CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE

Transcription

1 CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Obstetric Early Warning Score Guideline Implementation date December 2010 Version Three Supersedes Obstetric Early Warning Score Guideline (Version 1) Contact Name and Job Title (author) Dr L Woods, Consultant Anaesthetist, City Hospital Campus Date of submission December 2013 Date on which guideline must be reviewed (this should be one to three years) Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis) December 2019 All women who are admitted to antenatal/postnatal wards and labour wards. Abstract Key Words This guideline describes when and how to use the OEWS chart for all women when admitted to antenatal/postnatal wards and labour wards. OEWS calculation, frequency, escalation, referral. Statement of the evidence base of the guideline has the guideline been peer reviewed by colleagues? Evidence base state highest level from (1-5) 1a meta analysis of randomised controlled trials 1b at least one randomised controlled trial 2a at least one well-designed controlled study without randomisation 2b at least one other type of well-designed quasi-experimental study 3 well designed non-experimental descriptive studies (ie comparative / correlation and case studies) 4 expert committee reports or opinions and / or clinical experiences of respected authorities 5 recommended best practise based on the clinical experience of the guideline developer

2 Consultation Process Target audience Consultant Obstetricians & Consultant Anaesthetists, Senior midwives. Nottingham Maternity guideline Development Group All NUH Midwives, Consultants & Consultant Obstetric Anaesthetists and all local trainee obstetricians & anaesthetists. This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. NHS Nottingham City and Nottingham University Hospitals NHS Trust are committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation. The Trusts are committed to ensuring that the public and staff are given information in a clear and concise way and in a manner that people understand. In situations where there are concerns about an individual s ability to understand information or consent to treatment because a medical condition has affected their cognitive functioning and mental capacity please refer to the Mental Capacity Act intra-agency guidance and complete appropriate documentation. Page 2 of 7

3 OBSTETRIC EARLY WARNING SCORE GUIDELINE Introduction The confidential enquiry into maternal and child health recognised that there is a need for the routine use of an early warning scoring system in obstetrics which will help in the more timely recognition, treatment and referral of women who have, or are developing, critical illness (CEMACH, 2007). CEMACH recognise that in itself the use of an early warning scoring system is only part of the solution in recognising the seriously ill and / or deteriorating woman; it is the response to the abnormal score that will determine any real change in the outcome to the woman. Clinical Application The Nottingham University Hospital (NUH) Obstetric Early Warning Score (OEWS) is recorded on the NUH obstetric early warning chart. It is utilised for all women admitted to the antenatal / post natal wards and the labour wards across both campuses. The OEWS should not be used in isolation but should be used in conjunction with clinical assessment. It may be appropriate for women who are pregnant but being nursed within the acute wards at NUH to have OEWS observations taken. This must be under the guidance of the obstetric team. OEWS Calculation When the OEWS is used a score is allocated to each maternal vital sign or observation. The minimum dataset is as follows: a. Respiratory rate (most sensitive indicator of critical illness) b. Blood pressure c. Heart rate d. Temperature e. Haemoglobin oxygen saturation f. AVPU neurological score g. Pain h. Urine output Women who have undergone an operative intervention must have their fluid balance recorded on an NUH fluid balance chart. Page 3 of 7

4 The total number of red and yellow scores is calculated; the score becomes clinically significant if the woman triggers one red or two yellow scores at any one time. Documentation The OEWS must be recorded on the NUH obstetric early warning chart. Frequency of OEWS Staff should use their clinical judgement in determining the frequency of recording OEWS observations; however as a guide the OEWS score should be undertaken. Care Episode Frequency Of Assessment* Observations Antenatal In Patients 08.00hrs 14.00hrs 20.00hrs Intrapartum Period On admission in labour Post Natally Normal Vaginal Delivery Operative Vaginal Delivery Manual Removal Of Placenta Repair Of 3 rd and 4 th Degree Tears Major post partum haemorrhage Caesarean section Once following birth prior to transfer home or to the postnatal area. Then daily until discharged home. These observation should be recorded on the post natal ward: At 30 minute intervals for the first hour. Then hourly for 4 hours. Then 4 hourly until 24 hours postprocedure. Then daily until discharged home. These observation should be recorded on the post natal ward: At 30 minute intervals for the first two hours. Then hourly for 4 hours. Then 4 hourly until 24 hours postprocedure. Then 6 hourly until discharged home. Page 4 of 7

5 *This is a minimum and may be increased by the midwife or the doctor if the maternal condition deteriorates, or if the number of red or yellow scores increases. Early Warning Score Alerts Any woman scoring either one red, or two yellow parameter scores, on any set of observations, should be reported immediately to the on call obstetric SHO using SBAR principles (situation, background, assessment, and recommendation). This information should be recorded in the hospital records. The on call obstetric SHO should attend within 30 minutes. If the SHO does not attend within this time frame the midwife should contact the SHO again stating the current condition of the woman; including an updated OEWS. If the SHO is likely to be delayed the midwife should contact the obstetric registrar or obstetric consultant (Appendix One). After the woman has been reviewed by the obstetrician a plan of care must be documented in the hospital records. Escalation If the midwife experiences difficulty in obtaining medical review and the condition of the woman significantly deteriorates medical assistance should be sought using the 2222 emergency call system and asking for the Obstetric Team. Difficulty in obtaining medical review should be reported using the NUH incident reporting process. Referral to Clinicians Outside The Maternity Service When the woman has been assessed by the obstetrician or the anaesthetist it may be necessary to involve or seek advice from clinicians outside of the maternity service (eg Haematology, Cardiology, Intensivists, Critical Care Outreach, Medicine, Surgery, Radiology etc). If a referral is considered clinically necessary it must be discussed with the on call obstetric consultant, and the reason clearly recorded in the hospital records. The on call obstetric team must verbally contact the clinician they wish to seek advice from via the hospital switchboard, and using SBAR principles ensure concise and focussed information is given. The date, time, and reason for the referral and the name of the person contacted must be clearly annotated in the hospital records. Referral to other specialties must be at senior level (Consultant or Senior registrar). Page 5 of 7

6 Extended Post Natal Stays Some women may stay in hospital for an extended time frame due to neonatal reasons. It is at the discretion of the midwife caring for the mother to cease daily OEWS recordings if the mother is well. Staff Training Staff will be provided training on the recognition of severely ill pregnant women and maternal resuscitation in line with the Nottingham University Hospitals Maternity Services Training Needs Analysis (2010). Monitoring Plan The obstetric early warning score guideline will be monitored in conjunction with the NUH Maternity Services Clinical and Operational Monitoring Plan. References CEMACH (2007) Saving Mother s Lives Page 6 of 7

7 APPENDIX ONE OBSTETRIC EARLY WARNING SCORE ALERTED MIDWIFE RESPONSIBLE FOR THE WOMAN S CARE MUST DIRECTLY CONTACT THE ON CALL OBSTETRIC SHO VIA THE BLEEP SYSTEM THE OBSTETRIC SHO MUST REVIEW THE WOMAN WITHIN 30 MINUTES IF THE ON CALL OBSTETRIC SHO IS NOT AVAILABLE WITHIN 30 MINUTES, THE ON CALL OBSTETRIC REGISTRAR / CONSULTANT MUST BE CONTACTED VIA THE BLEEP SYSTEM IF THE WOMANS CLINICAL CONDITION DETERIORATES THE OBSTETRIC EMERGENCY TEAM MUST BE SUMMONED VIA SWITHCBOARD USING THE 2222 EMERGENCY BLEEP A PLAN OF CARE MUST BE DOCUMENTED IN THE MEDICAL RECORDS. Page 7 of 7