Transcript Education CD Rom #2

© 2004-2007 Grey Bruce Health Network
Caesarian Section
Education Workshop
(click to go to the desired section)
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Introduction to Workshop/Instructions
Evidence-Based Care Program
C-Section 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
Caesarian Section Pathway Package
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This pathway is for patients who come to our hospital for a
caesarian section birth.
The pathway consists of parts:
 Clinical Practice Guideline
 Patient Pathway (same as used for Vaginal Birth)
 Patient Education Materials (same as used for Vaginal Birth)
plus “Recovering from a Caesarian Section” and information on
“Intrathecal spinal analgesia for pain”
 Breast Latch Assessment Tool
 Caesarian Birth Clinical Pathway
 Newborn Clinical Pathway
 Newborn order sets( Newborn & Circumcision)
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© 2004-2007 Grey Bruce Health Network
Caesarian Section 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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© 2004-2007 Grey Bruce Health Network
Caesarian Section Pre-Printed Orders
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There are 2 sets of pre-printed orders for this
pathway package: (No C-Section Orders)
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Newborn orders
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Newborn Circumcision orders
These orders can be found on the unit or on the
GBHN website gbhn.ca
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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.
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-HEARYOU) Back To Sleep (613) 954-5995 or visit the website at: www.hcsc.gb.ca/hppb/childhood-youth
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© 2004-2007 Grey Bruce Health Network
Caesarian Section Clinical Pathway
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This pathway is intended for patients who have come
in for a Caesarian Section Birth. The first page of the
pathway is the Postpartum 3-24 hrs. First two hours
are usually spent in Recovery Room.
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© 2004-2007 Grey Bruce Health Network
Caesarian Section Clinical Pathway
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The first page of the pathway covers Postpartum (324hrs) and the 2nd page 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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© 2004-2007 Grey Bruce Health Network
Caesarian Section Clinical Pathway
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You will notice a new task beginning Postpartum 3-24
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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© 2004-2007 Grey Bruce Health Network
Newborn Clinical Pathway
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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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© 2004-2007 Grey Bruce Health Network
Caesarian Section Clinical Pathway
 The discharge criteria ( last page) should be checked
daily and initialed if any of the criteria are met.
In addition, any indicators need to be entered as “met” or
“not met”.
 When all discharge criteria have been met for both
baby and mother, they can be discharged home.
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End of Caesarian Section
© 2004-2007 Grey Bruce Health Network
This is the end of the general information for the
Caesarian Section pathway.
To get further information by trying the pathway on a
sample patient, move to the Simulation portion of the
Caesarian Section workshop.
Test your knowledge of Caesarian Section pathway
by doing the Caesarian Section 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.
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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 preadmission appointment. Nancy should also
receive her patient education materials at this
visit and be instructed to bring these with her
when she comes back in to have the baby.
Once the Caesarian Section is complete, the
pathway begins with the postpartum phase.
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
Once the Nancy returns from the Recovery Room the pathway
starts at the postpartum phase 3-24 hours.
Assess the Patient Outcome and Performance Indicators
1.
Immediate skin-to-skin Mother-Newborn contact
□ Met □ Not Met □N/A
2. Breastfeeding initiated within 1st hour postpartum
□ Met □ Not Met □N/A
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
The first page of the pathway is the rest of the first postpartum day(324hrs). 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. (see a sample page 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. See a sample filled out.
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
The 2nd page of the pathway is for postpartum day 2 -3.
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. (see a sample page completed).
The rest of the sections are tasks that are to be completed
for that day including the Patient Outcome Indicator
3. Mother demonstrates ability to provide safe and
effective care and feeding of the newborn
□ Met □ Not Met □N/A
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Simulation Cont’d
© 2004-2007 Grey Bruce Health Network
On each day of all pathways, you will notice a referral to a Patient
Pathway.
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. Also, the Patient Pathway should be referred to
on a daily basis to help Nancy understand the plan of care.
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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, on your shift, and check if any of these
goals have been met. If they have, initial and date
them.
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Newborn Clinical Pathway
© 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 (see sample). 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
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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Caesarian Section 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?
What is the Breast/Latch Assessment tool and how is it
used?
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Answers
© 2004-2007 Grey Bruce Health Network
Answers: Caesarian Section Quiz
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What are the inclusion/exclusion criteria for this pathway? This pathway is used for
all women who deliver via caesarian section .
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, Back to
Sleep. These are all handed out in the pre-admission clinic or on the unit if they have
not been brought to hospital.
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 the EBC
Program
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