Specialist Trainee Induction QEUH

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Information for New Middle Grade Staff (ST2-7 & LAT appointments)

Welcome to the Queen Elizabeth University Hospital Obstetrics and Gynaecology Department.

We hope that you find your time here educational and worthwhile, both now and in your future career as an Obstetrician and Gynaecologist.

This induction pack should cover most questions you may have, but if you are unsure of anything please do not hesitate to contact either Sarah Woldman, Lynne Thomson or Vanessa Mackay. Your educational supervisor should also be able to support you in their role too.

Please ensure that for workplace correspondence you have an nhs/ggc email address before starting. Ask us if you are unsure how to set this up. NHSGGC Email Usage Policy applies to all our staff using GGC or NHS Mail. The policy can be found on Staffnet. We need to comply!

Remember to confirm patient ID (DOB and ADDRESS) for ALL patient encounters.

Clinical Lead / College Tutors

Clinical Lead

Dr. Vanessa Mackay
[email protected]
Consultant Obstetrician and Gynaecologist, QEUH
Secretary: Leanne Roe 0141-201-2266

College Tutors

Dr. Sarah Woldman
[email protected] 
Consultant Obstetrician and Gynaecologist, QEUH
Secretary: Sharon Black 0141-201-2820

Dr. Lynne Thomson
[email protected]
Consultant Obstetrician and Gynaecologist, QEUH
Secretary: Annette Kirkbride 0141-201-2348

The Consultant team

Consultant

Rota abbreviation

Secretary

Number

Jane Richmond (Cl Director)

JR

Cheryl Lindsay

201 2236

Hassan Ali

HA

Liz Spencer

201 2353

Laurie Anderson

LA

Shona Sim

232 7955

Janet Brennand

JB

Leanne Roe

201 2266

Karina Datsun

KD

Carole Carruth

201 2264

Janice Gibson

JG

Cheryl Gaughan

201 2236

Karen Guerrero

KG

Sharon Black

201 2820

Catriona Hardie

CHa

Liz Spencer

201 2353

Chris Hardwick

CH

Kim Kennedy

232 7908

Robert Hawthorn

RH

Carole Carruth

201 2264

Fiona Hendry

FH

Kim Kennedy

232 7908

Claire Higgins

CHi

Shona Sim

232 7955

Aradhana (Mona) Khaund

AK

Nicola Stewart

232 7971

Marie Anne Ledingham

ML

Kim Kennedy

232 7908

Vanessa Mackay (Cl Lead)

VM

Leanne Roe

201 2266

Frances Powell

FP

Leanne Roe

201 2266

Stewart Pringle

SP

June Reid

201 1959

Mandy Reid

MR

June Reid

201 1959

Vladimir Revicky

VR

Karen Grossart

232 7955

Judith Roberts

JRo

Nicola Stewart

232 7971

Jessie Sohal-Burnside

JS

Annette Kirkbride

201 2348

Carla Summerhill

CS

Annette Kirkbride

201 2348

Lynne Thomson

LT

Annette Kirkbride

201 2348

Veenu Tyagi

VT

Sharon Black

201 2820

Sarah Woldman

SW

Sharon Black

201 2820

Padma Vanga

PV

Jacky Mathieson

232 7955

Hospital abbreviations in rota
QEUH  Queen Elizabeth University Hospital
VACH   Victoria Ambulatory Care Hospital
STOB   Stobhill Ambulatory Care Hospital

Hospital Sites

Queen Elizabeth University Hospital (QEUH)

You will be based within the Queen Elizabeth University Hospital but will work “off site” for some clinical sessions (see below). The unit is spread over 4 floors.

On the ground floor of the Obstetrics and Gynaecology department you will find labour ward (including obstetric theatres), gynaecology theatres (currently used for elective CS lists), maternity assessment, day care, antenatal and (few) gynaecology outpatient clinics, pre-assessment, early pregnancy assessment service and gynaecology day ward.

The seminar room is also located on this floor and is used for teaching and training although inevitably during the pandemic, teaching has become online.

On the first floor you will find the administration corridors including the secretaries, consultant offices and doctors’ room.

On the second floor, the high risk postnatal ward (47) and the antenatal ward (48) can be found.

The gynaecology ward (49) and low risk postnatal ward (50) are located on the third floor. Gynaecology Emergencies is within ward 49.

Gynaecology elective surgery is currently being done in the main theatre suite in the QEUH.

There are 3 ECG machines in the maternity unit situated in labour ward /MAU /ward 48. The wards, including 49, would use the one situated in 48. Outpatient departments and Gyn Triage/Dayward/Theatre should use the one located in MAU in the event of an emergency. Please put it back where it came from and report any problems with machines to the base location.

Parking in the hospital is limited. Staff parking permits will not be available for trainees. There are some non-permit holder areas where you can park in the hospital (map enclosed in induction pack) but these tend to fill up quickly in the morning. People also park on the roads outside or in the visitor parking spaces. If you use these spaces for >4 hours, you are at risk of being given a parking ticket. Don’t park in the ambulance bays at the side of the maternity building or in the consultant emergency spaces. There are lots of spaces in the multi-storey car park behind the maternity building. Traffic wardens frequent the main road which has double yellow lines!

The WRVS shop is situated at the main entrance of the maternity building. This is open daily (0900-2000 Mon-Fri & 1200-1600 Sat/Sun). Hot drinks, soup, toasties etc can be bought in addition to sandwiches, snacks and cold drinks. There are also vending machines outside labour ward. You are welcome to use the tea rooms on MAU and LW. If you drink tea/coffee/use their milk, you should offer a donation. There is a kitchen next to the doctors’ room with a kettle and microwave but there is minimal crockery/cutlery.

A small quiet room next to the coffee room in the 1st Floor Admin Corridor is available for use as either a Prayer Room or for Breasfeeding needs. If anyone wishes to use these, then let us know.  

The QEUH Canteen/Aroma café is on the first floor of the main adult hospital. There are also shops on the ground floor including M&S, various food outlets and a cash machine

Victoria ACH (VACH)

The VACH is the day hospital opposite the now closed site of the original Victoria Infirmary. There are daily Gynaecology Outpatient/Ultrasound/Urogynaecology clinics here (Clinic K, 1st floor) and DSU lists (1st floor).

Parking at the VACH is in the basement car park (visitors/patients ≤4 hours as above) or on the street.

There is an Aroma café on the ground floor and staff canteen on the 2nd floor.

Stobhill ANC (STOB)

The Stobhill ACH is a day hospital on the old Stobhill Hospital grounds. There are daily one stop/colposcopy/MVA/ultrasound clinics in Clinic F on the 1st floor. Parking is in the car parks opposite or behind the building. There is also an Aroma café and small staff canteen.

Contact numbers/Paging system

QEUH page numbers

Obstetric Consultant

17222

Gynaecology Consultant

17332

Obstetric Registrar

17111

Gynaecology Registrar

17519

Obstetric FY2/ST junior

17523

Antenatal ward FY2/ST junior

17255

Postnatal ward FY2/ST junior

17552

MAU

17563

Gynaecology FY2/ST oncall

17066

Ward 49 junior

17280

Labour ward anaesthetist

17307

Blood Bank

17270/89104

Haematology

17602

Biochemistry

17684

Porters

17241

QEUH extension numbers

Antenatal clinic

62226

Day Care

62274/64362

Labour ward

62292/64317 (induction diary)

Labour ward recovery

64313 (also to book CS)

MAU

64363/64377

Ward 47

62268

Ward 48

62269/62267

Ward 49

62282/67644 (doctor’s room)

Ward 50

64369/64370

Gynaecology day ward

67642

Gynaecology pre-assessment

62273

Emergency paeds

62263

QEUH Labs extension numbers

Biochemistry

61681

Blood Bank

61597

Haematology

61598

DECT numbers (PHONE) – General Surgery

Gen Surgery Consultant oncall 1*

85793

Gen Surgery Consultant oncall 2*

85794

Gen Surgery Reg 1 oncall (Receiving Reg) held 24/7

82315

Gen Surgery Reg 2 oncall (Theatre Registrar) 0800-2030

85792

*General Surgery Consultant phones are held whilst consultants are in hospital – usually 0800-late weekdays and 0800-1700 (approx) weekends. Switchboard have phone numbers for out of hours. Should try DECT first then go via switchboard if need consultant.

