38 Obstetrics
, Wrong time: Improving of Obstetric Emergencies Wrong place,Management Wrong time: Improving Management of Obstetric Emergencies etric Settings
in Non-Obstetric Settings
Wrong place, Wrong time: Improving Management Written by Dr Tom Wall, Specialist Anaesthesiology Trainee. of Obstetric Emergencies in Non-Obstetric Settings
om Wall, Specialist Anaesthesiology Trainee.
ne is a time sensitive, unpredictable challenge for patients and practitioners. to obstetric practice focus on the timely management of common emergency re relatively unique to this patient population. In line with international practices, Obstetric medicine is a time sensitive, unpredictable challenge for patients and practitioners. ne is highly centralised in Dublin1,2. However, patients present as unscheduled Written by Dr Tom Wall, Specialist Anaesthesiology Trainee Skillsets unique to obstetric practice focusthese on the timely management of common emergency settings that do not routinely provide obstetric care. In our hospital, entationsscenarios highlighted patient safety issues,which we addressed in this Quality that are relatively unique to this patient population. In line with international practices, QI) project 1,2
obstetric medicine is highly centralised in Dublin . However, patients present as unscheduled
Obstetric medicine a time ersity Hospital (TUH), several is presentations of female is emergencies to settings that Scenario: do not27-year-old routinely provide obstetric care. In our hospital, these sensitive, unpredictable ts in extremis highlighted a critical medication brought in by ambulance in challenge for patients and nsider theemergency scenario presented on the right. presentations highlighted safety issues,which we addressed in this Quality severe shock.patient She is day 1-post practitioners. Skillsets unique
to obstetric practice focusproject uncomplicated vaginal delivery -partumImprovement haemorrhage (PPH) (QI) presenting to on the timely management of having discharged herself this eral necessary uterotonics were not common emergency scenarios and is clearly ilable forIn use, a working group was University Hospitalmorning (TUH), several presentations of thatTallaght are relatively unique to haemorrhaging PV. valuate the preparedness thishospitals patient population. In for line obstetric patients in extremis highlighted a critical medication with international practices, t’semergency presentations. Consider, in your institution;
safety issue. Consider presented on the right. we felt PPH and Pre-Eclampsia(PET) werethe 2 scenario centralised in Dublin.1,2 However, - Do you know where patients present as unscheduled encies, whcih require specific your uterotonics are emergencies settings that do Following aAdditionally, post-partum haemorrhage (PPH) presenting to pies and thus attention.to stored? not routinely provide obstetric rgenciesTUH, are unique to the obstetric several not - What are thewere doses and care. In where our hospital, these necessary uterotonics often present in thepresentations post-partum period, and emergency contraindications of immediately for use, a working group was tetric settings like ours highlighted patientavailable safety carboprost? obstetric medicine is highly
toinnovations evaluate for - Howpreparedness is ergometrine policiesestablished and even low-tech likethe hospitals Quality Improvement (QI) project given and when in PPH? ck), requires a significant QI framework to obstetric patient’semergency presentations. In Tallaght University Hospital d initiatives lead to actual implementation. (TUH), several presentations of ementation is highlighted for readers. obstetric patientsbelow in extremis
wed: ty ith
ped
em ied
issues,which we addressed in this
Scenario: 27-year-old female is brought in by ambulance in severe shock. She is day 1-post uncomplicated vaginal delivery having discharged herself this morning and is clearly haemorrhaging PV. Consider, in your institution;
Examining this, we felt PPH and Pre-Eclampsia(PET) were 2 - Do you know where highlighted a critical medication obstetric whcih require specific safety issue. emergencies, Consider the scenario your uterotonics are presented on the right. pharmacotherapies and thus attention. Additionally, Examining this, we felt PPH post-partum period, and thus to implementation is highlighted stored? to Following a post-partum non-obstetric settings like ours. below for readers. and Pre-Eclampsia(PET) were Solution Postwhilstthese emergencies are2 obstetric uniqueemergencies, to the obstetric haemorrhage (PPH) presenting What are the doses and whcih • Drugs & Therpeutics identified Implemenation Developing local policies and We developed local guidelines to TUH, where several necessary Committee population, they often present in the post-partum period, and require specific pharmacotherapies even low-tech innovations like and information • Guildlances for management • Nursing stock check • Theatre Simulation contraindications ofsheets to guide uterotonics were not immediately • Site specific information: NCDH Induction presenation • Pharmacy technician final attention. •Additionally, and thus ours, (a drug pack), requires a practioners, often unfamiliar available for use, a working group thus to non-obstetric settings like ours Door codes, bleeps, stock implementation • Working group re-review carboprost? whilstthese emergencies are location . significant QI framework to ensure with pregnant patients, on the was established to evaluate the • Yearly code&bleep • Single pack - all in 1 place verification population, ideas and initiatives lead to management of PET and PPH. hospitals preparedness for obstetric unique to the obstetric is ergometrine Developing local policies and even likeimplementation. OurHow patient’semergency presentations. they often low-tech present in theinnovations actual path These guidelines, located within Implementation
-
ours, (a drug pack), requires a significant QI framework to ensure ideas and initiatives lead to actual implementation. Our path to implementation is highlighted below for readers.
given and when in PPH?
Figure 1 QI development Journey:
lopmentIdea Journey: Idea to Implementation to Implementation
• Critical incidents reviewed: • Medication availability • Practioner comfort with patient population • Working group developed
Solution identified • Guildlances for management • Site specific information: Door codes, bleeps, stock location . • Single pack - all in 1 place
• Drugs & Therpeutics Committee • Theatre Simulation • Pharmacy technician final implementation
Problem identified
Figure 1 QI development Journey: Idea to Implementation NOVEMBER 2023 • HPN | HOSPITALPROFESSIONALNEWS.IE
Implementation
PostImplemenation • Nursing stock check • NCDH Induction presenation • Working group re-review • Yearly code&bleep verification
