TABLE 1: THE PATIENT JOURNEY Before the pathway
í Woman admitted the day before to antenatal ward. If local and no bed available on local ward, moved to holding bed, then moved when a bed became available
í On the day of operation woman transferred to theatre following enema and catheterisation on ward
í Husbands not allowed in theatre í Delivery suite staff attend in theatre to receive baby and take to delivery suite to weigh and dress
í Mother then transferred to the postnatal surgical ward (high dependency area)
í When stable moved to another postnatal bed í If local then moved to local ward í Total bed moves = 5
surgery pathway. The advantages are that unnecessary documentation is reduced, evidence based clinical care has a clear guide, it provides prompts and importantly, does not replace clinical judgment. On- going direction is provided for beginner practitioners and education to all patients on the selected pathway is offered.
CAESAREAN BIRTH INTEGRATED CARE PATHWAY PILOT: FROM OCTOBER 2010 The CBICP pilot has highlighted the challenges of introducing such a new concept and frequent adjustments have been required despite a comprehensive, multidisciplinary education programme to orientate staff. Utilisation of an FMEA (Failure Modes and Effects Analysis), a risk management process, has been invaluable in highlighting areas which can jeopardise success, and identifying systems to resolve
On the pathway
Woman arrives at 6.30am on the day of operation (no enema)
Taken to ward and prepared for theatre, seen by obstetric doctor and anaesthetist
Transferred to theatre escorted by ward nurse/midwife Husband encouraged to accompany wife to theatre Ward nurse/midwife stays to catheterise patient after the spinal anaesthetic and then receives the baby
Skin to skin is initiated as soon as possible Baby stays in theatre and breast feeds in recovery Mother, baby and husband transferred back to same ward and remain on ward in same bed until discharge on day 3
the problems. This is a methodology for analyzing potential reliability problems early in the development cycle where it is easier to take actions to overcome these issues, thereby enhancing reliability. The pilot has therefore been extended prior to full implementation, to monitor the redesigned processes.
CONCLUSION Selected women are now admitted on day of surgery and cared for, wherever possible, by the same member of nursing/ midwifery staff, including during the CS and recovery phase, as well as pre- and post operatively on the maternity ward. Husbands are fully included and ecouraged to attend in the operating theatre if they wish. This has evolved over three years into a fully integrated clinical care pathway, providing a standardised, multidisciplinary approach, supported by its own documentation, ensuring women
with special needs receive standardised care. The outcomes, evaluated through patient and staff satisfaction surveys and ongoing failure modes and effects analysis, translates into reduced bed transfers and enhanced workforce planning. Performance and service delivery is optimized, fragmented management approaches are addressed and communication is enhanced. Nurse/midwife satisfaction is extremely high leading to commitment, motivation and heightened therapeutic relationships and women are empowered to make choices because of improved continuity and information giving. The major outcome has been that women having uncomplicated elective caesarean section at Al Wasl Hospital are the focus of care, not the task or the system. ■
AH
REFERENCES References available on request (
magazine@iirme.com)
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