Paging system

  • 8888 – page no – extension
  • In the event of an emergency or fire, dial 2222. For emergency, request:
    • Adult resuscitation Team 2 (for non-obstetric calls or cardiac arrest within obstetrics) or
    • Obstetric Resuscitation Team
    • In the event of major obstetric haemorrhage, request both the Major Haemorrhage Team and Obstetric Emergency Team.
    • Request teams to attend “Ward XX, Maternity Block”
    • In Neonatal emergency, ensure use of “neonatal” and not “paediatric”

The Rota and Responsibilities

What are the hours of work?
How does the on-call rota work?
Obstetric oncall
Gynaecology oncall
EPAS
Handover/Safety briefs
When a second registrar is required on labour ward
Postnatal wards and MAU
Nights
CEPOD Theatre
Who is in charge of the rota?
What are my responsibilities as a registrar?
Use of Badgernet in Obstetrics
Computer Access
RTT (Referral To Treatment pathway)
How to complete a waiting list shell at clinic



What are the hours of work?

The rota is band 2B for ST3+. The Women and Children’s Directorate is committed to ensuring that Junior Doctors rotas conform to the European Working Time Directive and New Deal. An Hours Monitoring exercise can be requested by trainees at any time. This will be conducted every six months for all middle grade staff. Please note that completion of this is a contractual obligation, and will need to be repeated if insufficient completed forms are submitted.

How does the on-call rota work?

All daytime on-call shifts (both Obstetrics and Gynaecology) are 0830-2045 and night-shifts are 2030-0845 seven days per week. This is a very busy unit and effective handovers between day and night staff are mandatory in both Obstetrics and Gynaecology. In order to facilitate this, handover periods have been built into the on-call rota. Please can everyone ensure that they have changed into scrubs and are ready to start the handovers punctually on Labour Ward at 0830 and 2030.

Obviously, there are occasionally unforeseen circumstances which cause people to arrive late. If you anticipate that this will be the case, please can you phone the Labour Ward Coordinator (0141-201-2292) so that the remainder of the team knows how long you will be.

Sometimes, you may only be on-call 0830-1700 with a senior / subspecialty trainee taking over at 1700, or not on-call until 1700-2045 if there has been an ST2/LAT2 working with the consultant during the day. In these situations, it is imperative that a full handover is carried out in front of the LW patient board and the consultant informed of the changeover if not already aware. The consultant will attend this full handover at 0830/1700 (if changeover doctors)/2030.

Obstetric oncall

If you are the daytime on-call Registrar for Obstetrics (page 17111), you will cover all emergency work on the Labour Ward and maternity wards between 0830-2030. There is a separate team for the elective Caesarean Section list, led by a named Consultant or senior trainee (ST6/7) who will not be one of the on-call team. There is also usually a separate registrar who will conduct the postnatal ward round (47, 50) and cover MAU. The obstetric handover is followed by consultant-led ward rounds on Labour Ward and Ward 48. The Consultant body work in a resident “hot day” capacity Mon-Fri (outwith public holidays) between 0830-2030 on Labour Ward. The Consultant will either do “hot days” Mon/Tues or Wed/Thurs. The weekend Consultant Obstetric oncall is covered Fri-Sun by a separate day and night team, non-resident overnight and non-resident all day Sat/Sun.

Gynaecology oncall

If you are the Gynaecology Registrar (page 17519), you will have a formal handover of patient details and the page at 0830/2030 on Labour Ward. You will then undertake a consultant-led ward round at 0900 on ward 49 before undertaking review of patients in Gynaecology Emergencies (this obviously depends on triaging of cases). All receiving calls during daytime hours (0830-1700) will be directed to the on-call Consultant for appropriate triaging. Any patient who requires emergency review will be seen in the Gynaecology Emergency Unit (0900-1700). Out of hours, the receiving calls will come through to the Registrar page. Out-of-hours, GP referrals should go directly to Ward 49 to be assessed if the GP considers them to be stable. A&E referrals may need to be assessed in the Adult Emergency Department if it is unclear whether they are in fact a Gynaecological patient.

If medical staff in the main Adult Hospital request review of a ward patient, please discuss this with the on-call Gynaecology Consultant – it may be appropriate to transfer the patient to the Gynaecology Emergency Department for review (same day or next working day), or for the patient to be given an urgent appointment at a GOPD, or for a Gynaecologist to review the patient on the ward within 24 hours.

Many emergency Gynaecology referrals are not emergencies at all and can easily be seen at the earliest outpatient clinic. Ask the referring GP or ward doctor if this is appropriate. If you know the patient’s postcode, then they can be referred to the appropriate clinic within their catchment. Always put the on-call consultant’s name on any investigations and use the consultant team system to establish clinic and follow-up arrangements for emergency patients (you will find this in Gynaecology Emergencies). Referrals will be scanned through the vetting process appropriately.

Most patients seen through gynaecology emergencies will go home. Few require follow-up. An electronic discharge letter to the GP must be completed following every review in Gynaecology Emergencies. This includes all patients who are seen on Ward 49 out of hours. This is very similar to completing an IDLS and is just as important. This should be completed by the doctor who sees the patient.

  • Within Trakcare, select the ward attender patient episode from either SGH-Emergency Gyn or SGH49-Gynaecology. All patients being seen must be ward attended – nursing or clerical staff will do this.
  • From options above, select Discharge Letters then New OPCL.
  • In clinical notes, select New and complete the main body of the letter.
  • It’s important to also complete Additional OPCL info – New (just add in NA/Nil if no follow up required)
  • You must then Update and Authorise in order for the letter to be complete which will then send to GP electronically and be uploaded on to Clinical Portal

If urgent OP attendance is required, give the appropriate secretary a letter and she will scan onto Clinical Portal/contact Outpatient Appointments. Those with STIs or issues surrounding contraception should be given details of the Sandyford Clinic or advised to see their GP. If positive Chlamydia results come back, then write to the patient with an appropriate action plan, copying the letter to the GP and sending a referral to the Sandyford.

Unnecessary admissions should be avoided. Some women will be able to be given an appointment for review (including Transvaginal USS) in the Emergency Unit the next working day or have their details passed onto EPAS. Please discuss individual patients with the On-call Consultant if unsure what to do. The same applies to women awaiting assessment in the A&E department.

For patients who are being referred to the regional gynaecology MDT:

  1. When you submit a case for MDT discussion, copy Dr Hardie (local lead Gynaecology Oncology), Lesley Kelly (CNS based at GRI) into the referral as it is vital for them to look over the cases before MDT Meeting. They have GGC email accounts. There will be an additional CNS starting over the summer.
  2. If an inpatient on ward 49 is submitted for MDT discussion, please put a copy of the completed MDT referral form in the notes and document that submission has been done.
  3. If you submit an MDT form for a patient elsewhere in QEUH, it would be helpful to upload the referral onto Portal so that we know the form has been completed across specialties.

There is a whiteboard on ward 49 to allow us to keep up to date with any HDU/ITU/ward outliers. Please use this and ensure it is updated daily. This is located in the doctors’ room behind the ward clerkess’ desk.

IDLs should be reviewed on the ward round prior to discharge. Some of the IDLs may be more complex for eg longer term cancer patients and we would expect senior doctor involvement here.

