Presentation on theme: "Obstetric Early Warning Score Chart"— Presentation transcript:
1Obstetric Early Warning Score Chart RegionalObstetric Early Warning Score ChartTrack and TriggerAdapted from BHSCT EWS chart 2013Gillian Morrow, Intrapartum Midwifery Practice Educator, BHSCT
2BackgroundDespite recommendations in the most recent triennial reports, ‘Saving Mothers’ Lives’ (CMACE) and documented improvements in patient care using early warning scoring systems (EWS) in the general adult population, no validated system currently exists for the obstetric population.Recommendations for midwifery practice as set out inChapter 13 of Saving Mothers’ LivesCarry out, record and act upon basic observations forBoth women at low and higher risk of complication.“There remains an urgent need for the routine use of a national modified early obstetric warning score(MEOWS) chart in all pregnant or postpartum women who become unwell and require either obstetric or gynaecology services. This will help in the more timely recognition, treatment and referral of women who have, or are developing, a critical illness during or after pregnancy.”Recommendation 6: Specialist clinical care: identifying and managing very sick women
3Obstetric Early Warning Score Chart It is recognised that pregnancy and labour are normal physiological events. However, observation of vital signs are an integral part of careThere is a potential for any woman to be at risk of physiological deterioration and this cannot always be predicted. There is also evidence that there is poor recognition of deterioration in conditionRegular recording and documentation of vital signs will aid recognition of any change in a woman’s conditionThe use of EWS chart prompts early referral to an appropriate practitioner, who can undertake a full review, order appropriate investigations, resuscitate and treat as required
4Regional OEWS Chart 2013Early Warning Scoring System and Action Protocol for Early Pregnancy, Antenatal and PostnatalThe colour trigger (yellow and red) is simple and visual. A numerical score is more complexRed is the colour denoting serious patient condition requiring urgent actionYellow is the colour suggesting that the patient condition is worsening requiring escalation of treatmentBalance between too much information on a chart causing distraction and maximising useful variables recorded
6Who needs an Obstetric EWS Chart? All women whose clinical condition requires close observation; admitted early pregnancy, antenatal or postnatalAll post operative cases – in recovery and following transfer from theatreAny woman giving cause for concern (medical or obstetric causes)During/Following APH/PPH/EclampsiaSuspected infection e.g. Prolonged SROMHigh-risk women in delivery suite (not in labour)
7How frequently should the chart be completed? Frequency of Observations is determined by;Risk StatusDiagnosis / Reason for admissionInitial observations on admissionProtocolAn individual plan of care should be made by the Midwife/Nurse and Doctor which should specify the frequency of physiological observationsThe minimum frequency of observations as an in-patient is 12 hourly.
8Completing the Obstetric EWS Chart What sections need to be completed?All sections to be completed and include either;A/N, P/N, or EP loss, tick the relevantcolour coded sectionWhat if a section is not applicable?Insert NA within box providedPlease tick belowEarly PregnancyA/NP/NNA – Not applicable
9Completing the Obstetric EWS Chart ALL relevant sections must be completedTop section to include woman’s detailsAddressograph LabelName_______________________Consultant___________________Hosp. No.___________________Month_________________________Year__________________________Ward__________________________Booking BP______________mmHgBMI______________________Kg/m²
10Completing the Obstetric EWS Chart ALL relevant sections must be completedTop section to include woman’s detailsDateFrequency of ObsTime (24 hr clock)
11Completing the Obstetric EWS Chart ALL relevant sections must be completedTop section to include woman’s detailsDateFrequency of ObsTime (24 hr clock)Signature at bottom section – to correlate with signature list in maternity case notes
12Completing the Obstetric EWS Chart Respiratory RateYou must document the number. For example, you would write ‘22’ in the yellow columnOxygen SaturationYou must document the number. For example, you would write ‘99’ in the white columnOxygenIf you perform a set of observations you must document on the chart in the space provided if oxygen is delivered. This must always include the percentage oxygenIf the woman is on air you must document this instead of an oxygen percentage. Do not leave the oxygen section blank. Room Air = RA
13Completing the Obstetric EWS Chart TemperatureA ● should be inserted to aid viewing and connect dots with straight lines (not illegible comma shapes)Heart rateThis should be documented as a ● Please take care to keep the chart legible and connect dots with straight lines. If concerned a numerical value may be insertedBlood Pressure - Graphic trend using arrows & a dotted lineYou document this with an upward arrow ( ˄ )at the systolic and a downward arrow ( ˅ ) at diastolic, joined by a dotted line so you have a graphic trend. Numerical value may be documented.
