Case Study 4 - Maternity

Case study 4 – Maternity – Aruna During the scenario: If the RM needs prompting: 1. What questions/assessments would you ask the woman? • Assess Fundal tone/ check perineal suture. • Assess PV loss • Vital Signs- Maternity MEWS (inaccurate documentation, missing values) • General assessment – pale, diaphoretic, • Apply Oxygen 6L HM • Urine Output – (no fluid balance chart) • 4 “T”s- Tone, Tissue, Trauma, Thrombin • Check birth summary for retained products or PPH 2. Who would you notify? Why? • T/L or CMC • Obstetric resident /registrar If the T/L or CMC needs states “don’t worry about it” • Continue above observations assessments • Reiterate your concerns, use ISBAR • Ensure notification to the RMO Facilitator should place RM and RMO back-to-back to simulate phone conversation In the phone call the RM should use ISBAR RMO/Registrar comes to review the woman: 1. What information do you require? • Fundal tone, loss • Vital Signs • Brief history 2. What assessment would you do (Prioritise)? • ABC • PV loss (offensive lochia, leaking urine) • Visual inspection of the perineum • Assess pain • Fundal palpation (tender) • Pathology – Vaginal swab, MSU (not previously sent) • Bloods-FBC, UEC, CRP, LFT, BC • ↑ WCC • CRP not taken until deterioration occurred 3. What is your management plan for this patient? • Oxygen • IV access & IV fluids • IV antibiotics (broad spectrum) • IV fluids • Commence Fluid Balance • Monitor PVloss, pain, perineum • Frequent vital signs Who will you notify? • Obstetric Registrar or Consultant Registrar/Consultant comes to review the woman: 1. What information do you require from the RMO? • Assessment – est. blood loss, fundal tone, pv loss, pathology results • Vital Signs • Fluid balance • What treatment has been given so far Questions: 1. What are your next actions as a group? • Notify family/Consultant • Ensure care of baby • Follow up cultures • Infectious disease review • Isolation precautions • Frequent observations • Repeat bloods • Continuing assessment of PVloss, pain and perineum To Summarise ask the group: 1. What they thought went well? 2. What suggestions would they make to improve their roles? 3. Who else should have been notified: a. Team Leader or CMC b. Registrar/Consultant as MEWS=6

Case study 4 – Maternity – Aruna