Completion of a death certificates on ward 49 should involve a more senior doctor ie ST3-7 or consultant. Completion of this out of hours by the oncall ST3-7 is entirely reasonable if they feel comfortable doing it. The majority of patients who will die on ward 49 will already have a DNA-CPR in place and a cancer diagnosis. It would be appropriate in these cases to document in the case notes that in the event of death, the certificate should be completed with the cause of death being eg metastatic ovarian malignancy. There are learn pro modules and national guidance available to improve understanding here.

EPAS

The EPAS service at QEUH is open Monday – Friday 8am-4pm for referrals.  On Saturday, it is open from 0830-1630 for referrals. If a patient is referred after 1630 on a Saturday, there are no EPAS staff on Sunday to follow up the referral as the unit is closed.  Please note that the EPAS service is open at the Princess Royal Maternity (PRM) on a Sunday from 0830-1630.  Would all staff wishing patients referred from Saturday after 1630 liaise with gyn colleagues at PRM who can pass to EPAS on a Sunday. The contact numbers for PRM EPAS are 0141 211 5317 and 0141 211 5323.

EPAS now has the facility to accept electronic referrals via Trakcare.  This should make it easier to pass on patient details especially when taking calls or reviewing patients out-of-hours.

The Trak process is as follows:

Requesting process for clinical staff

  • Patient selected>select New Request>Others tab
  • Item search: enter early pregnancy assessment (or type EPAS)
  • Complete referral form

If there are any issues with this process, please can you feedback to the EPAS Team.

The generic EPAS mailbox which is checked regularly and you can email questions/get advice from is [email protected] This is not for referrals!

All early pregnancy scans carried out in GE or OOH should be documented on Badgernet. In “enter new note”, there is an USS option and gives you a drop down of the type of scan carried out. It then prompts you to fill in the boxes. This will allow an easier way to audit practice and allow EPAS to see any previous scans carried out on the ward. You should only be doing unsupervised EP scanning if your intermediate scan module is signed off.

Handover/Safety briefs

Handovers are a vital part of our day and a time to deliver succinct, accurate information about patients to the appropriate team. Positivity is another important point to encourage. We should never imply that the team beforehand have not been pulling their weight when there is a lot to hand over.  This is a unit with a huge workload 24/7! There is a structured paper handover proforma which should be followed (Appendix 1) but this has been updated with information with What Matters to Me. A separate email with this information will be sent by Dr Roberts. At the labour ward handovers please ensure that you follow this guide:

  1. Introduce yourself with both forename and surname.
  2. Explain what your role is for that shift.
  3. Be specific about what time period you will be on shift for. Some trainees finish at 5pm and it would be helpful to know if we need to have another brief handover period between trainees and consultants at 5pm.
  4. “What matters to me...” This has been introduced since June 2018 and has received a good response from trainees and consultants. This is a moment to highlight what is important to you for that shift. It may be something specific to your training or non-clinical. We also feel that it is a time to remind people to use positive behaviour within the unit. It is not compulsory for everyone to say something!

When a second registrar is required on labour ward

If a second registrar is required in an emergency situation in Labour Ward, then the Gynaecology Registrar will be paged.

Postnatal wards and MAU

The registrar cover of the postnatal wards (PNW) and MAU will depend on the number of trainees available each day. This will be evident on the rota. Sometimes, there will be a trainee who covers both the PNW and MAU in the morning. Sometimes, you will be asked to do the PNW round before joining the Antenatal Clinic. You would be expected to complete the review of all high risk patients highlighted in wards 47 (and any other patients who need seen on ward 50). This will include women on their first post-natal day after emergency C/S, rotational or mid-cavity forceps, PPH or 3rd/4th degree tears; those on antihypertensive treatment or septic; those with wound problems or any patient that the midwife has concerns about. If urgent senior advice is required, the on-call Obstetric Consultant should be contacted. Any major problems should be reported to the Consultant in charge of that patient, particularly if on-going postnatal review is going to be required.

We endeavour to provide a trainee to cover MAU in the afternoon separately where rota permits. Otherwise the gynaecology trainee will cover MAU. Remember if it gets too busy, then inform the on-call Consultant who will be available to help you. It is also important that you are aware that the agreed unit policy is that women presenting postnatally to MAU warrant a middle grade obstetrician review. Postnatal readmission is a DATIX trigger – remember to fill in a DATIX form.

Nights

Overnight, there will always be two registrars resident within the hospital (2030-0845). The more junior registrar will carry the Gynaecology page (Page 17519), and the more senior one carries the Obstetric page (Page 17111). Both registrars should start by receiving the Obstetric handover on the Labour Ward at 2030 which will also be attended by the night Obstetric Consultant. The Gynaecology Registrar will then visit Ward 49 to assess all patients who have been to theatre that day and any other patient who is causing concern. Out of hours, all calls from MAU will come to the Gynaecology page. On shifts where there is a more junior trainee (ST2-5), please feel that you can phone the higher ranking registrar, hot day consultant or night consultant for advice regarding patients in MAU. There will also be some nights where there will also be an ST2 shadowing the more senior registrar overnight. This is a useful extra pair of hands. Intensive shadowing occurs with the aim to move the ST2 stage trainees onto the middle grade rota with time and after an appropriate period of supervision.

Weeks of night shifts are split into 3 nights (Fri-Sun) and 4 nights (Mon-Thurs). It should be stressed that there is to be no use of a bed or a Parker Knoll chair for sleeping purposes overnight whilst on-call at middle-grade level.

It is important that the registrars oncall overnight work as a team with equal share of the workload. If Gynaecology and MAU are quiet, the Gynaecology Registrar may help out on Labour Ward, but their priority is to Ward 49 and Emergency Gynaecology at all times.

The on-call Obstetric Consultant should be informed of complex / high-risk maternity patients. Please adhere to the enclosed guideline in your induction pack regarding consultant attendance on labour ward (Appendix 2). However, please do not hesitate to contact the on-call consultant about any patient who you have concerns about.

Women in Surgical HDU need to be seen on the evening Ward Round.  Gynaecology is the responsible speciality for the on-going care of these patients who will either need post-op reviews (as with any other patient who has attended Theatre earlier that day), or be sick (eg sepsis) and need a minimum of twice daily medical reviews.  The on-call Gynaecology consultant should be informed of the patient’s condition and progress so that an appropriate overnight management plan can be made.  To date, it would appear that not all women in Surgical HDU have been reviewed in the evening, and this has been flagged up as sub-standard care in recent Risk Management reviews.

CEPOD Theatre

Gynaecological patients requiring emergency operations will need to be transferred to Adult QEUH CEPOD Theatre (Th 17/18) in the main hospital (level 2). It is the responsibility of the registrar/consultant team to ensure that the patient’s details are given to the CEPOD coordinator (Tel 83469) and the duty anaesthetist is informed (Tel 83466). Remember that occasionally elective cases will be cancelled during the day in our main Gynaecology Theatre so it is always worthwhile checking with the Gynaecology Theatre Sister/Coordinator to see if they have any space for emergency operations. We will occasionally have to “break into” an elective list in gynaecology theatres if CEPOD is very busy and we have an acute emergency to deal with eg. ruptured ectopic. Be guided by your consultant on how best to handle these situations.

Who is in charge of the rota?

Dr. Sarah Woldman is responsible for the weekly rota and oncall rota. Requests for annual and study leave are on a first come first served basis, so in order to avoid disappointment, please confirm with Dr Woldman before making any travel/holiday arrangements. All approved requests for annual and study leave will be entered onto the Google calendar. We can normally accommodate 2 registrars taking leave at the same time (sometimes there is capacity to accommodate 3). Please use up your allocated annual leave each year.

If you make changes to the rota after it is issued, please ensure that you have agreed the change with Dr Woldman and inform the relevant clinical areas. If this involves a swap of out-of-hours cover, please discuss with Dr Woldman in advance. Remember that there can be last minute changes to the rota so check your emails regularly for updates.

If you have any rota queries, please discuss these with any of us.

What are my responsibilities as a registrar?

