Transcript Education CD Rom #2 - Evidence

© 2004-2007 Grey Bruce Health Network
Vaginal Birth
Education Workshop
(click to go to the desired section)
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Introduction to Workshop/Instructions
Evidence-Based Care Program
Vaginal Birth Pathway Workshop
Introduction
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© 2004-2007 Grey Bruce Health Network
This interactive workshop is designed to go along with a workbook.
Keep the workbook handy as you go through the workshop to
engage in the required activities.
This is a web-based workshop, and thus has links throughout each
page to enable you to move throughout the workshop. Whenever
you see words underlined like this, you can click on that area to go
to another section or to find more information on a topic.
At the bottom of each page are navigational buttons to help you
move through the workshop.
You can go through as much or as little of the workshop as you like
at a time.
If you have any questions about how to use this workshop or the
individual pathways, feel free to ask your Site Champion.
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© 2004-2007 Grey Bruce Health Network
Evidence-Based Care Program
These pathways have been developed as a part of the Evidence-Based Care
Program, which is Schedule 6 in the agreement of the Grey Bruce Health
Network.
The intent is to develop clinical pathways and other evidence-based care tools
based on clinical practice guidelines, that flow across all hospitals and
community services in Grey and Bruce (including Grey Bruce Health
Services, Hanover and District Hospital, South Bruce Grey Health Centre,
Grey Bruce Health Unit, and the Community Care Access Centre).
It is hoped that these pathways will improve:
 Coordination of care through more communication across professions;
 Continuity of care, through increased linkages among hospitals and the
CCAC;
 Clinical outcomes, through increased usage of best practices; and
 Patient satisfaction, through linked expectations and increased patient
teaching at our agencies.
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© 2004-2007 Grey Bruce Health Network
Vaginal Birth Pathway Package
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This pathway is for patients who come to our hospital for a vaginal
birth.
The pathway consists of 7 parts:
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Clinical Practice Guideline
Pre-Printed Orders
Patient Pathway
Patient Education Booklet
Breast Latch Assessment Tool
Vaginal Birth Clinical Pathway
Newborn Clinical Pathway
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© 2004-2007 Grey Bruce Health Network
Vaginal Birth Clinical Practice Guideline
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Two guidelines were used in the development of this
pathway - “Family Centered Maternity and Newborn
Care: National Guidelines”, Health Canada, and
“Healthy Beginnings: Guidelines for Care During
Pregnancy and Childbirth”, Society of Obstetricians and
Gynecologists of Canada (SOGC).
These guidelines summarize the evidence used in the
development of this pathway.
They can be found electronically on the GBHN website
www.gbhn.ca .
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Vaginal Birth Pre-Printed Orders
© 2004-2007 Grey Bruce Health Network
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There are four sets of pre-printed orders for this
pathway package:
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Admission orders
Postpartum orders
Newborn orders
Newborn Circumcision orders
These orders can be found on the unit.
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Patient Materials
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© 2004-2007 Grey Bruce Health Network
This package has a patient pathway, which explains to the patient
what is happening to them while in hospital. It should be given to the
patient in the pre-admission clinic.
In addition, there is a patient education booklet called “Having your
baby in a Grey Bruce Health Network hospital”, which should also be
handed out in the pre-admission clinic. (When printing booklet from
GBHN website include the Pacifiers and Respiratory Syncytial
Virus(RSV) handouts )
This booklet should be discussed at the pre-admission clinic to go
over any questions before the patient arrives, and discussed again in
the postpartum period before the patient is discharged.
There are also several accompanying education materials that should
also be used for education of the caregivers.
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There are 4 pieces – “Let’s Grow a Healthy Baby”, “Community Resources for Parents”
order from Public Health Unit at (519) 376-9420 x 433, and “Hearing Screening for your New
Baby” Hearing Foundation at 866-HEAR-YOU) Back To Sleep (613) 954-5995 or visit the
website at: www.hc-sc.gb.ca/hppb/childhood-youth
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Vaginal Birth Clinical Pathway
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© 2004-2007 Grey Bruce Health Network
This pathway is intended for patients who have come in
for a Vaginal Birth.
The first page of the pathway is the Labour Triage with
Admission. It is to be used when the patient presents to
hospital.