14Changes to Regional Chart Urine Output if CatheterisedProteinuriaWound (now incorporated in blue P/N section)IV siteDrain siteThe monitoring of urine output is important in many clinical settings. However, formal estimation of urine output is not always available at first assessment and measurement of urine output is not routine in the majority of patients in hospital. Urine output monitoring is essential for some patients as dictated by their clinical condition and this must be included on the fluid balance chart..
15A/N – P/N – Early Pregnancy Loss PV LossNoYesAmniotic Fluidif ROMClearRed/GreenOffensiveOdourlessA/N PV BleedPink/BrownRedA/N Uterine ToneNormalTenseLochiaTrickleHeavy or FoulP/N Uterine ToneContractedHigh FundusRelaxed/AtonicWound –ooze/red/swollen/painPlease tick belowEarly PregnancyA/NP/NNA
16Completing the Obstetric EWS Chart Neuro ResponseTick the appropriate box that applies to the womanPain ScoreNauseaLooks unwellNeuroResponseAlertVoicePainUnresponsive
17Completing the Obstetric EWS Chart Neuro ResponseTick the appropriate box that applies to the womanPain ScoreTick the appropriate box which applies to the woman. The pain score is explained on the back of the EWS chartNauseaTick the appropriate box which applies to the woman. The nausea score is explained on the back of the EWS chartLooks unwellNeuroResponseAlertVoicePainUnresponsive
18Completing the Obstetric EWS Chart Neuro ResponseTick the appropriate box that applies to the womanPain ScoreTick the appropriate box which applies to the woman. The pain score is explained on the back of the EWS chartNauseaTick the appropriate box which applies to the woman. The nausea score is explained on the back of the EWS chartLooks unwellUse your clinical judgement and tick the appropriate box
19Obstetric Early Warning SCORES Calculate and record the total number of yellow and/or red scores, including those on the lineYou must always have a scoredocumentedIf OEWS does trigger a score document in case notes and inform midwife/nurse in chargeFollow the action protocol documented on the back page of the chart and record action in the case notesYou are expected to report if you have any clinical concerns irrespective of the OEWS score.21GM
20Action Protocol ACTION PROTOCOL The Early Warning Scoring System and Action Protocol are designed to help identify deterioration in the woman and ensure appropriate early intervention. All action taken must be fully documented in case notes. Staff should use their clinical judgement, and seek advice if they have concerns about any woman, regardless of the score.If an OEWS chart is being commenced in a freestanding midwife led unit the parent obstetric unit needs to be informed and transfer protocols commenced
21Action Protocol Continue observations as before White OnlyContinue observations as beforeInform Midwife/Nurse in ChargeRecheck observations in 1 hour (or more frequently if clinically indicated)Single YellowInform Midwife/Nurse in ChargeImmediately ontact the on-call obstetric SHO/Reg using SBAR to review the woman within 30 minsRecheck observations in 30 minutes (or more frequently if clinically indicated)≥ 2 Yellow or 1 Red
22Action Protocol Inform Midwife/Nurse in Charge Immediately ontact the on-call obstetric SHO/Reg using SBAR to review the woman within 20 minsRecheck observations in 15 minutes (or more frequently if clinically indicated)2 RedInform Midwife/Nurse in ChargeImmediately ontact the on-call obstetric Reg using SBAR to review the woman within 20 minsDiscuss with Obstetric Consultant/TutorRecheck observations in 15 minutes (or more frequently if clinically indicated)Consider calling other specialties or Emergency Obstetric Team as appropriate> 2 Red
26ReferencesCMACE (2011) Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer: NICE (CG50) (2007) Acutely ill patients in hospital Royal College of Physicians (2012) National Early Warning Score (NEWS) Report of a Working Party