Roadmap for Integrating Point-of-Care Ultrasound into Midwifery & Women’s Health Practice: Evidence and Standards

Objectives: By the end of this webinar, the participant should be able to:

1. Clearly state evidence-based rationale for integrating ultrasound into practice^1-7

a. Identify needs and barriers

b. Identify care local/regional deficiencies in care that would be improved by integrating POCUS (point-of-care ultrasound)^2,3,6,7

2. Utilize a planning template for determining feasibility of implementing POCUS into practice

3. Utilize an Implementation template for acquiring resources needed to implement POCUS.

4. Investigate and select an appropriate training model for the scope and setting:

Evaluate ongoing implementation process using SWOT analysis

Introduction

The need for implementing POCUS in practice has been well-documented and is becoming a common practice internationally. In order to perform POCUS safely and effectively for the ultimate goal of improving healthcare of women and newborns, a systematic program with proven guidelines must be in place. This course will outline the steps involved in assuring that all considerations are demonstrated.

Identify Barriers to implementation⁹

Lack of training

1. Lack of adequately trained instructors

2. Lack of training opportunities

3. The American Academy of Physician Assistants (AAPA) recently approved the creation of a constituent organization, the Society of Physician Assistants in Clinical Ultrasound (SPACUS),whose stated goal is “promoting the use of ultrasound by PAs through education, governance, and advocacy for all providers who utilize ultrasound from the seasoned physician assistant to the stud

ii. Machine availability Lack of guidelines¹⁰: development of guidelines for clinical practice and recommendations for credentialing, competency standards, and certification should also be a focus of professional PA organizations

iii. Lack of Certification to assure hospital credentialing ¹⁰

iv. Radiologists concern re: POCUS¹¹

Utilize a planning template for determining feasibility:

Engage local and national stakeholders within existing healthcare entities

i. Published practice statements from national practice organizations

ii. Regulatory boards, Ministries of Health, Health system administration

iii. Professional organizations

iv. Radiology

v. Physicians

vi. Clients

— Find local advocacy groups (women’s groups, etc)

— Assess resources and infrastructure assessment

2. Establish methods to incorporate POCUS practice into the existing healthcare system

a. Construct a prospectus including a timeline

b. Explore reimbursement options.¹

Utilize and Implementation template for acquiring the following:

a. Financial support

b. Machines and supplies⁸

i. use of PUMs (portable usd machines)⁶

ii. Barriers: Equipment purchasing and maintaining costs are barrier for many midwives⁴

iii. Hardware requires input from clinical user to properly select and maintain¹²

iv. Hardware requires input from clinical user to properly select and maintain¹²

v. Pocus software functions are integral to documentation and quality programs¹²

c. Protocol development

i. POCUS Stewardship¹³ : emphasizing critical evaluation of clinical indications prior to performing pocus as well as pt and test characteristics when integrating results into clinical decision-making. “Integrating POCUS stewardship principles into clinical practice and existing workflow is feasible but must be accomplished in an intentional and thoughtful manner.” ¹³– includes proper pt selection and clinical indication; gaining mastery of POCUS must extend beyond image acquisition and interpretation.

ii. Importance of POCUS Stewardship - means change in management, safety and accuracy and catching a missed dx. ¹

iii. NNS – being a good steward – NNS is concept used to consider which pts most likely to benefit from clinician performed usd. NNS is e expression of the number of pocus examinations needed to be performed to attain a benefit to the pt.¹

d. Workflow – workflows are valuable in pocus¹²

e. Documentation and referral mechanisms

4. Investigate and select an appropriate training model for the scope and setting: (most operator-dependent imaging modality ^9,10,14,15

a. Task analysis to determine scope of practice domains and practitioner qualifications

b. Curriculum development or adaptation

“Introduction of an evidence-based training with full description of curriculum designs or educational programs on obstetrical ultrasound for midwives were included and scrutinized against pre-defined

criteria according to the PICO (Population, Intervention, Comparator, Outcomes) scheme is warranted”.¹⁵

c. Implement a competency template for evaluating performance

d. Proficiency assurance and ongoing monitoring

e. Costs of training

f. Other considerations:

i. Major issue re: pocus is training with experienced providers and equipment. Guidelines are needed to establish the use of pocus in a safe and effective way. There are currently no pocus programs specific to ob/gyn in Europe. ISUOG has a web-based program for ob/gyn usd but NOT for pocus.⁶

5. Review machine options and availability for appropriate use in a given clinical setting. Machine availability and insufficient POCUS training and education opportunities limit widespread clinical use of POCUS by PA’s¹⁰

6. Evaluate ongoing process using a SWOT analysis:

a. Strengths

b. Weaknesses

c. Opportunities –

Solutions include expanding residency training in ultrasound skills, extending funding for PoCUS training to rural physicians in practice, moving PoCUS training courses to rural sites, and creatin telesonography training for rural physicians.²

POCUS requires strong governance structure to function properly¹²

d. Threats — Barriers to implementation¹⁰:

—Lack of training

—Lack of adequately trained instructors

—Lack of training opportunities

i. The American Academy of Physician Assistants (AAPA) recently approved the creation of a constituent organization, the Society of Physician Assistants in Clinical Ultrasound (SPACUS),whose stated goal is “promoting the use of ultrasound by PAs through education, governance, and advocacy for all providers who utilize ultrasound from the seasoned physician assistant to the studen

—Lack of machine availability & Lack of guidelines: development of guidelines for clinical practice and recommendations for credentialing, competency standards, and certification should also be a focus of medical and professional organizations

—Certification assures hospital credentialing boards of practitioners meeting standards

Roadmap for Integrating POCUS into Midwifery & Women’s Health Practice

Integrating Point-of-Care Ultrasound into Midwifery & Women’s Health Practice: Webinar Outline