Abstract

There are many reports and recommendations in maternity care with some confusion and lack of clarity. Standards are available from confidential reports in maternal deaths, Clinical Negligence Scheme for Trusts, Safer Child Birth, Maternity Critical Care Working group and local trust guideline. There are local & national concerns about recognising and managing sick mothers and need for regular audit of services.

We aimed to develop and define auditable standards of care for obstetric women requiring ITU admission at Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust.

In our first retrospective audit of fifteen obstetric women admitted to ITU over a period of two years, services were assessed using CNST standards 2.9, 4.8, 5.10. This audit highlighted poor documentation and difficulty in identifying evidence. Recommendations were made including defined auditable standards and a named person to ensure compliance. Local guidelines were revised. From recommendations we identified twelve auditable standards. Documentation of clearly defined reason for transfer to ITU, daily multidisciplinary review, SBAR (situation, background, assessment, recommendation) handover, entry level of ITU, length of stay, discharge criteria, outreach follow up and clinical incident form were assessed.

A repeat audit of eight obstetric ITU admissions in next twelve months was completed. Retrospective case notes review was conducted by the same person. Re audit confirmed improved documentation however extracting evidence continued to be difficult.

Numerous national guidance and standards can be confusing however it is possible to identify local auditable standards to improve care and assessment of care.