Each middle grade doctor should discuss specific responsibilities with their allocated Educational Supervisor. You should ensure that you meet with your ES for initial induction meeting by the end of September. In general, middle grade doctors have responsibilities for the patients attending their named consultant and should try to review their team’s in-patients whenever possible.

Your consultant will advise you on administrative duties. You will be allocated an Obstetric Discharge Letter Consultant – it is your responsibility to work alongside others allocated to this team to ensure that Obstetric discharges are kept up to date.

All correspondence for typing is done via digital dictation using Winscribe Version 4.2. Each consultant has a unique dictation code which you insert into both username/password using the Winscribe programme on the desktop (see Appendix 3). Please remember to scan the patients ID barcode for each letter where possible in addition to stating the patient’s name and CHI number. The secretaries request that you speak clearly whilst dictating, making sure that you identify yourself, your grade, date of dictation, and the clinical activity on which you are dictating. Concise letters make the referring GPs happy too!

If there is a definitive decision made about a surgical procedure in clinic, then the patient should be consented that day. If unsure, should be done later/morning of surgery if DSU. Avoid the use of “+/-“ on consent. Medical student involvement should be documented that it has been discussed and whether agreed to or not. Don’t consent if you do not feel experienced enough to discuss the procedure fully.

Dictated clinic and discharge letters will be signed electronically by the relevant consultant.

In addition to dictation, registrars spend lots of time writing in casenotes in Gynaecology/electronically using Badgernet in Obstetrics. We can all improve written documentation by remembering to include date and time, sign, print our name and document our grade for every written entry. We should document evidence of Discharge planning on the daily Gynaecology consultant ward round. Remind your consultant to make a written comment on the Estimate Date of Discharge (EDD) for both elective and emergency Gynaecology inpatients. Documentation is regularly audited within our department.

Use of Badgernet in Obstetrics

Badgernet  is a paperless, end-to-end Maternity system which is used at QEUH. It records every stage of the pregnancy from first appointment to postnatal home visits. It fully supports care pathway management to provide flow between care plans, assessments, reports and management plans. It wholly supports NHSGGC’s continuing move away from paper resources. During induction, you will receive training on how to use this system if you are unfamiliar with it. You can also access the Badgernet “Sandpit” to familiarise yourself with the system within the Intranet.

http://www.staffnet.ggc.scot.nhs.uk/Corporate%20Services/eHealth/eHT/Pages/BadgerNet-Sandpit.aspx [Staffnet link - you must be connected to the NHSGGC network to view]

There is a quick guide to Badgernet which is attached as a separate document by email to you which will be useful on labour ward (Badgernet troubleshooting).

A few documentation issues regarding Badgernet which have recently been raised:

  1. ensure that a specialist review is completed at the time or retrospectively if you are making the decision to take someone to theatre or performing a delivery in the room.
  2. Currently there is no place on Badgernet to document "decision time". As notes are often written in retrospect we cannot always rely on the Badger timeline to give us this information although it is often but not always documented by the midwife contemporaneously​. In order to ensure it is not missed it is therefore advised that you document decision time either in your specialist review or free text of your operation note.​You may wish to make a note of this on your consent form ie in the event of a Category 1 Caesarean section, although this will not always be appropriate. 
  3. There is now an antenatal and postnatal ward round page on Badgernet which should be used instead of a specialist review
  4. Complete a peer CTG review for each patient on the LW ward round.

The peer review CTG field is accessible as follows - in labour and birth section -  click on partogramadd notes - add peer CTG review

  1. Document on Badger the category of Caesarean section and communicate this to the midwifery and anaesthetic team.

Computer Access

Computers are available specifically for junior staff use in the Junior Doctors’ / Dictation Rooms (1st Floor, Administration Corridor). These can be used for preparing teaching presentations, audit work, internet access and the K2 training package. There is also ample access to mobile laptops in most clinical areas to ensure work can be carried out efficiently. If you experience any technical problems with the computers, then let us know.

RTT (Referral To Treatment pathway)

It is vital that an RTT MUST be recorded for each and every patient attending an Outpatient clinic. A reminder that when Trak outcomes are completed in Obstetric clinics, the left hand RTT box must be filled in too with one of the following options highlighted:

Non RTT – click on this if patient attended appointment

Did not attend – rebook

DNA – No Further Appointment

Also, a reminder that completing the Trak outcome does not automatically book a follow-up appointment – the patient still needs to go to the front desk.

It may be necessary to record more than 1 outcome at clinic to accurately reflect the patient’s treatment.  An example of this is when a patient is prescribed medication today as part of their treatment, and there is also the requirement for them to be listed for surgery.

In this instance the following should be recorded on TRAK.

  • 1A Treatment started today in the RTT column
  • IPWL or DCWL RTT already closed in Outcome column – this option will open the waiting list entry shell for you to complete.

N.B Please remember that if the patient has had treatment started at a previous OP/IP/DC episode “1B - treatment previously started” should be recorded for all subsequent review appointments.

How to complete a waiting list shell at clinic

When you choose an outcome which means that the patient requires a procedure, the WL screen below will launch. There are 3 sections only which need to be completed – 2 have drop down menus and are circled in the picture below and defined here:

  1. Estimated length of stay: the number of days that the patient is likely to be an inpatient (for a day case, this will be zero)
  2. Primary procedure: this is the intended procedure. Select the procedure the patient is to have from the spy glass menu. By typing in a few letters from the procedure, a list will appear for you to select from. If the patient is to be admitted for more than one procedure, you may enter another procedure by selecting it within the Secondary Procedure field.
  3. Patient type/treatment hospital: select either IP (inpatient) or DC (day case) from the spy glass and the hospital that the patient will be admitted to.
  4. If you have any specific information which you would like to add, this can be typed into the remarks box e.g. specialist equipment required for theatre.
  5. Once you have completed the details, click UPDATE. The waiting list entry is now complete. It is essential that UPDATE is clicked to complete this screen as, for Treatment Time Guarantee applicable patients, it is this action that generates their initial TTG letter.

SEE ILLUSTRATION BELOW

Reporting Absence Procedure

Over the course of a year, there will be a number of unexpected absences amongst medical staff of all grades with most of these being related to sickness (ie not prospectively approved Leave). It is therefore important that we have a consistent and robust Sickness Absence Reporting System in place within the department as this is crucial for allowing arrangements to be made for covering clinical activities at short notice. For clarity, the reporting procedure to be followed is outlined below:

Reporting Absence Procedure

Any member of medical staff (ST2+) who needs to report an absence Monday-Friday, should do so by telephoning either Dr Woldman (rota coordinator, does not work Thurs), Dr Thomson (does not work Monday) or Dr Mackay (does not work Wednesday).

If you are unable to speak to one of the above people, please call Sally Kennedy (Directorate PA; Tel 0141-201-2235) who will pass on the information to an appropriate Consultant/Manager.

Messages should not be left on voice mail or with other wards or departments. Mobile phone text messages, Whatsapps or emails are also not acceptable.

If sickness absence is required during a weekend or if you take unwell during an overnight shift, please telephone the on-call Consultant.

Following a conversation with one of the above, you may be asked to phone in on a daily basis or an interval plan made for when further communication is required – this will depend on the nature of the medical condition. Staff on Sick Leave have an obligation to maintain contact/communication with their manager which is appropriate to their condition, so please keep us updated.

The above procedure for reporting Absences is important to follow, as failure to adhere to local absence reporting procedures for any member of GG&C staff may be dealt with under the Disciplinary Policy and Procedure. Absence which is not supported by medical evidence as required (see below); absence which has not previously been reported; absence which has not been authorised by the appropriate level of management or has not been communicated using the correct procedure as outlined above, will be deemed to be Unauthorised Absence.

Certificates

For absences between 3-7 days: staff need to provide written self-certification to Dr Woldman, Dr Thomson or Dr Mackay. This needs to be received within 7 days of the first day of absence.

