1. A Desai G Singh R Choudhary B Kapoor S Thacker CNST Audit 11/06/2010

2.  Why was the audit done?  What was monitored?  How was the data collected?  What are the findings?  Summary  Recommendations Outline of presentation

4.  CNST requirements Show approved documentation Show it is implemented Show it is monitored  Audit Use the approved documentation Monitor its implementation Introduction

5. Guidelines

6.  Induction of labour  Prolonged pregnancy  Previous caesarean section  Maternal observation – during induction  Fetal observations – during induction  Process for dealing with maternal requests  Review 1% of cases for 1 year Requirement of CNST (Level 3)

8. 1) Prior to induction (prostin) 2) During Induction – 1 st 6hrs 3) During induction – 2 nd 6hrs 4) Post 12 hrs Monitoring - Stages

9. Monitoring – prior to induction

10. Monitoring – during 1 st 6hrs

11. Monitoring – during 2 nd 6hrs

12. Monitoring – after 12hrs

14. Information Sources

15. Collection Form Reason -Post term -Previous c-section Induction Method -Prostin -ARM -Cook’s Catheter -Foley’s Catheter Fetal Assessment -Auscultation -Movement -Both

17.  Total number of cases = 40 Case Notes Reviewed

18. Reason for Induction

19. Parity

20. Gestation

21. Risks Explained

22. Membrane Sweep

23. Method of Induction

24. Pre Induction CTG

25. Observations – Admission MaternalExamination

26. ARM on Admission

27. During 1 st Prostin (0-6hrs) Fetal AssessmentObservations

28. Post 6hrs Prostin CTG All Prostin PatientsPre 2 nd Prostin

29. Post 6hrs Prostin - Assessment

30. ARM post 6hrs prostin

31. Post 6hrs – Pre 2 nd Prostin

32. During 2 nd 6hrs – not ARM Fetal AssessmentObservations

33. During 2 nd 6hrs – 2 nd Prostin only Fetal AssessmentObservations

34. Post 12hrs - Assessment

35. ARM post 12hrs

36. Prostin Needed

37. Delivery Outcome Reason for inductionMethod of induction

38. CTG Stickers missing in notes

40. Summary of findings 35% had risks explained 98% had assessments 92% had CTG 88% had assessments 31% had regular observations 80% had CTG 80% had assessment ~50% had maternal assessment 60% had fetal assessment 78% had fetal assessment 20% had regular observations 80% had assessment

42. 1) Risks explained to mother needs documentation on induction prescription form 2) Fetal assessments need to noted regularly after administration of prostin 3) Maternal observation and abdominal examination needs to be repeated before administration of prostin 4) CTG stickers must be include in the notes 5) Re-audit before end of November Recommendations