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EFM Case Study #12: Chain-of-Authority - For Nurses (1.0 contact hour - monograph)

Hours: 1.00


Best suited for: Obstetricians and family practice physicians. Midwives, obstetric nurse practitioners, residents and other interested healthcare practitioners skilled in EFM and EFM stakeholders are also welcome to participate.


Original Release Date: December 22, 2016
Review Date: June 22, 2019
Expiration Date: December 22, 2019

Description: Differences in clinical opinions regarding the interpretation of EFM data or other clinical factors between two perinatal practitioners can and will happen. Choosing not to share a clinical opinion when it is clinically indicated or refusing to take into consideration another’s opinion into a patient’s plan of care has been shown to increase malpractice risk. Researchers identified that even if there is a resolution process many practitioners fail to share their clinical opinions due to lack of administrative support to do so. Clinical differences should be anticipated and prepared for but not all facilities have nor support use of a multidisciplinary resolution process. Creating a simple, unbiased, collaborative resolution process is required by all facilities that offer care to pregnant patients. A Chain-of-Authority offers an easy solution when differences in opinion exist but creating a safety culture that supports the free expression of clinical opinions is paramount. All resolution should start with the primary nursing and medical practitioner and end when a collaborative compromise is reached. This monograph defines the Chain-of-Authority process, outlines proper procedure to invoke it through the evaluation of two case studies, and offers risk management and patient safety considerations for success.

Learning Objectives: Upon completion, participants should be able to:
1) Critique two EFM Case Studies and critical thinking drills involving clinical disagreements
    and the use of a Chain-of-Authority (COA).
2) Outline the steps to invoking COA in your facility; if no COA policy, assist in developing one.
3) List two risk management solutions that increase successful conflict resolution before,
    during, and after invoking COA. 

Learning Assessment: There will be a posttest for this activity with a minimum performance requirement of 8 out of 10 correct answers (80%).

Estimated time to complete activity: 60 minutes

Method and Medium: To obtain CNE credit, complete a pretest, view the entire online presentation, complete the evaluation and posttest. Once completed, a certificate will be generated for printing.

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Continuing Nursing Education Information: Successful completion of this course includes completion of the post-test with an 80% passage rate and completion of the course evaluation. This continuing nursing education program has been approved for 1 contact hour by LAMMICO/Medical Interactive. LAMMICO/Medical Interactive is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Refund Policy: If purchased, there will be no refund once the activity has been accessed.

Disclosure Policy - Read

About the Authors: Dr. Kenneth Brown - Read Bio & Carol A. Curran RNC, MS, OGNP - Read Bio

Disclosure Statement: The authors, editors and planning committee members for this activity have no relevant financial relationships to disclose.

Managing Editor: Dawer Azizi, MHA, CPHRM, LAMMICO Director of Risk Management

Editor: Sharon Cusanza MSN, RN, NEA-BC, LAMMICO Senior Risk Management Education Specialist

Content Advisors/Planning Committee Members:
Dawer Azizi, MHA, CPHRM, LAMMICO Director of Risk Management
Geri  Cook, RHIA, CPHRM, LAMMICO Senior Risk Management Specialist
Carol Curran, RNC, MS, OGNP, LAMMICO Senior Perinatal Educator and Business Specialist
Sharon Cusanza, MSN, RN, NEA-BC, LAMMICO Senior Risk Management Education Specialist
Karen Davis, MA, CPHRM, LAMMICO CME/CNE Writer/Editor
Karen Duncan, JD, RN, Legal Counsel – Medical Interactive
Karl N. Hanson, MD, FAAFP, LAMMICO Physician Consultant  
Amanda Martin-Sanchez, MEd, BSN, RN, CNOR, LAMMICO CME/CNE Educator
Elmore Rigamer, Jr., MD, LAMMICO Physician Consultant
Ruth Ryan, MSW, BSN, RN - Consultant, CME/CNE Writer

Electronic Hardware and Software Requirements - Read

Web Master Contact Information: For assistance, contact Shea Ivey at 866/398-1038 or help@medicalinteractive.com
If clicking the link above does not work, please copy and paste the email address in the "To" field of your preferred email account.

Disclaimer: This activity is presented by LAMMICO as risk management education. It is not legal advice, nor does it establish medical standards of care. Standards of care vary depending on the unique presentation of each patient. The information contained herein is not a substitute for the reasonable discretion of skilled and informed clinicians at the point of care. Medical Interactive seeks to meet all the continuing education requirements for every state nursing board. However, the regulations in each state differ, and may change.  Before taking any course, you should confirm whether the course meets your state board's requirements for continuing education credit.

Copyright Information: Copyright © 2016

Bibliography: To view and download References & Resources for this presentation, please select the Tab/Link below.


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This course is offered through Experix, a wholly owned subsidiary of Physicians Insurance, and is based on more than 30 years' experience in providing continuing medical education. This course is complimentary for Physicians Insurance members.


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