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Labour and Delivery Posters
Do practice guidelines guide practice? route cause analysis of factors associated with admission to intensive care unit(ICU) from labour ward in a large teaching hospital
  1. KK Kondov,
  2. HAM Mousa,
  3. PS Sharpe
  1. University Hospitals of Leicester, Leicester, United Kingdom

Abstract

Introduction Admission to ICU is associated with increased maternal morbidity, mortality and a significant rise in the cost of healthcare provided by hospitals.

Aim Route cause analysis of factors associated with admission to ICU from maternity unit in a teaching hospitals delivering 10000/year.

Method We have identified all cases admitted to ICU in the period 2007-2010. Case notes were reviewed retrospectively using special data collection forms. Compliance to local guidelines were assessed under 3 major groups – major postpartum haemorrhage (PPH), severe pre-eclampsia/eclampsia (PET) and sepsis. Other causes for ICU admissions were also analysed.

Results 71 cases were reviewed including 37(52%) patients with major PPH, 11(15%) patients with severe PET, 15(21%) patients with sepsis and 30 (42%) cases had other diagnoses. Guidelines were followed only in 6 (55%) patients with severe PET. In 8(54%) patients with severe sepsis, “Surviving Sepsis Campaign Guidelines” were followed. There was lack of adherence to the guidelines in 4 (10.8%) patients with major PPH. During that period of time there was no maternal mortality.

Conclusion Lack of adherence to guidelines is a major contributing factor for admission to ICU. Each maternity unit need to examine methods of improvement of adherence to guidelines especially in high risk cases. The causes for poor adherence were found to be:

Lack of critical care education amongst the midwives/junior doctors

Lack of awareness of relevant protocols

Understaffed LW and interrupted continuity of care - frequent changes of midwives during the shift

Overly complicated / repetition of paperwork

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