The Delivery Suite Shift Co-ordinator: Roles and Responsibilities (GL819) This document forms appendix 4 of the Policy document Delivery Suite Staffing (Obstetric, Anaesthetic, Paediatric and Midwifery CG479) Approval Approval Group Job Title, Chair of Committee Date Maternity & Children s Services Clinical Governance Committee Chair, Maternity Clinical Governance Committee 14 th July 2017 Change History Version Date Author, job title Reason 1.0 2009 J Tuckey, Delivery Suite Trust requirement Manager 2.0 July 2011 J Tuckey, DS Manager Reviewed 3.0 August 2014 J Tuckey, DS Manager Reviewed 3.1 March 2017 S Philips, Practice Educator Live changes requested to pg. 5 & 6 4.0 June 2017 R Smith, DS Manager Reviewed minor wording changes throughout pg. 3 SoM reference removed pg. 8 Anti D reference removed To be read in conjunction with the following Delivery Suite Staffing (Obstetric, Anaesthetic, Paediatric and Midwifery) protocol (CG479) Escalation and Diversion protocol (CG483) This document is valid only on the date last printed Page 1 of 9
Overview This document outlines the roles and responsibilities of the Delivery Suite co-ordinator. The co-ordinator is a senior, experienced Delivery Suite midwife who is responsible for ensuring high standards of care through the safe, smooth running of the Delivery Suite. She will be responsible for the deployment of resources, supporting and developing staff and will work in partnership with others to ensure optimum care is provided. Good communication between all disciplines, including support staff, leadership and professionalism at all times are essential. Out of hours the Delivery Suite co-ordinator also takes on the responsibilities of the maternity unit co-ordinator. The co-ordinator should be supernumerary to the Delivery Suite staffing to enable them to fulfil their role. In the unlikely event that there is no designated shift co-ordinator on duty, the maternity unit co-ordinator must be informed and the matron for maternity hospital services. If out of hours the supervisor of midwives and the on call consultant should be informed at the earliest opportunity. Senior staff not rostered on duty will be contacted and asked to work for overtime or additional hour s payment. 1.0 Communication It is essential that the co-ordinator communicates effectively with all members of the Delivery Suite and wider team to ensure the safety of mothers and babies at all times. The co-ordinator should: At the start of the shift, contact the Induction of Labour Suite to check on women who require induction. Contact the antenatal ward to obtain information on women who are a cause for concern or who are in early labour to ensure effective planning of their care and to take in to consideration the potential workload over the next 24 hours. Regularly update the white board in the main office add the categories of dependency as level 1 or level 2 as indicated by the Escalation and Diversion Policy (CG483) Remind Medical staff to update their contact details on the white board in the main office on changing shifts Must ensure that the obstetric and anaesthetic staff are aware of women who are high risk on admission to the unit. If there are potential neonatal concerns, the paediatric team must also be informed. Contact the co-ordinator of Buscot Ward (NICU) regarding relevant cases and the availability of intensive care cots at the beginning of every shift. She should also update on the condition of mothers at risk of pre-term delivery. This document is valid only on the date last printed Page 2 of 9
Update the Maternity Co-ordinator and/or the Maternity Matron for hospital services of the Delivery Suite activity and staffing levels. Brief of any staffing shortfalls, sickness or capacity issues Be aware of the activity in the Midwifery Led Birth Centre and at home births. Carry the designated bleep at all times. This will facilitate direct communication with the co-ordinator for ambulance control, community midwives, staff on other maternity wards and the Emergency department. Contact the duty consultant obstetrician where there is concern with the practice or decision making of junior or middle grade doctors. All discussions should take place in a confidential environment and conflict avoided. See Delivery Suite staffing policy (appendix 2 of the policy document Delivery Suite Staffing (Obstetric, Anaesthetic, Paediatric and Midwifery CG483) Ensure the consultant obstetrician is aware of all cases as detailed within the Delivery Suite staffing policy (appendix 2 as above) Regularly update the white board on pregnant or postnatal mothers admitted under other specialist teams ( outliers ) and contact the ward or department to arrange to visit these women as appropriate 1.2 Emergency theatre cases When it is necessary to open up a theatre, the Theatre Co-ordinator should be bleeped on 327 and the ODP on bleep 268 day or night. It is necessary to stipulate both the time frame for emergency caesareans i.e. Baby to be delivered within 30 minutes and NCEPOD category If there is a need to open a second theatre the coordinator is required to follow the Second Emergency Theatre flow chart which can be found as Appendix 7 in the Delivery Suite Staffing Policy (Obstetrics, Anaesthetic, Paediatric and Midwifery). The emergency theatre co-ordinator can be contacted on bleep 789. 