Obstetric Emergencies In The Maternity Discussion

Obstetric Emergencies In The Maternity Discussion

Abstract

Obstetric emergencies in the maternity unit are almost a norm and can happen at any time. Prompt response, excellent communication and teamwork increase the efficiency and effectiveness of the emergency response. Over decades, maternal morbidity has continued to rise in Sierra Leone from complications of childbirth, intra-and-post-partum. The major obstetric emergencies are postpartum hemorrhage, eclampsia, and sepsis. With Partners In Health – Maternal Centre of Excellence (MCOE) in Sierra Leone, we expect more women and more referrals and hence the potential of having more complicated cases. It is therefore important to have measures in place to curb the menace by being prepared all the time. The first steps would be to have the unit prepare themselves by assessing potential emergencies, establishing early warning systems (use of MEOWS); Identifying team leads who have the knowledge and capacity to lead during emergencies, emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. This is put in place, could reduce or prevent the severity of obstetric emergencies. A successful emergency response team would benefit greatly from having appropriate emergency supplies in the emergency trolley/crash cart, having established and written protocols on handling emergencies, having a rapid response team that will include, the use of standardized communication tools (SBAR) and constant implementation of drills and simulations. Obstetric Emergencies In The Maternity Discussion

Keywords: Obstetric emergencies, maternity, labor and delivery, emergency preparedness, train

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Background

Many different types of obstetric emergencies can occur during labor and delivery. Some of the most common ones include pre-eclampsia/eclampsia caused by hypertension, post-partum hemorrhage, abruption of the placenta, and sepsis (Ameh et al., 2019). Obstetric emergencies can be very serious and can lead to both short- and long-term complications for the mother and baby. In addition, obstetric emergencies can lead to serious injuries for both the mother and baby.

Maternal mortality has continued to increase in recent years. Preeclampsia, eclampsia, and embolism are now the leading cause of maternal mortality among non-Hispanic black women in the US (Collier & Molina, 2019). In Sierra Leone, maternal morbidity is a major health concern, with a ratio of 510 deaths per 100 000 live births, and is among the highest rates in the world (Carshon-Marsh et al., 2022)Obstetric Emergencies In The Maternity Discussion. According to the study by Carshon-Marsh et al. (2022), hemorrhage was the major cause of maternal mortality. This is in part due to the country’s high rates of maternal mortality due to unsafe abortion, antenatal hemorrhage, preterm birth, and inadequate antenatal care. Improving access to safe abortion services, improving antenatal care, and reducing the incidence of preterm birth are all important steps in reducing maternal morbidity and mortality in Sierra Leone.

The risk factors for obstetric emergencies include age, obesity, chronic diseases, previous cesarean section, large baby, multiple births, and difficult labors. Regular prenatal care is essential for identifying and managing any health conditions that might increase the risk of obstetric emergencies. Another way is education and awareness to ensure pregnant women are aware of the risks associated with obstetric emergencies and the steps that they can take to reduce their risk. Although our hospital has a competent nursing team and other care providers who can manage emergencies, morbidity and mortality from the emergencies are on the rise. It is unknown what continues to prevent full abatement of the poor outcomes. Thus, this capstone project seeks to intervene effectively to curb the development of obstetric emergence and improve the outcomes of care in the labor and delivery room.

Impact Statement

The capstone project aims to provide emergency preparedness training to all the midwives, nurses, and clinical officers at maternity, focusing on the importance of being prepared in terms of manpower, supplies, and skills-wise. The expected outcome will be enhanced patient safety and the ability to mitigate adverse outcomes.

Project Objective

The objective of this project is to implement obstetric emergency preparedness in the labor and delivery unit and improve overall patient safety. The project will ensure that a well-prepared team is available to recognize early warning signs and activate emergency protocols promptly. If a success, the hospital will adopt the project interventions at BEmONC sites to improve maternal and newborn outcomes.  Obstetric Emergencies In The Maternity Discussion

Project Design and Implementation

            Following the identification of the needs in the labor and delivery room in terms of emergency preparedness, the next phase will second design phase that will involve scheming a plan to address the identified needs. Considering the project objectives, the project manager (the MSN student) will create a timeline, and outline the resources needed to achieve the goals. During the design phase, the project manager (PM) will also select a team of nurses and clinicians to help implement the plan. The PM roles will also include overseeing the project, allocating resources, and ensuring that all goals are met.

Resources needed for the project include funding, trained personnel, and appropriate equipment such as emergency supplies in the emergency trolley/crash cart, written protocols on handling emergencies, and a rapid response team. The project will also involve the use of standardized communication tools (SBAR), the constant implementation of drills and simulations, and training for nurses and clinicians. According to Pattinson et al. (2019)Obstetric Emergencies In The Maternity Discussion, implementing skills and drills on Emergency obstetric care (EmOC) training is significant in helping reduce maternal deaths. During this time, the team will also investigate different ways to improve emergency preparedness such as drills, training programs, and communication tools. A focus will also be placed on ensuring that all stakeholders are aware of and involved in the project.

