The Newcastle upon Tyne Hospitals NHS Foundation Trust The Directorate of Women s Services DELIVERY SUITE R. V. I PROFILE OF LEARNING OPPORTUNITIES AND LEARNING ZONE Issue: August 2008
LEARNING ZONE Reproductive Medicine Library Continence Services Breastfeeding Workshops PRECONCEPTUAL Maternity Assessment Unit (MAU) Pain Specialists Community Midwives Hospital Midwives Portering Service Smoking Cessation Dietician Social Worker ANTENATAL CARE Physiotherapists Risk Management Head of Midwifery Security Services Fetal Medicine Unit Maternity Assessment Unit Bereavement Office Delivery Suite General Practitioner Radiography NCT/La Leche Obstetric/Medical Clinic INTRAPARTUM CARE Gynaecology Antenatal Ward Accident and Emergency CEMACH Health Visitors Neonatal Staff/Unit Obstetricians POSTPARTUM CARE Laboratory Services Haematology, Biochemistry, Pathology, Microbiology Head of Midwifery Pharmacy Parent Education Child Protection Services Theatre Ultrasound MAU Anaesthetics Drugs & Alcohol Midwife Teenage Pregnancy Midwife Infant feeding coordinator Patient Information Learning Disabilities Services Interpreting Services Peer Breastfeeding Support Infection Control Community Perinatal Mental Health Team Staff Counselling
The Royal Victoria Infirmary Delivery Suite Welcome Welcome to Delivery Suite, located on the 2 nd floor of the Leazes Wing at the Royal Victoria Infirmary. We can be contacted via Maternity Reception on 0191 2825119. We welcome student midwives at various stages in their training and hope you will find the experience enjoyable. We are a busy regional referral centre and have approximately 6500 births per year. You will be allocated a Named Mentor and an Associate prior to commencing your placement. Your off duty will mirror theirs. It may be helpful to visit and meet with your mentor before you start your allocation. We are committed to ensuring that you are supported in your learning during your placement. Staff will endeavour to afford learning opportunities wherever possible to maximise your experience. Your mentor(s) will be identified prior to your arrival. In partnership with your mentor your learning needs will be identified. A learning contract will be developed. This needs to be realistic, achievable, and time specific wherever possible. Opportunities will be made to ensure the learning can be achieved Documented evidence will be required, the use of a reflective diary is a good example We have a multidisciplinary approach to working on delivery suite and operate on a patient allocation basis; the enclosed overview of the staff working on the department may be of some help to you.
The Royal Victoria Infirmary Delivery Suite Midwifery, Nursing, Medical and Administration Staff Responsibilities Delivery Suite Manager Senior Midwife responsibility for delivery suite Band 7 Midwives Senior Midwives, Co-ordinate staff Educational Support Sometimes mentors Supervisors of Midwives Practice Support Midwives Senior Midwives Support midwives in clinical practice Practice educators Help with skill acquisition Midwife Practitioners Variation of expertise Work clinically often on a rotational basis to other wards and departments Mentors and Preceptors Delivery Suite Core Team Midwives Midwives with a special interest in promoting normal birth for women and also those with a special interest and skills in dealing with women with high-risk pregnancies. Coordinate Delivery Suite Are mentors and preceptors and act as support and an information resource for other midwives. Midwives on Preceptorship programme Newly qualified and new-to-post midwives Undertaking a structured, supportive learning experience on their first allocation to delivery suite. Theatre Nurses Theatre trained nurses who assist medical staff at operative procedures, e.g. caesarean sections Help train midwives in these procedures Anaesthetic Nurses and Operating Department Practitioners (O. D. P s) Nurses and practitioners trained in anaesthetics and recovery Assist in anaesthesia in theatre procedures and in use of epidurals, Information resource for staff Healthcare Assistants Work as part of the multidisciplinary team in caring for women on delivery suite Maintain the preparation of rooms for women Medical Staff Obstetric: Consultants, Specialist Registrars (SpR) and Senior House officers (SHO) Neonatal/ Paediatric: Consultants, SpR s and SHO s. Anaesthetists Ward Clerks/ Data input Clerks Deal with administration, Good information resources, Process notes through E2 System
The Royal Victoria Infirmary Delivery Suite Shift Patterns and Requesting Off Duty On Delivery Suite the Shift Times are as follows: 12 Hour Shift: 07:30 to 20:30 Early Shift: 07:30 to 16:00 Late Shift: 12 MD to 20:30 Night Shift: 20:00 to 08:00 Should you have any requests or preferences regarding off duty and also set study days please contact Fiona Noble on Delivery Suite. We do try to be flexible but you must work at least 50% of your clinical hours with your named mentor.
