Welcome to our Presentation

Presentation OutlineIntroductionBackgroundRationaleResearch QuestionLimitationsLiterature ReviewEthical ConsiderationAim & ObjectivesMethodologyResults and DiscussionConclusionRecommendationReferences

TITLE: EQUIPPING THE MATERNITY UNITS OF THE NATIONAL REFERRAL HOSPITAL (NRH) WITH EMERGENCY

KITS

A case study on the availability of proper emergency kits.

Nursing SymposiumMay 10 2012 Presenter:

Betty ManehanitaiSenior Lecturer /RN,Midwife

Midwifery ProgramSolomon Islands

Topic : Capacity of the Maternity units at the

National Referral Hospital (NRH), Honiara to manage obstetric

complication and emergencies:

1. INTRODUCTION

Management of Obstetric Complications and Emergencies - ongoing challenge

almost every places of birth around the globe especially in the developing countries

common phenomenon occurring mostly in the laboring and birthing rooms and including the antenatal and post natal units.

Equipping with emergency kits enhances the efficient management of complications and emergencies to save lives.

‘Be prepared at all times for the worst’.

way forward to improve maternal health in our country as we are working towards achieving MDG5 Maternal Health by 2015.

This small case study was designed and

carried out in the maternity units of the National Referral Hospital

It was conducted over a period of three weeks. ( March - April 2012)

Background

Background cont…

The National Referral Hospital (NRH) the nation’s highest referral and teaching hospital.

serves the total population of approximately 600,000 people (2009 census)

receives referral cases from Honiara city and Provincial patients around the country.

Background cont..

The Hospital has about 10 wards

Total number of 305 beds

298 nurses working in this Hospital.

The maternity unit has a total of 54 nurses and midwives along with 3 obstetricians and gynecologists’ consultants and 4 obstetricians and gynecologists’ registrar.

Rationale “Over 350,000 women and over 2 million infants around

the world die each year as a result of preventable complications in pregnancy and childbirth”(ICM, 2012)

NRH maternity units continued to record such incidences.

According to the delivery registry at the NRH birthing unit for the month of Aril 2012, a total of 397 births was recorded.

74 deliveries out of 397 encountered complications

Rationale Cont…Unavailability of proper emergency kits contributes in

delaying efficient management

Study was conducted to determine if the maternity units at the NRH are equipped with proper emergency kits.

Research Question Does the Maternity unit have

proper emergency kits to manage these complications?

LITERATURE REVIEW Emergency kits are very important tools to be in the place of birth as

it is handy to have them and use whenever emergencies arise. It can save a life if it has all the necessary drugs and equipments in place. (Dr. Miriam O’Connor (PEMOC) training in July 2011 ,Honiara)

Be Prepared...for the worst ....Most Obstetric Complications Occur Suddenly Without Warning!If women do not receive medical treatment in time, they will probably suffer disability…

LITERATURE REVIEW Cont…

The maternity department should be fully equipped despite the rare occurrence of CPR” (Boyle 2002, p 7).

‘Every maternity setting should have protocols in place for the management of emergencies such as post partum hemorrhage, shoulder dystocia and eclampsia ‘(Pairman et al 2008).

LITERATURE REVIEW Cont…Emergency kit is a kit box/container

Copy of unit protocols/clinical guidelines

Box-content check-lists (dated and signed)

Up to date on-call roster and phone numbers

Other ‘frequent-flyer’ numbers( eg labs, theatres)

Most recent relevant STMs

Assign the job in job descriptions/roster duties

In the boxes…….put stuff you will need

Aims and ObjectivesAIM The aim of the study was to explore whether:

The Maternity Unit of the National Referral Hospital have the capacity to manage obstetric complications and emergencies with the availability of proper emergency kits.

OBJECTIVES:To ensure that the identified study sites are

fully equipped with emergency kits and are available.

To ensure the staff working in these identified studied sites have the knowledge and skills of setting and using emergency kits.

METHODOLOGY Study Design

Combination of Qualitative exploratory study and Quantitative counting of numbers

Qualitative Questionnaire

Focus Group Discussion

Key Informant Interview

Quantitative :

Blind observation

Study sites Postnatal unit,

Birthing unit,

Antenatal unit

Study Population and Sampling

Study Population - 51 (total pop of 3 units)

Questionnaire – 51 Response – 21

Sampling method – purposive sampling which includes individuals who know the relevance for the purpose of the study

Key Informant Interview (KII) – 9

Available for interview – 6

Study sample – nominated sampling was used to identify individuals who possess the necessary characteristics or experiences. Doctors/Nurse Managers/CNC

Focus Group Discussion (FGD) – 10 Participated – 7

Study sample - convenience sampling identified those at hand who have the necessary information relevant for the purpose of the study

Study Population and Sampling cont…

Data Collection

Questionnaires - designed and structured according to the relevant information required for the purpose of the study.

