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Monitoring care of women after operative vaginal delivery: basis for an effective strategy to improve quality of patient care
  1. L Gwyn,
  2. I Abdoolatiff,
  3. N Misfar,
  4. EA Martindale,
  5. U Krishnamoorthy
  1. East Lancashire Hospitals Maternity Unit, Lancashire, UK

Abstract

Background Adhering to standards of good clinical practice following Operative vaginal delivery helps minimise risk of physical and physocological morbidity to mother.

Setting East Lancashire Hospitals Maternity Unit.

Methodology Review of 150 consecutive cases of OVD (operative vaginal delivery) identified through Athena in 2009.

Results Four key areas of care were analysed: post procedure pain relief, bladder care, Thromboprophylaxis and debriefing consultation.

62% had postprocedure analgesia with diclofenac and paracetamol while 21% received other analgesics. 10% received no analgesia while 6.6% had no documentation regarding pain relief.

Volume of first void was documented only in 3.3%, with time of first void noted in 20%. Documentation on bladder care was absent in 50.6% and fluid balance chart was seen only in 2.6%. 30.6% had indwelling catheter but only 18.6% had catheter left in for at least 12 h as recommended.

Thrombo-prophylaxis Risk assessment was noted in 39.3%, but only 22% received prophylaxis. 99.3% stayed ≥1 day with 49.3% staying in ≥2 days.

Debriefing occurred in 11.3%. However only 1.3% (two women) were debriefed regarding indication and none regarding impact of OVD on future deliveries.

Conclusion and Recommendations Scope for improvement in standards of care after OVD was highlighted in all areas. Continuous audit of OVD has since been implemented within the unit and guidelines revised. All OVD cases are discussed at case review meetings daily since November 2009. Areas of deficiency in after care are identified and rectified immediately, through this strategy of team based reflection and proactive risk management.

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