The Royal Victoria Infirmary Delivery Suite Supervisors of Midwives Statutory supervision of midwives has been in place since the early 1900 s, it is a means by which midwives are supported in, and with, their practice. Statutory supervision of midwives supports protection of the public by promoting best practice, preventing poor practice and intervening in unacceptable practice. It uses a framework for supervision, which leads to improvements in the standard of midwifery care and better outcomes for women through the empowerment of midwives to practise safely and effectively. Supervisors also have a role in advising and supporting women using midwifery services. Supervisors of midwives are practising midwives with three years practice experience who have been nominated, accepted by the Local Supervising Authority (LSA) and completed the preparation of supervisors education programme. Once qualified, you will be allocated a named supervisor of midwives with whom you will have an annual supervisory interview. Supervisors are also available for support of student midwives. A list of Supervisors and an on call rota is available on the notice board behind the midwives station on delivery suite.
The Royal Victoria Infirmary Delivery Suite Learning Opportunities During your allocation to delivery suite it is anticipated that alongside your mentor(s), your experience includes the following: Caring for a woman in normal labour Communicating effectively with the woman and her partner(s) during labour Can undertake and document correctly the clinical observations of: Blood pressure Pulse Temperature Respirations Abdominal Palpation Fetal Heart with a pinnards and sonicaid Participate in documenting clinical information on a partogram Caring for a woman receiving analgesia Entonox Diamorphine TENS Epidural Water immersion A woman requiring continuous fetal monitoring A woman who is receiving a Syntocinon infusion Can prepare an intravenous infusion prior to its use Using NICE Guideline interpret a CTG Witness/participate in assisting a woman to give birth Actively manage the third stage of labour Follow universal procedures Become familiar with and adhere to Trust policies and guidelines on infection prevention and control Use of computer in documentation
The Royal Victoria Infirmary Delivery Suite Learning Opportunities Neonate During your allocation to Delivery Suite it is anticipated that alongside your mentor(s) your experience includes the following: Understanding the benefits of skin to skin contact Initial examination of the newborn Resuscitation at birth Care of a low birth weight baby Breastfeeding Artificial feeding Labelling of the baby Notification of birth Use of the computer in documentation Transferring a woman and baby to the ward/home Transferring a baby to SCBU Complicated Cases Preterm labour Use of tocolytic Twin pregnancy in labour Insulin dependant diabetic on a GKI regime P.I.H. Regime Fetal blood sampling Forceps and a Ventouse delivery Episiotomy Repair of an episiotomy and / or tear Care of a women following a fetal death Other Personnel It can be arranged for you to work alongside the following to help acquire further insight and understanding of women s diverse care High Risk Team Normality Team Theatre Staff Anaesthetic Nurse Practice Support Midwife Bereavement Officer
KEY ELEMENT INTERPERSONAL SKILLS LEARNING OPPORTUNITIES Use of the telephone: Answering and making calls Ring back etc DECT system Emergency calls Use of the computer to: Obtain investigation results Obtain/ transfer patient notes Compile delivery notes Register Births E mail access Intranet access Obtain unit policies and procedures Internet access Talking to: Patients Relatives Medical Staff Other members of multi disciplinary team and making appropriate referrals Other opportunities to develop interpersonal skills Midwives handover RESOURCE/ RELEVANT PERSONEL/ DEPARTMENT Ward clerk/ Qualified staff/ Health Care Assistants (HCA s) Data input clerk/ Ward Clerk/ Qualified Staff/ Health Care Assistants/ Medical staff Band 7 Midwife/ Coordinator Midwives and HCA s, Medical staff Specialist Midwives, Bereavement Officer, Social Worker, Anaesthetic Staff Research Midwives, Physiotherapist Delivery Suite Coordinator, Midwives Ward round Risk Management Meetings Facilitating investigations-blood tests, USS Delivery Suite Coordinator, Midwives, Medical staff Risk Management Midwives, Midwives, Medical staff Midwives, medical staff
LEARNING OPPORTUNITIES RESOURCE/ RELEVANT PERSONEL/ DEPARTENT Obtaining consent for examinations and procedures Midwives, Medical Staff Transfer of women and babies Woman, Relatives, MAU Midwives, Delivery Suite Midwives, Medical Staff, Post- and Ante-natal ward Midwives, SCBU nurses and medical staff, Bereavement Officer, Other Hospitals, Ambulance Crew Team working Observation of roles within the team Infection Control Trust Guidelines, Infection Control Team, Matron for Antenatal services, Midwives, HCA s
