the Project
Resources
• National Fetal and Infant Mortality Review
Program
• Materials: publications, technical
assistance, electronic resources
• FIMR Projects: about 200 in local and
state levels
• Email: nfimr@acog.org
FIMR Process
Definitions
• Fetal death: a death prior to delivery if the 20th week of
gestation has been reached and fetus does not breathe
or show any other evidence of life such as beating of the
heart, pulsation of the umbilical cord, or definite
movement of voluntary muscles.
• Infant death: any death of an infant from birth up to
(but not including) one year of age.
• Neonatal: death of a live born infant before 28 days of
life.
• Post neonatal: death of an infant after 28th day up to
(but not including) one year of age.
FIMR Data
• Vital statistics
• Maternal interviews
• Medical records
• Social services
Vital Statistics
STRENGTHS
WEAKNESS
• Traditional/well
• Limitations
established
• Accuracy
• Availability
• Community specific/
Population based data
• Helps with FIMR focus
Medical Records
STRENGTHS
• Availability
• Glimpse system care
• Fetal, neonatal and
maternal information
• In patient and
outpatient records
WEAKNESS
• Technical
• Lack psychosocial
data
• Time consuming
• Poor imaging on
computerized records
Maternal Interview
STRENGTHS:
• Community voice
• Powerful information
• Consumer perspective
• Bereavement follow
up and referrals
• Cultural focus
WEAKNESSES
• Can be hard to locate
• Conflicting
information
Social Service Records
•
•
•
•
•
•
Referrals
Support services
Education
WIC
Case management
Other
Starting the Process
• Community picks
•
•
•
focus
Identify data tools
Identify FIMR
abstractor/interviewer
Identify legal
information
NFIMR Forms
•
•
•
•
•
Comprehensive
Multi-system
Free
Revised
History of use
Abstractor
• Flexible
• Knowledge base
• Transportation
• Computer and
people skills
• Unbiased
storyteller
FIMR Legal Issues
• Know your statutes/immunity
• Institutional Review Board (IRB)
• Health Insurance Portability and Accountability
•
•
•
•
Act (HIPAA)
Confidentiality protocols
Accessing records/limitations
Storing information
Child abuse reporting laws
HIPAA
• Health Insurance Portability and
Accountability Act (HIPAA) of 1996: to
protect privacy and security of exchange
of health information.
• See sample letters in FIMR: HIPAA Privacy
Regulations
Confidentiality is key.
Abstract
(ab.strakt”) v.t. to separate from;
remove, summarize; reduce
Access
• (ak’.ses)n. a coming
to the means or way
of approach:
admission; entrance;
attack; fit.
Traveling from B to A
Abstraction Methodology
• Organization of cases
• Accessing sources
• Identification of
•
barriers
Communication skills
Early Organization
• Assemble abstracting
•
•
materials: fetal/infant
packet, case identifiers,
legal forms
Abstracting supplies:
pens/pencils, extra
abstraction forms
Make a list of hospitals
and contact
persons/phone and
secure fax numbers
Abstraction Pathways
Identification of Fetal/Infant
Death
Abstractor notifies
Medical Records
Of request to Review
Is request approved?
Yes
Abstract
hospital record
Is education indicated?
NO
Yes
Provide copies of
statutes. letters
No
Communication
with Directors/Managers
Abstraction Pathways
Were providers
Identified?
Yes
No
Completed data
Abstractor contacts
providers and
requests to abstract
Is request
approved?
Yes
Abstract
records
Case is summarized
including information
from maternal interview
Ask provider to
fill out forms
Completed Data
No
Yes
No
Abstracting Barriers
Abstracting Barriers
• Provider refusal
• Lost records, incomplete misfiled
• Communication confusion
• Missing contact person: Always have a
back up person
• Traveling
Communication Skills
• Not burn bridge
• Take time to be known
• Represent your project
• Refusal to participate due to many factors
• May join with time if decreased threat
• Have sensitivity to provider grief
Abstractor Interventions
• Abstractor not to change system by self
• Key points
- Confidentiality
- Ethical decision: system vs. individual
• Omissions/clerical errors
• Suspected child abuse
• Copy records for others
Additional Information
• Details back of forms
• Treatments and follow up
• Answer timing questions
• Supportive lab information
• CRT helps to evolve type info needed
Abstracting Tips
• Chronological order events
• Don’t put in your opinion
• OK to present conflicting information
• Notation on forms if didn’t find information
• Keep forms de-identified
Basic FIMR Abstracting Rule
“If the information about a question is not in
the chart it was NOT done.”
Summarizing The Story
• Medical/social and maternal interview
• De-identified
• Preserves mothers voice
• Caution what eliminate/not bias
• Consistent for CRT deliberation
• Types: narrative/bulleted/italics
Caring For Self
Reflections on Abstracting
• The greater past relationship you have with a provider,
•
•
•
•
•
the less likely they will give you access to their records.
The record you abstract quickly is most likely to be the
hardest to summarize.
The longer a case is discussed at a CRT meeting, the
more certain it is that no one has the faintest idea of
what happened.
The probability of crying is directly proportional to the
number of cases you have abstracted.
If you can’t figure out what steps to do next in an
abstraction pathway, call another abstractor. They may
not have any idea either but you sure will feel better.
The ‘success’ of the project is directly proportional to the
community’s response.
“The best preparation for tomorrow is
to do today’s work superbly well.”
Sir William Osler
References
Buckley, K., Koontz, A. & Casey, S. (1998). Fetal and infant mortality review manual: A
guide for communities. Washington, DC: American College of Obstetricians and
Gynecologists.
Harmer, B. (1929). Text-Book of the principles and practice of nursing. New York: The
MacMillan Company.
Lauterbach, S. & Becker, P. ( 1996) Caring for self: Becoming a self-reflective nurse,
Holistic Nursing Practice, 10(7), 57-68.
McNeely, E. (2005). The consequences of job stress for nurses health: Time for a check
up. Nursing outlook, 53(6), 291-299.
Pellatt, G. (2003). Ethnography and reflexivity: Emotions and feelings in fieldwork. Nurse
Researcher, 10(3) pp.28-37.
Polit, D. & Beck, C. (2004). Nursing research principles and methods. 7th ed. Philadelphia,
PA: Lippincott Williams & Wilkins.
Shafer, J., Noell, D., & MCClain, M. (2002) Fetal and infant mortality review: A guide for
home interviews. Washington, DC: American College of Obstetricians and
Gynecologists.
The fetal and infant mortality review process: The hipaa privacy regulations. (2003)
Washington, DC: American College of Obstetricians and Gynecologists.
Wise, P. & Wulff, L. (1992) A manual for fetal and infant mortality review. Washington,
DC: American College of Obstetricians and Gynecologists.
Appreciation for Don Noell for the photographs, Mike Noell for
emotional and financial support
and for
Frank Meoni at Christine E. Lynn College of Nursing
Florida Atlantic University for technical assistance with this project.