1. Results from re-audit:
Achieving Clinical Negligence Scheme For Trusts (CNST) Standards
Improving Documentation Standards - Experience At Royal Bolton Hospital 
N Katakam, E Church , S Sasson , J Mechery, S Das - Obstetrics & Gynaecology , Royal Bolton Hospital, Bolton, UK
Background - CNST is designed to:
Provide a structured framework to deliver high standards in organisational governance, patient care and safety
Increase awareness of the national agenda for the NHS
Empower maternity services to determine & manage risks
Reduce claims by reducing the number of adverse incidents
Provide quality assurance to the service and stake holders.
Compliance with the standards provides a discount on CNST contributions. (Level 1 – 10 %, Level % and Level %)
Caesarean Section
Classified
Reason
for CS
Consultant informed
Reason for delay
Antibiotics
Post-op Care
Future pregnancy
Assessment process and principles for each level is different
Level 1 – Policy (Documenting)
The process for managing risks has been described and documented
Level 2 – Practice (Implementing)
The process for managing risks, as described in approved documentation at Level 1 have been implemented
Level 3 – Performance (Monitoring) The process for managing risk, as described in approved documentation at Level 1, is working across the entire maternity service. Where deficiencies are identified:
Action plans must have been drawn up and
Changes made to reduce the risks.
Operative Vaginal Delivery
Pre-
assessment
Informed consent
Effective analgesia
Care following delivery
Bladder
care
Perineal Tears
Method:
Level 1 – Guidelines were developed for Caesarean Section (CS), Operative Vaginal Delivery (OVD) and Perineal Trauma (PT)
Level 2 - Retrospective audit was performed on documentation for Caesarean Section (CS), Operative Vaginal Delivery (OVD) and Perineal Trauma (PT) in January’09.
Results: Documentation standard was found to be varied and failed to meet CNST standards.
Level 3 - Action plan: Pre-printed, carbonised proformas were developed for CS, OVD and PT. Re-audit was done in October’09.
Pre-
assessment
Good lighting
Informed consent
Suture material
Bladder
care
Care after repair
Postnatal appt
Incident
Form
Conclusion
Continuous audits are ongoing on a 2 monthly basis and are presented at Labour Care Forum and departmental teaching meetings.
Achieving level 3 of the CNST standards requires intensive monitoring of every aspect of organisation and clinical care.
This exercise highlights trends that may need addressing.
It provides opportunity for trainee doctors and midwifery staff direct involvement and ownership of CNST in routine practice.
Results from re-audit:
Dramatic improvement in documentation was noted. Proformas ensured uniformity, ease of completion and easy to audit.
CS - Improved from a range of 20 to 100 % in various criteria to 90 to 100 % in all the criteria.
OVD - Improved from a range of 42 to 92% in various criteria to 100 % in all the criteria.
PT - Improved from a range of 0 to 94 % in various criteria to 100 % in all the criteria
Acknowledgements – Dr Rimma Markarian, Dr Catherine Henderson, Diane Tinker - Advanced Midwifery Practitioner, Caroline Finch - Midwife
(This work has also been accepted for presentation 32nd BICOG, Belfast, June 2010)