KEY ELEMENT CLINICAL SKILLS CARING FOR WOMEN IN LABOUR LEARNING OPPORTUNITIES RESOURCE/ RELEVANT PERSONEL/ DEPARTMENT ASSESSMENT OF WELL BEING OF MOTHER AND FETUS: Recording, understanding and interpretation of maternal vital signs: Blood Pressure, Pulse, Temperature, Respirations, Fluid Balance, Bladder Care (including catheterisation), Positioning and Pressure Area Care Assessment of labour progress including: Uterine action Abdominal palpation Vaginal Examination (VE) Monitoring and interpretation of fetal heart rate and rationale for choice of method: Intermittent auscultation: Pinnards/ sonicaid Continuous cardiotocography (CTG) using NICE Guidelines to interpret Artificial Rupture of Membranes (ARM): Rationale Safe procedure Features of amniotic fluid (also in SROM) Completion of partogram: Need for accurate and contemporaneous record Midwives, Delivery Suite Core Team Midwives, Anaesthetic Staff Midwives Midwives Midwives, Medical Staff Midwives Midwives
PAIN RELIEF: Safe Administration: Legal Statute Professional Standards Local Policy Routes of administration Adverse Reactions None pharmacological methods: Positioning Mobilisation Water Immersion TENS Reflexology/ aromatherapy Use of Snoozelum Midwives, Medical Staff, Anaesthetic Team. Pharmacist, Infection Control Team, NMC, Intranet Core Team Midwives, Midwives, Physiotherapist Pharmacological methods Inhalation: Entonox Oral IM: Diamorphine Epidural Midwives, Medical staff, Anaesthetist and anaesthetic staff, pharmacist Meeting women s needs: Ascertaining wishes Discussion of pharmacological and nonpharmacological methods Midwives, Core Team Midwives, Anaesthetist SECOND STAGE OF LABOUR AND DELIVERY: Assessment of onset: Appropriate method Preparation of environment: Safety Equipment Parents wishes Midwives Midwives, HCA s, Policies, Parents Delivery: Positioning Mode of delivery: Spontaneous Vaginal (normal): Instrumental: rationale Assistance and guidance to mother and partner Midwives, Delivery Suite Core Team Midwives, Medical Staff, Anaesthetists, Anaesthetic Staff, Theatre Staff
THIRD STAGE OF LABOUR: Preparation of mother: Provision of information and choice of appropriate method with an understanding of physiology: Active management vs. Physiological third stage Physiological Management: Physiology of placental separation, preparation of mother, signs of separation, management (no oxytocic, none cord clamping) Active Management: Choice and safe administration of oxytocic Controlled Cord Traction (CCT) Determining blood loss and it s significance Assessment of consistency and position of uterus following expulsion of placenta and membranes and recognition and management of deviations from normal Assessment of placenta and membranes following expulsion and action when deviations from normal Midwives, Medical Staff, Unit policy, Research, Midwives, Delivery Suite Core Team Midwives Midwives, Delivery Suite Core Team Midwives, Unit Policy, British National Formulary (BNF), Medical Staff Assessment of genital tract trauma: Physiology, grading of trauma, rationale for episiotomy, infiltration with local anaesthetic and technique of episiotomy, women s choice provision of evidence based advice re:comfort and healing, repair according to research, recognising when medical assistance required Midwives, Medical staff, Practice Support Midwives, Medical Staff, Unit policy, Research
CARE OF NEWBORN: Assessment of newborn: Assessment of condition at birth and appropriate action, use of APGAR Relay information to parents Recognise failure to establish respirations Preparation of resuscitation equipment Appropriate request for paediatric assistance Care of airways Administration of oxygen Initiation of resuscitation procedures Care of parents Care following assessment: Maintenance of optimum temperature Initial interaction Initiation of feeding Identification of newborn Midwives, Delivery Suite Core Team, Paediatricians, SCBU staff, Unit policy Midwives, SCBU Link Nurse, research, unit policy
Suggested Reading and Web Links RVI Delivery Suite Guidelines www.nice.org.uk www.rcog.org.uk/ www.rcm.org.uk/ www.cesdi.com ALSO (1996) Advanced Life Support in Obstetrics: Course Syllabus. ALSO (UK) Office Newcastle Backer C (1996) Nutrition and hydration in labour. Br J Midwifery 4; 568-572 Department of Health Expert Maternity Group (1993) Changing Childbirth. London. HMSO Barrett JFR, et al (1992) Randomised trial of amniotomy in labour vs. the intention to leave membranes intact until the 2 nd stage BJOG 99; 5-9