For absences more than 7 days: a medical certificate is required. Please send the certificate to Sally Kennedy (Directorate PA, First Floor Administration Corridor, Maternity Block, QEUH). If a staff member does not return to work when the certificate ends then further consecutive certificates must be provided.

A final medical certificate confirming fitness to resume duties also needs to be sent in before or on the day of return to work, with advance communication being received confirming the proposed Return to Work (RTW) date.

Return to Work Discussion

There should be a RTW Discussion (undertaken by Dr Mackay, Woldman or Thomson). GG&C staff in most other disciplines will have a RTW Discussion following an absence of any length, and this should also apply to medical staff. It is primarily designed to help promote good standards of health, fitness and wellbeing and to provide appropriate support where needed. The RTW Discussion may be a phone conversation or an informal meeting depending on the scenario and work commitments on both sides (eg shift to be undertaken, location of duties etc).

In the unlikely event that a doctor has four sickness absences in a rolling twelve month period, then this would “trigger” an additional meeting. This is explained further in the GG&C Attendance Management Policy which can be provided to you should you so wish.

Musculoskeletal disorders (MSD)

Please find below a link to HR Connect information and guidance on supporting staff either absent with MSD or struggling at work with MSD:  Moving and Handling - NHSGGC

Protocols, Policies and Mandatory Training

StaffNet
How to Access Obstetrics & Gynaecology Guidelines
Crossmatched blood samples
Labelling specimens
Corporate and Role Specific Statutory and Mandatory Training Reqirements for Medical Staff
OASI
Sharps disposal
Obstetric patients with surgical problems


StaffNet

StaffNet, which is the intranet for NHS GG&C, issues important updates for the whole of GGC trust, in addition to information for specific sites eg QEUH campus. Citywide clinical policies can be accessed through this site, and also all the current documents relating to Human Resources. All computers should open to the StaffNet site when you access the internet. In particular, your attention is drawn to the current clinical guidelines relating to Obstetrics and Gynaecological management which should be read as soon as possible during this post. We would also bring to your attention recent obstetric guidelines on Active Management of 3rd stage in labour at Caesarean Section and use of a Fetal Pillow which are included as Appendices 4 and 5.

How to Access Obstetrics & Gynaecology Guidelines

Crossmatched blood samples

Elective Gynaecology Surgery

  • For women who are added to the Waiting list for surgery during an out-patient clinic appointment, please think ahead and request a Group and Save sample during the appointment.  The patient’s second sample will then be taken at the Pre-operative Assessment Clinic as usual.
  • For women who have their surgery arranged following tests or a phone consultation where it is not possible to take a sample prior to attending POA Clinic, then the first sample will be taken at POA with the second sample taken on admission.  This has the potential to delay surgery and relies on junior medical staff being available for POA as soon as the patient is admitted.  Admitting day staff should inform the On-call Gynaecology SHO if admission is before 0900, and the Ward 49 doctor after 0900.

Emergency admissions

  • All patients being grouped and saved should have their records checked by the doctor performing the test.  If there is no previous sample, then this should be communicated to the staff caring for the patient so that they are aware that a second sample would be required for a cross-match to be done.
  • If a cross-match is required urgently (eg in event of major haemorrhage or patient transferring direct to CEPOD from A&E or Gynaecology Emergency), a second sample should be taken straight away with two venepunctures by two different people and two requests sent.

Labelling specimens

  • Never take a sample from a ward patient who is not wearing an identification band
  • Never label a blood sample from the request form. Check the patient’s name, DOB and CHI from the identification band.
  • Never label samples away from the patient.
  • Never label or sign samples taken by someone else.
  • Never pre-label sample bottles

Corporate and Role Specific Statutory and Mandatory Training Reqirements for Medical Staff

All staff, regardless of role or work location, must complete the following statutory and mandatory modules upon entry to NHS GGC and throughout their employment.

These topics are:

Corporate requirements - all NHSGGC Staff:

  1. GGC 001 - Fire Safety
  2. GGC 002 - Health & Safety, An Introduction
  3. GGC 003 - Reducing Risks of Violence & Aggression
  4. GGC 004 – Equality, Diversity and Human Rights
  5. GGC 005 – Manual Handling Theory
  6. GGC 006 - Public Protection - Adult Support & Protection and Child Protection  
  7. GGC 007 - Standard Infection Control Precautions
  8. GGC 008 - Security and Threat
  9. NES  Safe Information Handling Foundation – Information Governance

Role Specific requirements – all Medical Staff:

  1. GGC 061 - Management of Needle sticks and Similar Injuries
  2. NES Scottish IPC Education Pathway Foundation – Prevention and Management of Occupational Exposure

Learnpro modules can be accessed by all NHSGGC staff by registering with Learnpro. Go to https://nhs.learnprouk.com/lms/Login.aspx and follow the registration instructions and when you are prompted for your identification number, please enter your payroll number. To update your details, please go to https://nhs.learnprouk.com/lms/Login.aspx, log into your account and follow the attached guidance on how to change your identification number to your payroll number. Ensure that you update your details on Learn Pro to GGC if you have recently been working outside this trust. Please note that if you have completed the current version of these modules in the last 3 year cycle, or 2 years for Fire Safety, on Learnpro or via the Acute Core Programme, you will not be required to redo them as your learner activity will be updated in your Learnpro record and you will be considered as compliant for that topic until renewal is due.

Monitoring - You are able to check your own progress via your Learnpro personal account. Organisational performance monitoring for your area will be undertaken by an SMT representative who is responsible for monitoring local statutory and mandatory training compliance. Dr Hardie and Dr Thomson will monitor your progress and we would expect to be able to see evidence of completion of these modules by September 2018. During the course of the year, you will also be given the opportunity to attend mandatory Evacuation Training. This will be incorporated into the rota when the dates for 2018-19 are released.

OASI

We are a recognised centre for use of the RCOG OASI care bundle. The aim is to reduce overall OASI rates through an increase in the use of standardised prevention practice. You will be trained in this at induction. Contact Judith Roberts, Fiona Hendry or Claire Rowan for more information (nhs/ggc email accounts). You can watch this video from the RCOG which summarises OASI and its use:

Sharps disposal

Please look at the updated tool box talks on management and disposal of sharps and reporting an incident. There is also an information leaflet on the importance of “near miss” reporting.

Sharps - NHSGGC

 

Obstetric patients with surgical problems

  • Surgical registrar contacts Obs reg to provide details of every pregnant patient admitted as an emergency including up to 6 weeks post-partum
  • “Outliers” board in Labour Ward will be updated with all current pregnant patients admitted acutely to surgery in QEUH.
  • Pregnant in-patients will receive an obstetric consultant review (consultant to consultant request or routinely in all IP stays over 24 hours). This will help lower the chances of delays in diagnosing acute pathology and help answer general obstetric queries.
  • The ward team will inform the obstetric registrar when every pregnant patient is discharged to allow removal of patients from outliers board, emergency clinic review of patients if not reviewed as an IP and arrangement of any other obstetric follow up.
  • Consultant to consultant referral of any obstetric patients causing concern for acute surgical pathology in the obstetric unit (includes post-partum and post-caesarean section patients with concerns regarding major wound complications).
  • Grade of initial surgical review will be determined by the Surgical Consultant.
  • Repeat referral for ongoing concern following initial review will mandate a Consultant review.
  • If a post-partum patient is transferred with acute surgical or wound-related complications, their care will be taken over by Surgery.
  • Note that a general surgical review is not a pre-requisite for referral to Tissue Viability.

(REFER TO DECT numbers on Contact Numbers/Paging list above).

Study Leave

All requests for study leave must be arranged prospectively and applied for through TURAS. The Training Programme Director, Dr K Brogan, is required to approve each application and the forms should be submitted more than one month in advance in order to be eligible for the claiming of expenses.

If you wish a period of study leave, please ensure that the dates are approved by Dr Woldman and study leave is granted by College Tutors before booking a course. Book early to avoid disappointment.