At the right hand side of the sheet is a place to enter the
date. The patient outcome and performance indicators we
are looking to achieve need to be dated and inputted as
“met” or “not met”.
There is space on this page for your progress notes (use
regular progress note sheets if more space is needed)
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Vaginal Birth Clinical Pathway
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© 2004-2007 Grey Bruce Health Network
The next two pages of the pathway cover Postpartum (324hrs) and Postpartum 24-48hrs. Date and time the
column for your shift, tasks are initialed as they are
completed, or enter N/A and initial if they are not
applicable to the patient. The patient outcome we are
looking to achieve is to be initialed and inputted as “met”
or “not met”.
There is space available for progress notes on the
bottom at the back of the page (add regular progress
notes page if you require more space)
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Vaginal Birth Clinical Pathway
© 2004-2007 Grey Bruce Health Network
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You will notice a new task beginning Postpartum 324 hours that refers to a Latch Score. This refers to a
Breast/Latch Assessment tool that is to be used.
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The Discharge Criteria, the last page of the pathway,
should also be checked daily. If any of the criteria
have been met, these should be initialed and dated.
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Newborn Clinical Pathway
© 2004-2007 Grey Bruce Health Network
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Once the baby is born, the doctor can use the
Postpartum and Newborn order sets. The Newborn
Pathway should be started on the baby’s chart.
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This pathway is a day-style pathway, and follows the
baby’s stay for the 48 hours in hospital.
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Like the mother’s pathway, tasks should be initialed as
they are completed, or indicate N/A and initial if the
task does not apply for the patient. For example, if the
baby is female, circumcision will not be discussed
under “Psychosocial Support/Education”, so this can
be entered as N/A, and initialed.
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Newborn Clinical Pathway
© 2004-2007 Grey Bruce Health Network
 Indicators need to be entered as “met” or “not met”.
 The discharge criteria (last page) should be checked
daily and initialed if any of the criteria are met.
 Space is available for progress notes on the bottom at
the back of the page (add regular progress notes page
if you require more space).
 When all discharge criteria have been met for both
baby and mother, they can be discharged home
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End of Vaginal Birth section
© 2004-2007 Grey Bruce Health Network
This is the end of the general information for the
Vaginal Birth pathway.
To get further information by trying the pathway on a
sample patient, move to the Simulation portion of the
Vaginal Birth workshop.
Test your knowledge of Vaginal Birth by doing the
Vaginal Birth quiz.
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Simulation
© 2004-2007 Grey Bruce Health Network
Try it! Click here to see the clinical pathway.
Take a look at the clinical pathway. On the first page is a
master signature sheet. Sign it, and then for the remainder
of the pathway you can just initial as tasks are complete (if
you have a Master Signature Sheet for your facility, this
will not be on your pathway page).
There are also some basic instructions on the first page on
how to use the pathway.
Each page will need a patient ID sticker. Flip to the first page
of the pathway, “Labour Triage with Admission”:
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
Our sample patient Nancy is pregnant and has
arranged for a hospital visit and pre-admission
appointment. During her visit, Nancy should receive
her patient education materials and be instructed to
bring these with her when she comes back in to
have the baby.
When Nancy arrives in hospital in labour, the Labour
Triage With Admission page should be started. It
also includes the Performance and Patient Outcome
Indicators for Active Labour and the 1st 2hrs
Postpartum.
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© 2004-2007 Grey Bruce Health Network
Assess the Patient Outcome and Performance Indicators
Labour Triage with Admission
Patient received appropriate prenatal care
□ Met □ Not Met □N/A
2. Patient meets criteria for admission
□ Met □ Not Met □N/A
3. Fetal Heart rate measured by intermittent auscultation
□ Met □ Not Met □N/A
1.
Do any documentation on the progress notes at the
bottom of this sheet instead of your regular progress
notes. Complete other documentation as per your
corporation.
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© 2004-2007 Grey Bruce Health Network
Assess the Patient Outcome and Performance Indicators
Active Labour
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Fetal Heart rate measured by intermittent auscultation
□ Met □ Not Met □N/A
5. IV or Saline Lock started for medication
administration only
□ Met □ Not Met □N/A
Do any documentation on the progress notes at the
bottom of this sheet instead of your regular progress
notes. Complete other documentation as per your
corporation.
