Local Safety Standards for Invasive Procedures Repair of vaginal and/or perineal trauma in the birthing environment (Delivery Suite, Rushey MLU or Homebirth) (GL1042) Approval Approval Group Job title, Chair of Committee Date Maternity & Children s Clinical Governance Committee Chair, Maternity Clinical Governance Committee 4 th November 2016 Change History Version Date Author, job title Reason 1.0 October 2016 1.1 January 2018 Jane Siddall, Consultant Obstetrician& Nicky Benns, Clinical Risk Manager Sam Fleming Trust requirement Amended following RCA to reinforce good clinical practice and pause to count swabs when new packs opened or additional clinician takes over and ensure witnessed by nominated checker and documented Pg 4. Documentation bullet point 2 sub-point 1 & 2 added (pg 4/5) This document is valid only on date last printed Page 1 of 5
Procedure Prepared by: Miss Jane Siddall, Consultant Obstetrician Miss Nicky Benns, Maternity Clinical Risk Manager of copies of Copies Intranet site Policy hub/clinical/maternity/intrapartum Trust website - http://www.royalberkshire.nhs.uk/intrapartum.htm No of copies Pdf download Pdf download Document Review Review Date Reason for Review Reviewed by Signature Document Amendment Amendments may only be made to the electronic copy to ensure all formally issued location copies are maintained to the updated requirements Amendments (changes of up to a sentence in length) must be performed by senior members of staff only Major changes (changes greater than a sentence in length) must result in immediate review of the procedure This document is valid only on date last printed Page 2 of 5
1. Equipment requirements It is the responsibility of the practitioner to ensure the availability of fully functioning equipment for a safe repair. This will include: Bed suitable for the procedure and weight of patient. Focused beam light (not a handheld torch). Surgical head torches or those which can be positioned securely are acceptable in a domestic setting) Perineal suture pack for repair of vaginal and perineal trauma (Robinson Healthcare pack 8421) containing; o A needle holder (18cm) o Toothed dissecting forceps (18cm) o Straight suture scissors (17cm) o Spencer Wells arterial forceps x 1 (18cm) o 5x X ray detectable swabs 30 x30cm o 1x drape 100 x 180cm to place under woman s buttocks o 1x polyprop tray for surgical instruments and swabs to be placed o 1x cardboard wallet to hold all four surgical instruments o 1x crepe sterile paper 50 x 50cm to provide a work surface for operator Protective clothing and gloves including latex free gloves Absorbable suture material (Ethicon W9962, 2-0 Vicryl Rapide with taper cut needle) Regional or local anaesthetic. o Local is 1% plain Lidocaine, maximum dose 20ml Access to call bell (in a hospital setting) or telephone to summon additional help if required When new equipment or technologies are introduced staff should receive regular updates and continuous professional development. 2. Workforce The minimum staffing requirements 24 hours a day seven days a week is that the practitioner has been trained and assessed as competent to undertake the repair independently, or is a learner under direct supervision of a fully qualified practitioner. This document is valid only on date last printed Page 3 of 5
Fully qualified practitioner Obstetrician ST3 or above (mandatory RCOG requirement in eportfolio) Midwife assessed on RBH competency framework documentation as competent Locum or agency obstetrician or midwifery staff The competence of non-substantive staff should be assessed before being allowed to carry out invasive procedures. Supervision of students, trainees and observers This will include doctors in training at ST1 or ST2, student midwives and learners in other supporting roles. 3. Procedure The guideline for repair of episiotomy and perineal tear is GL836 The guideline for a Rusch balloon is GL909, but these are normally inserted in the obstetric theatres. The procedure for managing a retained swab is GL905. 4. Documentation Documentation is standardised to promote sharing of patient information between members of the team. Mothers who are sutured in the home or on Rushey MLU should have a written pro-forma completed and filed in their records. Mothers whose repair is done on Delivery Suite should have the perineal repair s section of the K2Guardian electronic record completed. Verbal consent for procedure should be recorded Swabs must be counted in multiples of five before the procedure is commenced. It should be noted that it is the responsibility of the clinician undertaking the repair to ensure that swab and instrument checks are performed, correct, documented, actioned if an item is unaccounted for and undertaken with an appropriate witness. The witness must be aware that their assistance is required, understand their responsibility and should not be someone who is present in a learning capacity (as per guideline GL836) This document is valid only on date last printed Page 4 of 5
If the birthing environment is the home and the midwife is unaccompanied, the witness to the swab count can be the partner. The midwife must explain the importance of counting the swabs and ensure the partner is able to count in multiple of fives. If the midwife is unaccompanied and the partner is absent, the midwife must bring all swabs and instruments to the delivery suite to have the count confirmed by a senior midwife. Instruments should be counted before the start of the procedure Swabs and instruments must be recounted if there is a change of practitioner undertaking the repair. Swabs must be counted at the end of the procedure. All counts must be recorded and both practitioners must be identified. If a vaginal pack is used, the mother should have a bright pink band attached to her wrist, to be removed AFTER the pack has been removed. 5. Handover and information transfer The practitioner should be complete the health care record prior to transferring care following procedure The mother should be given patient information leaflet Tears and Stitches (available on external trust website under patients and visitors table, information leaflets filed under M). This should be recorded in the suturing record. When the mother is moved from one care setting to another, or if there is a change of personnel, the handover should be done using the SBAR tool. 6. References RBH Guidelines GL836 (Repair of episiotomy and perineum) GL905 (Retained swab) GL909 (Rusch balloon) This document is valid only on date last printed Page 5 of 5