Educational Supervision

Each member of middle grade staff will be allocated an Educational Supervisor for usually a 12 month period. It is your responsibility to meet with your ES within the first 4 weeks of joining the hospital. An induction interview should review your current stage of training and set realistic goals for the first 6 month period. You should seek an interim review with your supervisor after 4 months to ensure that you are on-target. If you have any issues regarding your training, you should speak to your ES in the first instance. If the issues are not resolved or you do not feel able to discuss the matter with them, please feel free to discuss this with your College Tutor.

All new medical staff must complete the mandatory GGC on-line Clinical Induction Programme within 6 weeks of starting their new post http://glasgow-nhs.clinical-induction.co.uk - you should receive an email/information regarding this. The postgraduate department will be in touch with trainees throughout the year to ensure that they complete this. Trakcare training is also mandatory and will be arranged as part of your induction by the postgraduate centre.

Postgraduate Teaching

There is regional postgraduate teaching on Friday afternoons. These are shared between the PRM and QEUH.

Please check the GGC app for an up to date list of these.  Unless you are on-call or 2nd on, Friday afternoons are usually kept free for regional or local teaching. They are not a session so please check with the on-call team before leaving if teaching finishes early.

Attendance at teaching is compulsory unless on leave / on-call / nightshift / clinical commitment (there are some unfortunately) and a record of attendance is taken. Teaching is not “bleep-free”. It is your responsibility to ensure that you have notified the wards beforehand and checked that there are no outstanding patient reviews etc. to be done.

Junior medical staff will be expected to participate in teaching.

The unit’s multi-disciplinary Obstetric Risk Management and Perinatal Mortality Meetings are held on the last Tuesday afternoon of each month as part of the usual teaching session. The teaching programme also includes Combined Obstetric/Neonatal teaching, Obstetric drills, Gynaecology CPC Meetings and Grand Rounds.

Trainees will be expected to complete the K2 package (online CTG teaching) whilst working at QEUH. This will be a mandatory requirement before your educational supervisor will agree to sign off your ARCP form at the end of the year. Dr Woldman and Dr Thomson will spot check this throughout the year and email data regarding completion to all trainees 3 monthly. It is vital that all Obstetricians have evidence of engaging with annual CTG training in light of the volume of SCI reporting and Each Baby Counts. There is also information on Antenatal CTG Interpretation from PROMPT attached as Appendix 6. GGC Guideline is being developed regarding CTG interpretation.

It is also mandatory for all trainees to attend one PROMPT course during their time with us. These courses take place regularly during the year in QEUH. Dr Padma Vanga will contact you regarding this.

We  now have 3 laparoscopic simulators. All trainees should now have a login to Surgtrac. Please email Dr Woldman if you do not have access. There are variety of tutorials and assessments that need completed and we strongly encourage you to spend time on the lapsim to ensure you maintain up to date with your laparoscopic training, and to prove competency in theatre. We expect ALL trainees to have done some lapsim assessments before they come to theatre. Clinical supervisors will expect evidence of this.  There will be a prize and certificate at the end of the year for those that have the most lapsim assessments completed.

The Hospital Clinical Society presentations take place throughout the year from September online, usually Friday 1230-1330. The O&G department deliver one talk per academic term, and there is a £100 cheque for the best trainee presentation each term. This is an excellent opportunity to present your work to a large, interested audience. Please ask if you wish to be involved.

The Hospital Library is normally located on the first floor of the Teaching and Learning Centre, next to the link corridor, but currently has been displaced due to the use of the Teaching & Learning Centre by the Lighthouse Laboratory.

Its book collection on Obstetrics and Gynaecology can be viewed online and requests placed for materials to be sent to you. The library staff are currently working from the Victoria ACH Library and can be contacted Mon-Fri 0900-1700 on 0141-347-8885 or Ext 81216, [email protected] Additionally, requests for support with accessing ejournals, information skills training or literature search requests can be placed online via the Knowledge Services section of the eHelp portal.

Regional teaching is organised by the Deanery. These sessions are compulsory unless on-call or on leave. If you are having difficulty attending teaching, then speak to Dr Thomson/Woldman.

Labour ward Forum meets monthly on the second Thursday of the month at 1330 via. Please send agenda items and ideas to Judith Roberts or Mary Hannaway by email. Trainees are welcome to attend on an ad hoc basis.

If you want the opportunity to be involved in formal undergraduate teaching (eg Core Teaching Block) then contact Dr Simone Vella (ggc email).

Security Information

Please be mindful of security at all times. The wards are entered using your security pass and you will find that this is used to gain access to all areas of the QEUH. Do not wedge security doors open or allow strangers into clinical areas without knowing their exact purpose. Please remember to ensure that the door to the reception area, between ground floor emergency gynaecology and the day ward, is kept locked overnight by pressing F after you have closed the door. This is repeatedly being left open after the cleaners have locked up, either by staff using the changing room or by staff using the waiting room as a rest area. This could leave staff arriving in the morning very vulnerable if an unauthorised person is able to access specific areas within the unit.  Please also be aware of the maps around the campus regarding any suspected terrorist threat.

There is a Junior Doctors’ Room in the Administration Corridor (1st Floor), Maternity Building, QEUH. This is unlocked therefore do not leave anything valuable here. Staff lockers are available in theatre changing areas but please do not occupy these unless covering that clinical area.

Staff lockers are also available for use by all staff in the Male and Female Changing Rooms. These operate by use of a combination code (ensure door is open and row of numbers on combination is horizontal/press and hold silver button on right side of black combination lock/while pressing and holding silver button, turn the numbers on the dials to the 4 digit number combination of your choice, in line with the raised black lines/release the silver button on the side/turn the black combination lock mechanism to the right/close the door of the locker and turn the black combination lock mechanism to the left/ensure the door is secure/double check your 4 digit number before scrambling all number dials/scramble all number dials/ to open your closed locker, turn the number dials to your chosen 4 digit number in line with the black lines, turn the black combination lock to the right and the door should be able to be opened). The female changing room is located beside the Seminar Room and Medical Records (ground floor), and includes showers and toilets. The Male Changing Room is in the night entrance corridor and is labelled as Preassessment 2 for security reasons (code for the door is C1650B). There is not a shower or toilets in the male room, but there is an easily accessible toilet next door and showers in the Theatre Changing Rooms.

There are facilities available to all junior medical staff in the main hospital, QEUH. This accommodation is situated on the third floor of the main hospital stack and Admin Office block. On level 3, it comprises a Junior Doctors Mess (containing microwave, fridge, dishwasher, 2 large couches, 1 PC with desk, TV, 20-30 chairs, water machine and hot water urn), Junior Doctors Hot Desk Room (8 PCs with chairs and a printer) and a Junior Doctors Study Room (4 PCs, chairs and printer). Within the Admin Office block of the main hospital, the areas next to the kitchen on Floors 1 & 2 are for junior doctors. There are hot desks with PCs and docking stations if they have a laptop. Printers are in the printer hub rooms on each floor.

Look at the following link regarding action plans for major incidents and adverse weather: [email protected]

Datix, Risk Management & SAER Reporting

The reporting of incidents forms part of the Risk Management Strategy and should be recognised as a means of improving the quality of patient care and minimising risk. The open reporting of even minor incidents allows weaknesses to be identified in the system, customs and practices changed and retraining of staff where necessary. Investigation must be balanced with the need to counsel and support staff through any potential or actual incident, and to ensure appropriate support is given.

We are all increasingly being asked to provide statements for SAERs. Being asked to provide a statement does not mean that you are being blamed. These must be seen as learning events. We are here to support you if you are struggling after being involved in an incident. You can speak to your ES or College Tutor at any time and Dr Mackay/Richmond is very happy to support you in any way. There is a SAER toolkit available on the hospital intranet and a Root Cause Analysis (RCA) Learnpro package for those who feel this would benefit them.