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
Once labour is complete, the pathway moves into
the postpartum phase first 2 hours.
Assess the Patient Outcome and Performance Indicators
6. Immediate skin-to-skin Mother-Newborn contact
7. Breastfeeding initiated within 1st hour postpartum
Do any documentation on the progress notes at the
bottom of this sheet add your regular progress notes
sheet if you need more space. Complete other
documentation as per your corporation.
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
Once the baby is born, there is another pathway to be
used for his/her chart, called the Newborn
pathway. It works much the same as the Vaginal
Birth pathway.
The Newborn pathway follows the same format with
postpartum first 24 hours and 24-48 hours. There
are tasks to be initialed for each day, and
indicators that should be met as well.
1. Prophylactic medications given after 1 hr post-birth
2. Breastfeeding assessed using latch assessment
tool
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
The next page of the Vaginal Birth pathway is the rest of the first
postpartum day(3-24 hrs). You will see columns on the right
hand side (one for each shift ) –write in today’s date at the top.
Below the date, write in the hours you will be caring for Nancy.
You will then use this column to initial as each task on that page
is completed.
The rest of the sections are tasks that are to be completed for that
day. Again, some tasks are not applicable to each patient, or to
each shift. For example, if it is night shift, you may not be
teaching Nancy, so under “Psychosocial Support/Education”,
you can indicate “N/A” and initial “Review Patient Pathway”.
You will notice on the postpartum pages that there is a reference
to a Latch Score assessment. This refers to the Breast/Latch
Assessment tool, which helps document feeding and latching
of the baby.
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© 2004-2007 Grey Bruce Health Network
Patient Pathway and Education Materials
On each day of all pathways, you will notice a referral to a Patient
Pathway. The Patient Pathway should be referred to on a daily
basis to help Nancy understand the plan of care.
Nancy should have her patient pathway from the preadmit clinic. If she
does not, we can give her another one for teaching purposes.
However, if Nancy is not ready for education, indicate N/A on the
pathway in this section and initial this task until she is ready for
education.
The education materials, including the handout – Having Your Baby in a
Grey Bruce Health Network Hospital and the other brochures and
booklets listed on the first page of this booklet can be referenced to
aid you in teaching.
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
At the end of each day, in the Discharge Planning
section (last section of each page), you will notice it
says “Assess Discharge Criteria Daily”. This means
you will need to flip to the last page, the Discharge
Criteria once a shift, and check if any of these
goals have been met. If they have, initial and date
them.
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
Let’s assume it is the second postpartum day, and Nancy
and her baby have now achieved all the Discharge
Criteria. They are now ready to be discharged.
If Nancy is transferred to another hospital, there are
instructions on what documents to send the receiving
hospital, so they can continue using the pathway on the
first page of the pathway under the heading “HOW TO
USE THE CLINICAL PATHWAY”
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Vaginal Birth Quiz
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© 2004-2007 Grey Bruce Health Network
What are the inclusion/exclusion criteria for this
pathway?
What patient education materials are used for this
pathway? When are they handed out?
When is this pathway started?
Where is the documentation done during the phases of
labour?
What is the Breast/Latch Assessment tool and how is it
used?
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Answers
Answers: Vaginal Birth Quiz
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© 2004-2007 Grey Bruce Health Network
What are the inclusion/exclusion criteria for this pathway? This pathway is used for
all women admitted for vaginal birth with no identified risk factors.
What patient education materials are used for this pathway? When are they handed
out? There is the booklet – Having your baby in a Grey Bruce Health Network
Hospital, as well as accompanying materials – Let’s Grow a Healthy Baby,
Community Resources for Parents, and Hearing Screening for your Baby. These are
all handed out in the pre-admission clinic.
When is this pathway started? This pathway is started in the preadmission clinic.
Where is the documentation done during the phases of labour? There is standard
corporate documentation already in existence for the phases of labour, so
documentation is done on these sheets rather than on the pathway to avoid
duplication.
What is the Breast/Latch Assessment tool and how is it used? This tool is used to
help us assess the mother’s breast, as well as how the baby is feeding and latching.
If you have had difficulty with any of these questions, go back through the material
on this pathway and/or the general pathway information in this workshop, or
ask your Site Champion any other questions you have or contact EBC program
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