1.3 In-utero Transfers The co-ordinator will liaise with the obstetric Consultant/Registrar and NICU after the need to consider a transfer has been identified. The co-ordinator will ensure the midwife responsible for the case completes the paperwork found in the In-utero Transfer folder and clinical incident form on the intranet and ensure notes are photocopied for outgoing transfers. Trust notes must not leave the hospital. This document is valid only on the date last printed Page 3 of 9
2.0 Resources - staffing 2.1 Shift handover At the handover the co-ordinator will ensure good communication facilitates the handover of all relevant issues pertaining to those women within the Delivery Suite environment as well as those who are of concern within the antenatal ward, community and outlying wards. At this hand over time the co-ordinator must update the ward team on changes in practice and important notices including Trust directives. Mid-way through the shift the co-ordinator will arrange an update in the report room for all staff. This will usually be at 13.45 and 01.45 at the end of the long day/night the team will meet in the handover room for a short debriefing session prior to going home. 2.2 Allocation of workload At the start of each shift the co-ordinator will consider the staff on duty and the workload and will prioritise and delegate staff according to skill mix and experience. She will ensure appropriate support for all staff in training including medical students and provide pastoral care as necessary. 2.3 Delivery Suite log The co-ordinator will complete the log on every shift. It is very important that this is kept up to date, as it is a record of all activity and staffing including staff sickness and allocation within the unit. Accuracy is essential as the log may be used to assist in investigations, complaints and litigation. A record should be kept of all admissions on the shift. All logs and admission records will be scanned and stored electronically by the ward clerk. 2.4 NPSA Intrapartum Scorecard The co-ordinator will complete the scorecard every four hours to reflect workload and staffing levels. This data is then uploaded on to a database for analysis by the ward clerks on a shift by shift basis. 2.5 EPR The EPR data base should be kept up to date reflecting the workload. The MRSA status and VTE assessment must be entered on to EPR for every woman on admission to the Delivery Suite. 2.6 Medical staff handover The co-ordinator is responsible for documenting in the Delivery Suite log that medical staff handovers have taken place. Following these handovers the co-ordinator should accompany all available members of the Delivery Suite medical team on a ward round. In the absence or sickness of a member of the medical staff the flow charts appended to the Delivery Suite Staffing Policy should be followed - Appendix 6 of Policy document Delivery Suite Staffing (Obstetric, Anaesthetic, Paediatric and Midwifery CG479) This document is valid only on the date last printed Page 4 of 9
2.7 Midwifery and support worker staffing levels The Maternity co-ordinator will review the duty rosters for the next 24 hours (numbers and skill mix). If the numbers and or skill mix fall below the minimum requirements the Delivery Suite co-ordinator will try to get extra staff or request that staff changes shifts to accommodate the shortfall based on the information provided by the maternity coordinator. The delivery suite co-ordinator will liaise with maternity unit co-ordinator to ensure that they are kept informed of potential staffing issues. 2.8 Optimise staffing rosters The co-ordinator is responsible for updating the Optimize rostering system during the shift regarding sickness and confirming that optimize accurately reflects the staffing levels on duty, at the end of the shift. Sickness and return to work information must also be recorded in Delivery Suite Information folder. The co-ordinator must also ensure that any staff returning from sickness on the shift have a return to work interview and that the paperwork is processed appropriately. 