Details of incidents relating to both Obstetrics and Gynaecology should be submitted via the on-line reporting system, Datix. This can be accessed via the intranet. Risk Management is an important part of improving clinical care, and all staff should be encouraged to submit forms where appropriate. Trigger Lists are attached as appendix 8 at the end of your induction pack.

Risk Management Meetings are open to all staff. Please contact Dr Judith Roberts (Clinical Risk Obstetric Lead), Dr Aradhana Khaund (Clinical Risk Gynaecology Lead) or Avril Marshall (Risk Midwife) for further information.

Audit

You are actively encouraged to participate in audit related activities while you are here. The Women and Children’s Directorate is keen to support quality improvement (QI) audit projects. A number of areas of practice have been identified in various governance or risk management settings as being important. Support is available from clinicians and clinical effectiveness for audits ranging from advice to half and full day QI audit training which is currently free and useful for CPD. Dr Padma Vanga is the Lead Clinician for QI in GG&C.

Please ensure that Dr Richmond/Vanga are aware of current audit activity here: audit name, aim, primary clinician, supervisor, number of patients involved, start date, planned finish date and whether this is a QI project.

Please also remember that all research in Gynaecology / Urogynaecology needs to be registered with the Clinical Governance Group by involving Dr Ros Jamieson (Clinical Director for Gynaecology).

Please ensure that you adhere to Data Protection Standards when accessing electronic patient records for audit as this is monitored. In order to provide the assurances that the Clinical Governance Group need to give that audits are relevant and overseen appropriately, Lead Clinicians are again to supervise this in each unit.

 

Workplace behaviour

Undermining behaviour is not acceptable within the NHS, no matter what your position or occupation is. We firmly believe in transparency and want to highlight that this unit has received red flags regarding workplace behaviour from the Trainee Evaluation Form in 2018. It is top of our priorities to tackle any problems. We are very concerned that the measures we had in place locally to facilitate reporting of these behaviours have failed to capture these problems previously.  

The RCOG Workplace Behaviour Champion for the West of Scotland is Dr Kate Patrick, Forth Valley ([email protected]). We have 2 locally appointed champions who are Dr Mandy Reid, Consultant Obstetrician ([email protected]) and Dr Justine Nanson, Consultant Anaesthetist ([email protected]). They are more than happy for you to contact them directly if you have experienced or witnessed unacceptable behaviour. You can also speak to your College Tutors or Clinical Lead.

You may wish to visit the document “Dignity at Work” which can be found on the intranet or contact Human Resources directly. The work of the Promoting a Positive Culture short-life working group has been ongoing over the last few years at QEUH, and some of these projects are reaching their final stages. A Newsletter with a specific slant towards celebrating success and sharing good practice in the unit will be published 3 monthly. “STOP IT!” laminated workplace behaviour posters are now on display in the junior doctors room and these will be displayed in all clinical areas.

We have developed phrases that can support good communication between staff in clinical areas, especially in situations of stress or when communications breakdown is evident. We are in the process of launching these phrases in labour ward, but the aim is for these phrases to be used in all clinical areas.  For ward/outpatient areas: “TIME OUT” can be used in situations of communication breakdown/rare episodes of dispute between colleagues. It signals that the conversation may need to be moved if appropriate to be away from the patient or to begin a more constructive conversation. For theatres: “STERILE THEATRE” can be used when chatter is becoming distracting in theatre or when the clinical situation means that all team members need to be focused and communicating as one team.

Staff Uniform and Dress Policy

In summary:

MASKS AT ALL TIMES UNLESS EXEMPT

Badge – Visible name and photographic identification badge to be worn at all times. No lanyards.

Hair/eyelashes – Hair tied back off face and up if it is shoulder length or longer. Hair should not touch collar and ponytails above collar. No false lashes.

Jewellery – no jewellery except a single plain ring. No wrist watches.

Nails – No nail varnish, articial fingernails or nail extensions.

Sleeves/ties – Bare below the elbows, sleeves rolled up. Ties preferably not worn or tucked inside shirt. Labour ward can issue you with an NHS fleece to be worn over blues but must be removed when performing clinical care/procedures.

No white coats

Theatre – scrubs, change your clothes if contaminated with body fluids or blood, fastened/tied clean theatre gown if moving from one theatre department to another, no theatre clothes in canteen/outside building, no open-toed shoes, hair tucked into theatre cap, remember visors are available.

Appendix 1: Structured Obstetrics Handover Proforma

Appendix 2: Consultant Attendance on Labour Ward

General Points

  • There should be no hesitation to call Consultants to the Labour Ward area.
  • If called to attend the Consultant must do so within a reasonable time. If they do not attend this should be documented.
  • In the non-urgent situation, consider whether you need Attendance or Discussion. Have ALL available information, including the case notes to hand, BEFORE you phone. In most situations it is not appropriate to inform a patient what you plan to do before you call: the Consultant should not be seen as a "rubber stamping" exercise.

The following* are basic indications for consultant attendance to labour ward.

They are NOT inclusive.

*denotes that when an ST7 is on-call, the attendance of a consultant for these indications is at the ST7’s discretion unless the consultant has specifically indicated otherwise. The Consultant should be informed of on-going problems and be asked to attend early if necessary

  • Attendance requested by Obstetrician of any grade or Senior Midwife
  • Attendance requested by Consultant Anaesthetist / Neonatologist
  • When LW staff "under significant pressure": co-ordinators responsibility to call.
  • If a second emergency theatre is opened.
  • Unexplained maternal collapse
  • Unexplained severe maternal compromise
  • Any woman who requires transfer to ITU
  • Severe pre-eclampsia*
  • Eclampsia*
  • Severe antepartum haemorrhage*
  • Suspected / Actual Uterine rupture
  • Any caesarean section after intrauterine death has occurred.
  • Caesarean section for major placenta praevia.
  • Any caesarean section for severe fetal abnormality*
  • Caesarean Section <32 weeks*
  • Previous classical caesarean section*
  • Previous laparotomy for pathology anticipated to lead to difficult entry / access*
  • Any laparotomy for non-Obstetric pathology (includes bladder trauma)*
  • Full dilatation caesarean section*
  • Trial of forceps / vacuum*
  • All Rotational Forceps*
  • Vaginal breech delivery*
  • Failed assisted delivery*
  • Shoulder Dystocia*
  • Planned Vaginal Twin deliveries.*
  • Massive post partum haemorrhage involving significant resuscitative measures*
  • Third / Fourth Degree Tear*

Commonsense must prevail: if in doubt, shout!

Many Obstetric problems can be anticipated and a management plan documented in the notes by a Consultant. The Consultant on call should be made aware of unusual or complex cases and/or management plans.

Appendix 3: Winscribe Dictation Codes

CONSULTANT

WINSCRIBE DICTATION CODE (USERNAME/PASSWORD)

Dr Hassan Ali

1890

Dr Laurie Anderson

1878

Dr Stein Bjornsson

1881

Dr Janet Brennand

1894

Dr Janice Gibson

1896

Dr Karen Guerrero

1891

Dr Catriona Hardie

1880

Dr Chris Hardwick

1905

Dr Robert Hawthorn

1882

Dr Aradhana Khaund

1906

Dr Marie Anne Ledingham

1892

Dr Vanessa Mackay

1904

Dr Stewart Pringle

1879

Dr Mandy Reid

1898

Dr Jane Richmond

1893

Dr Judith Roberts

1889

Dr Aparna Sastry

1847

Dr Karina Datsun

1887

Dr Christina Taggart

1888

Dr Lynne Thomson

1907

Dr Veenu Tyagi

1899

Dr Padma Vanga

1899

Appendix 4: QUEH Obstetric Guidelines - Active management of third stage in labour

Appendix 5: Guideline for use of the Fetal Pillow

INTRODUCTION 

Caesarean section at full dilatation can be difficult if the fetal head becomes impacted in mother’s pelvis. Difficulties in disimpacting an engaged fetal head can often delay the delivery of an already compromised fetus and may cause fetal injuries. There is a higher risk of the new born admission to the NICU. Caesarean section at full dilatation also carries much higher maternal morbidity. There are higher incidences of uterine incision extensions, injury to uterine vessels, increased trauma to the urinary tract, post-partum haemorrhage and increased operating time. There is also increased maternal blood transfusion, sepsis, ITU admission and increased length of hospital stay for the mother.

