Introduction Postpartum haemorrhage (PPH), pre-eclampsia and sepsis are the most common indications for receiving obstetrics high-dependency care in the Royal Infirmary of Edinburgh (RIE). This study therefore aimed to evaluate adherence to the NHS Lothian guidelines for the management of suspected severe sepsis (SSS), severe pre-eclampsia (SPE) and PPH > 1.5 L. Immediate resuscitation, ordering of investigations and treatment administration were evaluated.
Method A retrospective audit of paper and electronic patient records was performed on patients who received high dependency care for SSS, SPE and PPH > 1.5 L in the RIE.
Results 16 patients had SSS. All patients had IV access, their ‘ABC’ (Airway, Breathing, Circulation) checked, oxygen saturations, pulse, BP and baseline bloods (FBC, U&Es, Clotting, ABGs, G&S) monitored. Checking of capillary refill time (13.8%), administration of high-flow oxygen (12.5%), blood cultures (87.5%), electrocardiograms (37.5%) and fluid balance monitoring (56.3%-81.3%) need to be performed more frequently. 16 patients had SPE. Baseline bloods (FBC, U&Es, urate, LFTs & G&S), administration of ranitidine and catheterisation were performed in all patients. Of concern are: checking of clotting screen (87.5%), blood pressure monitoring after administration of antihypertensives (33.3%-46.2%) and observations after Magnesium sulphate prescribing (25%). 37 patients had PPH > 1.5 L. Measures with 100% compliance were: the ‘ABC’ cheque, administering IV fluids and measuring FBC. Weighing blood loss, establishing intravenous access and administration of high- flow oxygen and warmed fluids (32.4%-54%) need to be performed more often.
Conclusion Many aspects of the guidelines are adhered to, but areas of concern must be improved in order to optimise patient care and outcome.
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