2.9 Sickness/injury during the shift When a member of staff becomes sick or is injured at work, the co-ordinator should refer them to Occupational Health or Accident and Emergency as appropriate and ensure an incident report is completed. In the event of sickness or injury to medical staff, she must ensure the relevant Consultant is informed as soon as possible. The Consultant will then follow the steps outlined in Instructions for arranging non-consultant O&G cover due to sickness absence algorithm, which is Appendix 1 & 2 on page 6 of the document Delivery Suite Staffing (Obstetric, Anaesthetic, Paediatric and Midwifery protocol (CG479). 2.10 Staff support The co-ordinator should endeavour to ensure staff are able to take appropriate breaks. Where breaks are not possible due to clinical pressures she must ensure staff are able to maintain adequate hydration as a minimum and must record missed breaks using the Optimize system. Mid-way through the shift the co-ordinator should arrange a mid-shift review meeting ( juggle ). The purpose of this review is to; update on the current situation on the Delivery Suite to arrange additional support for staff if required reallocate staff as necessary to check on staff wellbeing The co-ordinator is responsible for ensuring that she responds to all staff concerns. She should review the patients and document her findings ensuring that there is a clear plan of care to be followed and that the midwife understands the plan. Concerns should be escalated appropriately in a timely manner. This document is valid only on the date last printed Page 5 of 9
All midwife led cases should be reviewed by the co-ordinator to ensure that there is an appropriate plan of care in place. Women transferred from Rushey Ward should be reviewed by the co-ordinator and care discussed with the midwife providing support where necessary. Appropriate referral should be made to the duty registrar. 2.11 Education The co-ordinator will ensure that every opportunity is taken to provide on-going education of all staff and encourage staff to undertake on-line mandatory training during quiet periods. The co-ordinator will also facilitate attendance of teaching sessions arranged by the skills facilitator and other speakers. She/he will also support staff in learning new clinical skills and the use of equipment new to the department or the individual. 3.0 Capacity Issues When the unit is busy and there is a backlog of inductions and augmentations to be performed the co-ordinator will refer to the Escalation and Diversion Policy as it may be necessary to implement the unit diversion policy in order to complete work that is outstanding. 3.1 Bed Shortage The co-ordinator should identify those mothers who are suitable for early discharge from Delivery Suite and ensure women are not double booked on both wards. Liaise with the Maternity unit co-ordinator Bleep 179/Director of Midwifery ext.: 7269 or Matron for Maternity Hospital Services ext.: 7311 The co-ordinator should inform on-call Consultant/Registrar who might be able to perform an early ward round and discharge appropriately. She should also consider whether the Delivery Suite SHO and appropriately trained midwives (clinical or non-clinical) might be able to help with neonatal checks and therefore discharges on the postnatal wards at the earliest opportunity. The Maternity unit coordinator should consider whether it might be appropriate to transfer some antenatal women to the gynaecology wards. This would usually only be appropriate for women suffering from hyperemesis. Out of hours this must be done by the Delivery Suite coordinator through the Trust Bed Manager. Staff on the wards should be encouraged to discharge as many suitable women as possible, asking them to wait for their transport in the dining rooms if necessary. Refer to the Escalation and Diversion protocol (CG479). This document is valid only on the date last printed Page 6 of 9
4.0 Maternity Unit Diversion The decision to divert women to neighbouring maternity units for care when there is capacity or staffing issues is made jointly by the Consultant Obstetrician and the Maternity unit co-ordinator - refer to the Escalation and Diversion protocol. If unit diversion is implemented the shift co-ordinator is responsible for communicating this to staff and ensuring that the processes detailed in the Escalation and Diversion protocol found in the red folder in the report room are implemented. The triage midwife will make all necessary phone calls and liaise with women phoning in labour. Accurate records must been kept of all women diverted to other units and forwarded to the Director of Midwifery. 