FGD – developed some relevant questions and were used for discussion to get required information.

KII – questions were designed and structured and were used for face to face interview.

Data Analysis

Collected information from questionnaire, key informants – tabulated and converted to bar graph and pie chart for comparison Manual calculator was also used.

Key informants and focus group discussions, information was transcribed and coded into common themes.

Other qualitative information from the focus group discussions and the Key informants’ interview were all transcribed and organized to relevant common themes.

Ethical Consideration

Consent granted from the Assistant Director of Nursing, National Referral Hospital (NRH) followed by a letter to the Ethical Research and Organizing of the Nurses Symposium committee .

Following approval, a written letter and consent forms were distributed to the participants of this study.

A signed consent form was obtained from the participants of the Key Informants once the interview was accepted.

confidentiality be maintained

RESULTS AND DISCUSSIONS

81% of the questionnaires responded that there was no availability of different types of emergency kits

100% of both the key informants interviewed and blind observations done indicated that there are no emergency kits available in their units.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Questionnaires responses

Key Infromant Interview Responses

Blind Observation responses

81%

100%100%

Availability of different types of emergency kits in the maternity unit

Available

Not Available

No response

Results and Discussion

• 72 % stated that there was no support from their superiors

• 14% stated it is unnecessary because of the general emergency trolley

• 14% did not respond• Participants have the

knowledge and time available but the main reason was due to the above 72%.

Reason why not equipping the units with emergency kits

No knowledge0% Not neccesary because of

emergency trolley14%

No support from superior72%

No time 0%

Not responded14%

Questionnaire

Results and Discussion

• 52% of respondents stated that Post Partum Haemorrhage due to atonic uterus

• 29% Post Partum Haemorrhage from deep tears

• 24% accounts for both PET and APH

• Shock accounts for 14%

• delay in second stage was 5%.

0%

10%

20%

30%

40%

50%

60%

52%

24% 24%

0%

5%

14%

29%

Higest rated common obstetric complication & emergency encountered

RATE 1 Commonly encountered

Results and Discussion

Questionnaires Responses Key Informant Interview Responses

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%90%

83%

29%

16%

48%

83%

14%

3%

9%

0%

General Trol-ley

Borrow

Collect From W/stock

Ring Pharmacy

Not Respond

Questionnaire – 90% used the general emergency trolley 48% collect equipment from ward stock, 29% borrowed from other wards, 14% stated that they ring pharmacy for equipment.

Key informants’ responses, 83% stated that they managed obstetric complications by using the general emergency trolley and collected from the ward stock. 16% key informants responded by borrowing from other wards.

Results and Discussions

• 100% key informant interview general trolley was not sufficient

Questionnaire • 48% responded

general trolley not sufficient

• 38% stated general trolley sufficient

• 14% no response

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

38%

0%

48%

100%

14%

0%

sufficient Not sufficient Not responded

Sufficiency of general emergency trolley toManage obstetric complications

Results and Discussion

Key informants• 83% unutilized • 17 % responded

that they fully utilized them.

Questionnaires responses,

• 24% unutilized• 43% stated that

they fully utilized

Utilization the current emergency trolley

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Questionnaires Responses

Key Informant interviewed Responses

43%

17%

29%

0%

24%

83%

5%

0%

Fully Utilized

Partly Utilized

Unutilized

No responses

Results and Discussions

Questionnaire 67% stated the importance of having different types of emergency kits24% no response10% agreed to have one emergency trolley

questionnaires Responses

0%

10%

20%

30%

40%

50%

60%

70%0.670000000000003

0.1

0.24

Differrent types of emergency kits

One emergency trolley

Not responded

Importance of equipping the 3 units with different types of emergency kits

Results and Discussions

88% of questionnaire responses strongly agreed . 10% Agree0% Disagreekey informants’ responses, 100% strongly agreed as well.

Questionnaires Responses

Key Infromant Responses

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

86%

100%

Strongly Agree

Agree

disagree

not responded

Agree to equip their units with different types of emergency kits

Results and Discussions

• 81% of checks is done by the Clinical Nurse Consultant,

• 29% by the Nurse Managers

• 19% by Registered Nurses

RN CN CNC NM NA0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0.19

0

0.81

0.29

0

Person responsible for checking trolley

Person responsible

Results and Discussions

Questionnaires• 48% stated they

check it anytime after use

• 24% stated that they did daily checks

• 10% stated that they either checked once every shift or weekly.

