TITLE:
Services Response to Clinical Standards
PURPOSE:
To reduce the hospital mortality and morbidity by delivering the best health care practices to patients, especially high-risk in the appropriate time
CONDITION/APPLICABILITY:
This policy is apply to all the patient admitted in the obstetric and gynecology department in the security forces hospital
DEINITIONS:
High risk patients: defined as where the risk of mortality is greater than 10%, or where a patient is unstable and not responding to treatment as expected consultant involvement should be within one hour for high risk patients.
low risk patients : defined as women on labor room who are expected to be low risk without complications
POLICY:
This policy is done to classify the patient as high and low risk patient and specify with whom the patient will be seen and the time line for the management plan starting from the time of diagnosis till the time of effectively seen the patient, as well as the follow up of the patient
PROCEDURE:
When and by whom to see the patient
All the high risk patient admitted to the hospital should be seen and reviewed by a consultant once daily, and by senior registrar /register every 12 hrs. (including all acutely ill patients directly admitted and others who deteriorate).
Once transferred from the acute area “ICU” of the hospital to a general ward, patients should be reviewed during day duty by (consultant/ senior registrar /registrar) ward round at least once every 24hrs by consultant and once every 12hrs by senior registrar /registrar, seven days a week
Inpatient consultation should be seen on the same day by the senior registrar / registrar within 12 hours
“in the word “
All the patient operated should be seen by resident on call after
12 hrs. post OP day 0 and should be assessed and documented in
progress note and inform registrar on call for any query “i.e. two
round should be done AM round and PM round the AM round in
all the patient and the PM round in all the post operative patient
after 12 hrs. and the new admission and high risk patient “.
“in labor room”
5.2.1. All new admission should be seen and assess and categorize
by resident, supervised by registrar/senior registrar
covering the labor room into low risk and high-
risk patient
5.2.2.Low risk patient will be followed by resident on call and
discusses the progress by senior registrar/registrar on call” see
labor room policy “progress in labor “
5.2.3. High-risk patient should be followed by senior
resident/registrar and discusses the progress by senior
registrar/consultant .
5.2.4. Senior registrar /registrar should do round in regular base to
guarantee and supervise the plan of management and correct
document .
5.2.5. Delivery of a high-risk patient should be attended by senior
registrar.
5.3. Level of response of healthcare team
5.3.1. Level I cases need to be attended by consultant on call 15-30 min from time of admission
5.3.1.1. Patient arrested and required CPR
5.3.1.2. Patient who have eclampsia
5.3.1.3. All patient required admission to the ICU
5.3.1.4. Acute pulmonary embolism
5.3.1.5. Patient suspected to have sever abruptio placenta
5.3.1.6. Patient with severs antepartum or post-partum hemorrhage.
Level II cases need to be attended by senior registrar/registrar
immediately and by consultant within 30- 60 min
Patient in septic shock
Patient with moderate antepartum or post-partum hemorrhage required operation.
Patient highly suspected ovarian torsion
Subacute pulmonary embolism
Level III cases need to be attended by senior registrar/registrar within 15 min and by resident immediately and inform the consultant within 60 min to plan the management and attended by consultant within 24 hrs.
Sever preeclampsia
Placenta previa with mild vaginal bleeding
Patient required argent another specialty consultation
Deep vein thrombosis
High risk patient
5.5. Level IV cases need to be attended by senior registrar within 60 min and
by resident 30-60 min and inform the consultant within 24hr.
5.5.1. Low risk patient in labor
5.5.2. Pregnant women with UTI
5.5.3. Mild hyperemesis gravidarum
5.5.4. Threatened miscarriage
5.5.5. Post-operative with surgical site infection
5.6. Consultant should attend ”physically present in operation theater “
5.6.1. all caesarian section with complication
5.6.2. Patient with previous one and more caesarian section
5.6.3. Patient with documented extensive adhesion.
5.6.4. Patient preterm<30 wks.
5.6.5. Patient preterm <34 weeks abnormal lie “ transverse lie”
5.6.6. Second stage caesarian section.
5.6.7. Patient develop post -partum Hemorrhage and required
exploration under Anesthesia
5.6.8. Acute abdomen requiring laparotomy or laparoscopy.
“Notice senior registrar can start preparation and operation in cases of emergency situation where life threatening situation which will affect the maternal or fetal mortality and morbidity” cord prolapse, suspected rapture uterus, sever antepartum Hemorrhage, sever fetal distress “
5.7. all patient admitted to the labor room should be managed according to the policy of labor room, critical cases should be discussing with consultant on call and their opinion and plan of management should be documented in progress notes
RESPONSIBILITY:
All ob./gyn doctors
REFERRENCE:
NHS Seven Day Services Clinical Standards February 2016RCP (2007): Acute medical care: The right person, in the right setting – first time
RCS (2011): Emergency Surgery, Standards for unscheduled surgical care
AOMRC (2012): Seven day consultant present car
AOMRC (2013): Implementing 7 day consultant-present care
APPROVALS: