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The development and implementation of a risk assessment tool (labour) for attending deliveries on labour ward
  1. RM Hayward
  1. Neonatology, Royal Gwent Hospital, Newport, UK

Abstract

A recent survey of junior Doctors identified anxieties attending deliveries and uncertainty when to request middle-grade assistance. Such apprehension related to the inconsistent information provided by Midwifery staff when requesting the attendance of a Paediatrician at deliveries. The present audit aimed to identify limitations in the information provided by Midwives regarding the progression of labour and the potential for neonatal compromise at delivery. The audit also included the development of a risk assessment tool to address such limitations and a re-audit of the provision of information after its implementation.

Methods A prospective audit was conducted recording the information volunteered by Midwifery staff when requesting the attendance of a Paediatric SHO at deliveries. The audit criteria included:

  • L ocation (labour ward / theatre)

  • A ge (gestational)

  • B irth type

  • O ngoing concerns (e.g. CTG abnormalities)

  • U rgency

  • R isk factors (e.g. Group B Streptococcus, meconium, maternal pyrexia/tachycardia).

These factors were deemed important in conducting a risk assessment prior to attending a delivery to determine whether senior assistance would be required.

Results The information from a total of 50 calls was documented. Of these, 98% provided the location, 82% the birth type and 48% the urgency. Detailed information regarding gestation, ongoing concerns and risk factors for neonatal compromise were 16%, 18% and 24% respectively.

Following the initial audit, the LABOUR risk-assessment tool was implemented on delivery suite. The acronym was placed above phones and attached to patient notes and aimed to provide a framework for the information required when requesting the attendance of a Paediatrician. One month after implementation, a re-audit of calls to the Paediatric SHO was conducted. Of the 50 calls in the re-audit, 98% provided the location and 82% the birth type. Significant improvements in the urgency (74%), gestation (62%), ongoing concerns (60%) and risk factors (64%) were found.

Conclusion The LABOUR risk assessment tool has improved communication of essential information from Midwives to junior Paediatricians by providing a consistent framework for information regarding deliveries. This has enabled junior Doctors to determine the potential risk for neonatal compromise at delivery and to ask in advance for senior assistance.

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