• 10% did not respond. Once

every

shift

Daily

Weekly

Any time aft

er use

No resp

onse0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

10%

24%

10%

48%

10%

How often do you check and restock emergency trolley?

checking time

Results and Discussions62% responded needed assistance to set up their emergency kits. 19% stated that they are either very confident or confident to set up their own emergency kits.

confident to set up emergency kit

Very confident

Confident

Some what con-fident

Need assistant

2.Results Findings of the FGD

Theme 1. Opinion having different types emergency kit in their units.

Participants comments: All participant agreed that it is a good

thing to have in place for the following reasons; saves time running around looking for missing equipments, specific for different complications and saves lives.

2.Results Findings of the FGD

Theme. 2. current status of their emergency trolley.

Participants Comments: Has limited stocks and not in good condition. In the birthing unit they only have an ambu bag

which is not in its good condition as well, they also stated that they have oxygen for babies

only. They do not have an oximeter as well – out of stock in the pharmacy. They stated borrowing oxygen from post natal

ward.

2.Results Findings of the FGD

Theme.3. Who does the checking the trolley

Comments of the group. The majority of participants in the focus

group discussion clearly stated that they have not been allocated to check the emergency trolley daily

Only the boss does the checking and it was noted that it was not checked accordingly as well.

2.Results Findings of the FGDTheme. 4. Sharing experiences encountering and

managing obstetric complications

Participants responses.Participants from the birthing unit and post natal

ward shared their experiences on encountering Post Partum Hemorrhage in the National Referral Hospital as well as in the Area and Rural Health centers.

Difficulty and life threatening situations Managing obstetric complications with no emergency kit or proper emergency equipments available.

they recommended that there is a need to have a proper emergency kit specifically for a particular case and it must be available at all times.

Study Limitations Researchers

time other work related commitments,

money,

power interruptions and network congestions.

Virus

Limitations cont...

participants -different shifts

communication

Transport difficulties for others

monetary issues – no bus fare.

CONCLUSION To conclude, this study has identified

important gaps in the availability of proper emergency kits in the Maternity unit of the National Referral Hospital

The importance of having proper emergency kits in the 3 study sites is crucial.

Evidence has shown that there are no proper emergency kits available at this point in time when they encounter emergencies and obstetric complications.

Post Partum Haemorrhage due to atonic uterus and deep tears are the most common obstetric complications encountered. However, this study has shown that there are no proper emergency kits available to manage them.

CONCLUSION Although, the nurses and midwives already have

the capacity to set up and use these emergency equipments,

there is clear evidence that they needed support and assistance in setting their emergency kits.

The need of addressing this issue is a priority because the current emergency trolley is insufficient to manage obstetric complications and leads to borrowing of emergency equipment from other wards.

Thus ,delays managements.Therefore they strongly agreed to equip the

maternity unit with different types of emergency kits for efficient and effective management.

RECOMMENDATIONS

The following recommendations should be considered:

Emergency and Obstetric Training be provided for all nurses in the Maternity unit by the responsible authorities

Develop Updated protocols and listing for each emergency kit.

There should be collaboration between other health service providers example; pharmacy, theatre, doctors to set up proper emergency kits.

Nurse Managers and Clinical Nurse Consultants to allocate nurses/midwives for checking the emergency trolleys on every shift.

Seek funding for emergency kits.

•ACKNOWLEDGEMENT

The symposium committee for the opportunity to present this small study

Research and Ethical Committee

Assistant Director of Nursing NRH for granting us permission to use the NRH facilities to conduct the study

Nurse Managers of the Maternity Unit

Participants of the study

Thank you very much for your understanding, support and cooperation in assisting us to complete this study.

REFERENCES

Boyle. M, 2002, EMERGENCIES AROUND CHILD BIRTH, Radcliffe Medical Press, British.

International Confederation of Midwives Key Message 2012

O’Connor. M, 2011, V3 PEMOC FOR HONIARA, SOLOMON ISLANDS,BASIC EMERGENCY OBSTETRIC CARE, PNG

Pairman.S, et al, 2008, MIDWIFERY PREPARATION FOR PRACTICE, Elsevier, NSW.

Ree,C, 2003,Introduction to Research for Midwives, BfM, London.