5.0 Resources Equipment, supplies and cleanliness of facilities The co-ordinator is responsible for ensuring that all neonatal resuscitation equipment on the Delivery Suite and in the operating theatres are checked as a minimum of twice daily and following use. Adult resuscitation equipment should be checked daily. Each resuscitaire should be adequately stocked with drugs and other essential stock items. She/he must report failures or lack of equipment promptly to ensure equipment is fit for use at all times. She/he is also responsible for ensuring a safe working environment is maintained by the safe storage of equipment. 5.1 Delivery Pack Shortage There should be an adequate supply of sterile equipment at all times and that dirty forceps packs have been collected for re-sterilization. The co-ordinator should ensure that there are adequate supplies of packs prior to weekends and bank holidays. In the event of inadequate supplies the co-ordinator should liaise with Synergy CSSD to request forceps packs as a matter of urgency. Outside of normal delivery hours it may be necessary to arrange private transport after discussion with the Maternity unit co-ordinator. Normal delivery packs and suture packs are disposable and delivered monthly. If stocks are low please inform the ward clerk. In her absence contact procurement. 5.2 Fetal blood sampling kits These are delivered twice a month. If stocks are low the ward clerk should be informed who will be able to check when a delivery is due and order more if necessary. In the absence of a ward clerk the Delivery Suite co-ordinator will undertake this task. 5.3 Controlled drugs/ FP10 prescription pads for off-site dispensing Controlled drugs should be checked at the change of every shift and signed that this has been done. The co-ordinator should consider whether these drugs need to be ordered on a Monday, Wednesday and Friday. These may only be ordered by those senior midwives whose signature is recognised by pharmacy. Consideration must be given to weekends and Bank Holidays. This document is valid only on the date last printed Page 7 of 9
The co-ordinator is responsible for the safe storage of FP10 s and must check these on every shift. Only staff with a professional registration may order FP10 s. The cardboard back of the used prescription pad together with the back sheet of paper will need to be taken to the pharmacy office in order for a replacement pad to be issued. 5.4 Hepatitis B Stock level and expiry dates of the above should be checked daily and recorded. Monitor replacement of stock by pharmacy to ensure adequate supplies are available. 5.5 Housekeeping The co-ordinator should liaise with housekeeping staff concerning the priorities for cleaning of the delivery rooms during times of increased clinical demand and liaise with the housekeeping supervisor as necessary. 6.0 Health & Safety 6.1 Infection Control The co-ordinator must ensure that infection control standards are maintained and policies adhered to. She should challenge the practice of those members of staff who deviate from these standards in an informative and supportive manner. 6.2 Fire The co-ordinator has responsibilities in accordance with the unit policies in both the maintenance of a safe working environment and actions to be taken during a fire procedure. Fire marshals should be identified on each shift. See noticeboard opposite the reception desk for details of local fire policy. 6.3 Security The co-ordinator must ensure that the working environment remains secure at all times and reports any suspicious or actual breaches in security promptly to the security guards. This document is valid only on the date last printed Page 8 of 9
Please refer to the following for information and guidance: Policy hub (intranet) page for: o Escalation and unit diversion protocol for maternity (CG483) o Delivery Suite Staffing protocol (CG479) which includes; Responsibility of duty Consultant Obstetrician Responsibility of the duty Obstetrician Responsibility of the duty Anaesthetist and operating department practitioner o Maternity Services Co-ordinator roles & responsibilities (GL984) o Guidance for lift failure (GL867) o Adverse weather conditions (GL782) o Planning place of birth guidance (GL887) o Second emergency theatre flowchart (EMA084) o Homebirths o Adult safeguarding o Patient support information o Guidance for booking an interpreter/waiver forms Delivery Suite Co-ordinator Information File o Contact details for theatre staff o Instructions for senior midwives if annex fridge alarm is activated o Reporting sickness o Accessing maternity guidelines o Optimize information General information o Neonatal observations o Advice for managers on cold sores o Mental health team requests o Ordering taxis This document is valid only on the date last printed Page 9 of 9