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In the implementation phase, nurses and clinicians will be responsible for implementing the emergency preparedness plan in the labor and delivery room. The goal of this phase is to ensure that all patients are safe since the care provider will be prepared for any emergency that may occur.  The project team will cooperate with the Maternal Center of Excellence – a Sierra Leone Partner in Health to increase emergency preparedness in the labor and delivery room. The team will train the nurses on how to be more prepared in case of an emergency. The care providers at the labor and delivery unit will prepare themselves by assessing potential emergencies and establishing early warning systems (use of MEOWS). The project manager will help Identify team leads who have the knowledge and capacity to lead during emergencies, emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Once the project is complete, it will provide a blueprint for future projects that aim to increase emergency preparedness in the labor and delivery room. Obstetric Emergencies In The Maternity Discussion

Expected Results

By May 2022, we hope to see always stocked emergency trolleys, protocols on emergency preparedness, and knowledgeable nurses and midwives. This will be measured by auditing the emergency cases by the time the emergency was noted to end, the use of protocol, and the situation outcome.

Work plan

The work plan outlines the project plan, resource management plan, and steps necessary to complete a project (Sipes, 2020). By establishing specific deadlines and outlining the tasks required to achieve them, the PM can ensure that the project proceeds in an orderly and effective manner. For this project, the PM will conduct a training and mentorship program for the unit staff on triggers of emergency, proper monitoring of patients, and preparedness from May to July 2022. Next, the PM will audit all emergency cases with the team involved and evaluate what was done right and what could improve to adjust and learn. Another task will be the performance of emergency drills to see if the team is well equipped in terms of skills and resources. Obstetric Emergencies In The Maternity Discussion

Estimated Timeline

The timeline for the project is six months within which the project is expected to be completed. At this time, the project manager will schedule each project phase to fit into estimated timeframes. Compliance with the project timeline will also help comply with the MSN program schedules for the school.

References

Ameh, C. A., Mdegela, M., White, S., & van den Broek, N. (2019). The effectiveness of training in emergency obstetric care: a systematic literature review. Health policy and planning34(4), 257-270. https://doi.org/10.1093/heapol/czz028

Carshon-Marsh, R., Aimone, A., Ansumana, R., Swaray, I. B., Assalif, A., Musa, A., … & Jha, P. (2022). Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20. The Lancet Global Health10(1), e114-e123. https://doi.org/10.1016/S2214-109X(21)00459-9

Collier, A. Y., & Molina, R. L. (2019). Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. NeoReviews20(10), e561–e574. https://doi.org/10.1542/neo.20-10-e561

Pattinson, R. C., Bergh, A. M., Ameh, C., Makin, J., Pillay, Y., Van den Broek, N., & Moodley, J. (2019). Reducing maternal deaths by skills-and-drills training in managing obstetric emergencies: A before-and-after observational study. South African Medical Journal109(4), 241-245. http://dx.doi.org/10.7196/samj.2019.vl09i4.13578

Sipes, C. (2020). Project Management For the Advanced Practice Nurse (2nd Ed.). Springer Obstetric Emergencies In The Maternity Discussion

EVALINE’S CAPSTONE PROJECT

KOIDU GOVERNMENT HOSPITAL, KONO

SIERRA LEONE

RE: EMERGENCY PREPAREDNESS IN MATERNITY UNIT

Background

ABSTRACT:

Obstetric emergencies in maternity unit are almost a norm and can happen at any time. Prompt response, excellent communication and teamwork increases the efficiency and effectiveness of emergency response. Over decades, maternal morbidity has continued to rise in Sierra Leone from complications of childbirth, intra and post-partum. The major ones being postpartum hemorrhage, eclampsia and sepsis. With PIH MCOE, we expect more women and more referrals and hence the potential of having more complicated cases. we It is therefore important to have measures in place to curb the menace by being prepared all the times. The first steps would be to have the unit prepare themselves by assessing potential emergencies, establishing early warning systems (use of MEOWS), Identifying team leads who have the knowledge and capacity to lead during emergencies, emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. This if put in place, could reduce or prevent the severity of obstetric emergencies. A successful emergency response team would benefit greatly from having appropriate emergency supply in the emergency trolley/crash cart, having established and written protocols on handling emergencies, have a rapid response team that will include, use of standardized communication tools(SBAR) and constant implementation of drills and simulations. Obstetric Emergencies In The Maternity Discussion

IMPACT STATEMENT

The aim is to provide Emergency preparedness training to all the midwives, nurses, clinical officers at maternity, focusing on the importance of being prepared in terms of man power, supplies and skills wise. The expected outcome will be enhanced patient safety and also being able to mitigate adverse outcomes.

PROJECT OBJECTIVE

To implement obstetric emergency preparedness in maternity unit and improve overall patient safety, and a well prepared team that can recognize early warning signs and activate emergency protocols promptly. If a success, will adapt it at Bemonc sites so as to improve patients wellbeing Obstetric Emergencies In The Maternity Discussion

PROJECT DESIGN AND IMPLEMENTATION

Expected results

By May 2022, we hope to see always stocked emergency trolley, protocols on emergency preparedness, knowledgeable nurses and midwives. This will be measured by auditing the emergency cases by the time the emergency was noted to end, use of protocol and the situation outcome.

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Work plan

Implement a training and mentorship program for the unit staff on triggers of emergency, proper monitoring of patients and preparedness from May to to July 2022.

Auditing all emergency cases with the team involved and evaluate what was done right and what could improve so as to adjust and learn.

Performing emergency drills to see if the team is well equipped in terms of skills and resources.

ESTIMATED TIMELINE

3-6 Months Obstetric Emergencies In The Maternity Discussion