INFANT Guide (v2 Guardian and Athena)

INFANT (INtelligent Fetal AssesmeNT) is a module within Guardian that analyses fetal heart monitoring and draws clinical attention to any problems through the use of visual and audible alerts.

At the Bedside

If enabled, INFANT presents itself on the Guardian CTG screen and raises proportionate alerts according to the concern it has for fetal wellbeing. The noticeable difference with INFANT enabled is the presence of the ‘INFANT’ button beneath the CTG toolbar and the INFANT Concern State (ICS) Indicator is visible to the right hand side of the patient information bar as shown below. The ICS Indicator remains visible on all screens to indicate the current concern state. The INFANT user interface is only visible from the CTG window.

INFANT Concern State Indicator

The ICS (Infant Concern State) indicator will show the latest INFANT Concern State generated by the system. If INFANT is enabled, the ICS Indicator will always be visible on all of the screens of the Bedside application and will appear to the right hand side of the patient information bar.  It takes the form of a ladder with increasing concern states as shown below.

	INFANT Concern State – Level 4 (Green) This is the default state if no abnormal features have been detected.  Upon the start of a new CTG session the state will always be reset to Level 4 (Green).
	INFANT Concern State – Level 3 (Blue) This state is reached to draw attention to abnormal features but also to reassure clinicians that the features have been noticed. If isolated, these features are not of great concern. If they should repeat in the near term then they might be escalated to a Level 2 (Yellow) warning.
	INFANT Concern State – Level 2 (Yellow) When the trace becomes classified as abnormal then a Level 2 (Yellow) state is issued. An audible warning sounds at the Bedside if it is not acknowledged within 5 minutes of commencement. A clinician can mute this state when they acknowledge any event or events that combine to make this state active. If this state is not acknowledged within 15 minutes from its onset then a voice message from the Guardian bedside will state that a senior medical review is required and to acknowledge that they have seen the potential problem.
	INFANT Concern State – Level 1 (Red) This state is reserved for traces associated with impending fetal demise. An audible warning sounds at the Bedside if it is not acknowledged within 2 minutes. The pitch, duty cycle and repetition distinguish between Level 1 (Red) and Level 2 (Yellow) states. If a Level 1 Red event is not acknowledged within 4 minutes then a vocal message stating a senior medical review is urgently required will be played at regular intervals.

INFANT event markers

An event will be shown on the CTG in relation to the time when the event occurred. The event markers are shown in Red, Yellow or Blue to signify the level they convey.

Event marker types are as follows: Coincidence Multiple No baseline (Bradycardia) No baseline detected Sinusoidal Pushing Bimodal HR pattern Baseline drop Reduced variability Severe bradycardia Bradycardia Mild bradycardia Mild tachycardia

Tachycardia Severe tachycardia Absent variability Reduced variability Increased variability Decelerations Late decelerations No contractions Infrequent contractions Too frequent contractions Tonic contractions HR LOC? UA LOC?

The INFANT Panel

The INFANT panel has four tabs on the left hand side. The tabs are used to select a particular view:

Touch the Current Events tab to show all Level 1 (red) and 2 (yellow) events that are active (not cancelled or withdrawn). Events are listed firstly by severity followed by reverse chronological order (most recent top most). All events in this view will require user acknowledgement or cancellation. If a new event is issued then this view will automatically appear. Touch the Explain tab to show features on the CTG trace. Selecting a tick box on or off will show or hide the relevant features on the CTG trace. Touch the Historic Events tab to show all events that are no longer active and have been cancelled by the user or withdrawn by the INFANT system. Touch the Notifications tab to show all Level 3 (blue) notifications produced by the INFANT system. No yellow or red events will appear in this view.

On the INFANT panel's right hand side are two buttons:

Touch the Close INFANT button to hide the INFANT panel.  If any unacknowledged level 2 (Yellow) or higher events exist then the INFANT panel cannot be closed. Touch the Acknowledge button to either acknowledge or cancel any active events. You will be required to authenticate using either your fingerprint or password. A dialog is shown clearly displaying all events that this action will affect.

Events remain active until acknowledged. Depending on when an event is acknowledged will determine its subsequent behaviour:
 
If an event is acknowledged when the underlying conditions that lead to the event are still present, it will be marked as ‘Acknowledged’. The event remains active but will not generate an audible alert. If, after a period of time, the underlying conditions that lead to the event are no longer present it will automatically be cancelled.
 
If an event is acknowledged when the underlying conditions that lead to the event are no longer present it will be cancelled immediately.

Current Events view

For each event an item will appear in the Current Events view:

Level of Concern	Type & Subtype of Event	Time of Event	Event Status
Coloured  icons are used  in the events list to show the severity of each event: • Red (Level 1) • Yellow (Level 2) • Blue (Level 3)	A text description of the type and subtype if available e.g.: • Severe Decelerations • Mild Tachycardia • Reduced Variability	Time the event occurred or was escalated to this level.	The event may take one the following status values:  Please Acknowledge The event is active and needs user acknowledgement (to prevent audio warning). Acknowledged The event is active and has been acknowledged. Please Cancel The underlying features that led to the event being issued no longer persist.  The event may now be cancelled. Withdrawn The underlying features used to raise the event have changed and the INFANT system has withdrawn the event. Escalated The underlying features used to raise the event still persist and the event has been escalated to a higher level. Cancelled The event has been cancelled. Status information will not be shown for blue events as they do not require any user acknowledgement

Viewing at the Central Station

In the CTG/ Partogram view at the Central Station (shown below) you will be able to see icons for each room and their current Concern State level colour displayed at the top of the screen. The Patient label colour for each occupied room reflects INFANT's current Concern state and the Concern Ladder also displayed. The patient label and room icon will start to flash if either a Level 2 or Level 1 concern state has not been acknowledged and the bedside portal in that room is issuing an audible alert.

Remotely viewing a current CTG via Clinical Web Portal

After logging into Clinical Web Portal, each patient will display INFANT's current concern level to the left of their name as shown below

Clicking on your chosen patient will display the CTG view including concern level indicator and event markers as follows:

Please Note! The INFANT concern ladder and event markers will only display for a currently recording CTG trace. The iNFANT concern ladder will not display for currently stopped CTG traces, nor previous trace sessions retrieved from the archive.

Reviewing a historical INFANT record in Athena

Upon opening the record in Athena you will presented with the following labour record view (plus or minus Partogram and MEWS tabs depending on your version of Guardian):

Please note that all events including Notifications are listed in either the Current Events, Historic Events or Notifications views in the INFANT Panel. Clicking on any listed event or notification will display the segment of CTG when this event took place.

 

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