INFORMATION SESSION - The Complete Health Improvement Program
LEARNING SESSION ONE 29 TH OCTOBER 2013 MATERNITY QUALITY IMPROVEMENT.
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Transcript of LEARNING SESSION ONE 29 TH OCTOBER 2013 MATERNITY QUALITY IMPROVEMENT.
LEARNIN
G SESSIO
N ONE
29TH OCTOBER 2013
MATERNITY QUALITY IMPROVEMENT
FORMAT FOR TODAY
10.10 – 11.00 – Dr A Hamilton and Dr J Cartmill – QI Methodology
11.00 – 11.30 – Ms Ann Rath – National Maternity Hospital Dublin
11.30 – 11.50 – TEA /COFFEE
11.50 – 12.35 – Dr Mike Robson - National Maternity Hospital Dublin
12.35 – 13.00 – Q&A session
13.00 – 13.45 – LUNCH
13.45 – 15.20 – Trust Presentations
15.20 – 16.00 – Team time with Tea/coffee
16.00 – 16.30 – Feedback and next steps
YOUR SUCCESSES TO DATE
WORK IN PROGRESS
ANTENATAL CTG EVALUATION - NOT FOR USE IN WOMEN LESS THAN 28 WEEKS GESTATION Reason for CTG Maternal Pulse Membranes Intact Y/N
If NO, date and time & colour of liquor
Gestation
CTG FEATURES Reassuring Non – Reassuring Abnormal Baseline (BPM)
110 – 160 100 – 109 161 - 181
<100 >180 Sinusoidal pattern for >10 minutes
A rising baseline rate even within normal range may be of concern if other non- reassuring features are present Variability (BPM)
>5 bpm for 20 minutes <5 bpm for 20 - 30 minutes <5 bpm for 30 minutes or no variability for 15 minutes
Accelerations Present ≤ 2 for 20 – 30 minutes Absent for 30 minutes Decelerations None 2 provoked (related to uterine
tightening not in labour) with quick recovery
More than 2 provoked or any unprovoked decelerations within 20 minutes The presence of any decelerations in the antenatal period is of concern.
OVERALL OPINION NORMAL CTG SUSPICIOUS CTG PATHOLOGICAL CTG All four features reassuring One non – reassuring feature only Two or more non – reassuring or
one or more abnormal feature RECOMMENDED ACTIONS
Midwife to discontinue CTG
Senior Midwifery review Medical review (ST3 or above) Continue trace until review
Urgent medical review (ST3 or above) Continue Trace If review is delayed consider transfer to delivery suite asap. Inform Consultant Consider delivery
ACTION TAKEN Signature: Print Name: Designation : Date: September 2013 Adapted from PROMPT and a version of an antenatal CTG sticker developed by the SHSCT
Vaginal Examination Number Agreed Indication
Abdominal Palpation Fundus Lie Presentation Position 5ths palpable
Cervix Position Presenting part Anterior Length Station Right Left Consistency Caput Posterior Dilatation Position Moulding Comments on pelvic outlet
Membranes Intact Hindwater leak
Ruptured during VE ARM Accidental ROM
Forewaters Already ruptured ARM SROM
Liquor None Clear Blood stained Light meconium Thick meconium
Fetal Heart rate after VE:
Pinard Sonicaid Phono Fetal scalp electrode
Summary of Findings: Plan of care:
Signature: Chaperone: Date and time:
STRATEGIC CONTEXT
MATERNITY STRATEGY IN A DRIVER DIAGRAM
Sepsis Run Charts
SepsisRun Charts
St Luke’s Day Symposium 2013
Intermountain Healthcare Delivery Research Unit: ATP Course - Dr Brent James
• Care that works
• Care that is safe
• Care that leaves no one behind
St Luke’s Day Symposium 2013
Obstet Gynecol 2009;114:1254
The Gestational Age that Women Considered a Baby to be Full Term
Obstet Gynecol 2009;114:1254
The Gestational Age that Women Considered it Safe to Deliver
Obstet Gynecol 2009;114:1254
Weeks of Gestation
Morbidity of Late Preterm Infants in Massachusetts
• Late preterm infants: 22.2% vs Term infants: 3%• Sample: Term (377,638), Late Preterm (26,170)
• Morbidity rates doubled for each gestational week earlier than 38 weeks40 wks: 2.5%39 wks: 2.6%38 wks: 3.3%37 wks: 5.9%36 wks: 12.1%35 wks: 25.6%34 wks: 51.9%
Shapiro-Mendoza CK et al. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics. 2008;121:e223–e232
2.47% 2.65%3.36% 3.44% 4.26%
6.66%
0%
2%
4%
6%
8%
10%
37th Week(8,001)
38th Week(18,988)
39th Week(33,185)
40th Week(19,601)
41st Week(4,505)
42nd Week(258)
Gestational Weeks
Pe
rce
nt
NICU Admissions By Weeks Gestation Deliveries Without Complications, 2000-2003
Oshiro et al. Obstet Gynecol 2009;113:804-811.
NICU Admissions
1.92%
0.78%0.67%0.41%0.42%
0.68%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
37th Week(8,001)
38th Week(18,988)
39th Week(33,185)
40th Week(19,601)
41st Week(4,505)
42nd Week(258)
Gestational Weeks
Pe
rce
nt
RDS By Weeks GestationDeliveries Without Complications, 2000-2003
Oshiro et al. Obstet Gynecol 2009;113:804-811.
RDS
What Do We Need to Get Started?
MAP-IT• Mobilize• Assess• Plan• Implement• Track
Guidry, M., Vischi, T., Han, R., & Passons, O. Healthy people in healthy communities: A community planning guide using healthy people 2010. Washington, D.C.: U.S. Department of Health and Human Services. The Office of Disease Prevention and Health Promotion.