Emergency guidance on delivery suite: implementing the Quick Reference Handbook for obstetric emergencies

Dr Victoria Prabhu, Dr Annika Smith

Oxford University Hospitals NHS Foundation Trust

Plan

The problem: emergencies in obstetric practice can present unexpectedly and escalate quickly, requiring time-critical action often out-of-hours and by relatively junior anaesthetic staff. Our aim: to review and improve the availability of guidelines and algorithms that can be immediately accessed in an emergency on our busy tertiary delivery suite.

 

Do

1) A survey was sent to all consultant anaesthetists, resident anaesthetists and anaesthetic fellows who work on delivery suite, to gather data on where they would look for immediate access to guidelines in a range of example emergency scenarios.

2) A review of existing printed guidelines available on delivery suite was conducted, and areas for improvement were identified in the context of survey results.

Study

26 survey responses: 10 consultants, 13 residents, 3 fellows

• 42% were aware of the obs QRH
• 35% would use trust intranet guidelines ⟶ slow to access in an emergency
• 12% would look for guidance in places where it does not exist (e.g. iResus app for maternal cardiac arrest, which has no maternity-specific information)

Act

 

Implementing the Quick Reference Handbook for Obstetric Emergencies (Obs QRH):

 

• Pre roll-out: approval gained from obstetric anaesthetic consultant group, departmental clinical governance, and anaesthetic nursing/practitioner team.
• Initial roll-out: copies of the obs QRH were displayed in the anaesthetic rooms of both emergency theatres on the John Radcliffe Hospital delivery suite.
• Spreading the word: pre-publicised via email; included in the delivery suite handbook for resident anaesthetists.