WHAT IS A FETAL PILLOW?

Fetal pillow is a disposable soft silicon balloon device which is inserted into the vagina and placed beneath the head and then inflated to help lift the fetal head and dislodge it from the pelvis before commencing the caesarean section. Fetal pillow makes the delivery of the head easier and reduces the risk of complications for the mother and baby that occur when a caesarean section is carried out at full dilation.

INDICATIONS FOR USE: Caesarean section –

  • After a failed attempt at instrumental delivery
  • Second stage Caesarean section with deeply impacted head -  presenting part at or below the level of the ischial spines
  • Clinical judgement must be used regarding the likelihood of difficult delivery , and vaginal examination must be undertaken by a senior obstetrician ( Consultant or ST7) 

INSTRUCTIONS FOR USE

  • Patient to be in lithotomy position
  • The device is taken out from the pack onto the sterile trolley.
  • Deflate the silicon balloon completely by using the 60 ml syringe in the pack
  • Apply liberal amount of obstetric cream on the deflated balloon before inserting it inside the vagina
  • Hold the deflated balloon device like folded wings between the thumb and the finger, making sure that the tube attachment is at the superior end
  • Insert this in the vagina and place it behind the fetal head
  • Make sure the device lies flat, with the deflated surface in direct contact with the fetal head and push it posteriorly towards the sacral bone of patient.
  • Place patient’s legs flat on the operating table
  • Inflate the balloon using the 60 mls syringe to push in 180-200mls of normal saline through the two way tap in the tube.
  • Close the tap so that saline does not escape out
  • Commence lower segment Caesarean section
  • Make a curvilinear incision on the upper part of lower segment of the uterus just beneath the vesico-uterine peritoneal reflection to deliver the baby
  • Deflate the balloon by opening the two way tap and saline to be drawn out using the 60 ml syringe- done by midwife/ HCA after delivery of baby,
  • Operating surgeon to carefully remove the deflated device by hooking a finger on the plate and to pull it out gently before cleaning the vagina after Caesarean section.

CONTRAINDICATIONS: Presence of active genital infection

WARNING:

  1. Do not use air to inflate the balloon.
  2. Do not inflate the balloon more than 200 mls

Please complete evaluation form for each fetal pillow used – same as before during pilot .

Appendix 6: Antenatal CTG Interpretation

(Taken from PROMPT (Practical Obstetric Multi-Professional Training) course manual second edition (2013))

Antenatal CTG Interpretation

Although the evidence for EFM use antenatally is based on only a few small studies (four trials and 1588 women in total) from the 1980s, when CTG monitoring was just being introduced into routine clinical practice, a systematic review in the Cochrane Database of Systematic Reviews did not confirm or refute any benefits for routine CTG monitoring of ‘at risk’ pregnancies. 35

In clinical practice, there are a variety of antenatal indications for undertaking a CTG from 26 weeks of gestation onwards. The presence of a normal fetal heart rate pattern (i.e. showing accelerations of fetal heart rate coinciding with fetal movement) is indicative of a healthy fetus with properly functioning autonomic nervous system.

The RCOG Green-top Guideline on the management of reduced fetal movements recommends that interpretation of the antenatal CTG fetal heart rate pattern can be assisted by adopting the NICE classification of fetal heart rate features as indicated in their intrapartum care guideline. 36 Therefore, as is the case when classifying intrapartum CTGs, it would seem reasonable to use a structured pro forma to ensure the use of consistent terminology. However, using an intrapartum pro forma is not appropriate as it acknowledges that some decelerations are acceptable in labour, which clearly cannot be the case for antenatal CTGs where there are no contractions. It is also important to remember that the reason for performing an antenatal CTG is particularly relevant when determining any action to be taken, as is the gestation and status of membranes.

An example of an antenatal CTG pro forma that may be used for the classification of CTGs in non-labouring women only:

Antenatal CTG
Pro forma

Reassuring

Non-reassuring

 

Baseline rate
(bpm)

110-160

Rate:

 

Less than 109   Rate:

Comments:

More than 161 Rate:

Sinusoidal pattern for  10mins or more

N.B rising baseline rate even within normal range may be of concern if other non-reassuring features present.

Variability
(bpm)

5 bpm or more

Less than 5 bpm for more than 40 minutes

Comments:

Acceleration

Present

Non for 40 minutes

Comments:

Decelerations

None

Unprovoked deceleration/s

Comments:

Decelerations related to uterine tightening (not in labour)

Opinion

Normal CTG

(all features reassuring)

Abnormal CTG                        
(1 or more non-reassuring features)

 

 

Maternal pulse:

 

Membranes ruptured:

Y/N if yes, date and time:

Liquor colour:

 

Gestation (wks):

Reason for CTG:

 

 

Action: (an abnormal CTG requires prompt review by experienced obstetric/senior midwife)

 

 

Date:

 

Time:

Signature:

Print:

Designation:

               

Antenatal CTG classification

Normal:  A CTG where all four features fall into the ‘reassuring’ category.

Abnormal:  A CTG with any non reassuring features (including any decelerations).

When an abnormal CTG is identified, it should be reviewed by an experienced obstetrician as soon as possible (within 30 minutes) to make a clear individualised action plan, to include:

  • Other tests to be performed (ultrasound scan for growth, Doppler studies, etc.)
  • A specified time for the next obstetric review
  • Consideration for expediting birth

Appendix 7: DATIX Obstetric & Gynaecology Trigger Lists

Obstetric Trigger List

Obstetrics Baby

Obstetrics Mother

Obstetrics - Processes

Undiagnosed Significant Abnormality

Anaesthetic Complications

Delay in response to a call for assistance

Apgar less than 5 at 5 mins

Failure to give anti D

Obstetric conflict over case management

Meconium Aspiration

Bowel/Bladder Complications

Potential Complaint

Undiagnosed Breech

Unexplained Maternal Collapse

Poor Communication - written or verbal

Cord PH Venous <7.1

Cord PH Arterial <7.05

Iatrogenic Cord Prolapse

Inappropriate Delegation

Neonatal death

Maternal death

Equipment Issue

Undiagnosed intra-uterine growth retardation

Delay in over 30 minutes for decision to delivery for LSCS

Guideline/Protocol Violation

Unexpected term admission to neonatal unit

Shoulder Dystocia

Unlabelled Infant

Cardiac massage or medication 10 mins of birth

Fulminating PIH/Eclampsia

 Staffing

Neonatal seizure in term baby

Failed Forceps/Ventouse

 Needlestick injury

Intrapartum still birth

Laparotomy/Hysterectomy

 Unavailable Health Record

Birth trauma

ICU Admission

 

Fetal laceration at LUSCS

Acute Fatty Liver

 

Stillbirth >22 weeks

Haemoglobin less than 80g/litre post delivery

 

 

Miscarriage after amniocentesis

 

 

Over 1 hour for 2nd stage multipara

 

 

Post Partum Haemorrhage >1500ml

 

 

Pressure Sores

 

 

Over 3 hours for 2nd stage primagravida

 

 

Prolonger labour over 18 hours established

 

 

Post Natal Readmission

 

 

Uterine Rupture

 

 

Retained Swab

 

 

3rd/4th Degree Tear

 

 

Thromboembolism

 

 

Pulmonary Embolism

 

 

Blood Transfusion > 2 units

 

 

Unplanned delivery outside labour ward

 

 

Vulval Haematoma

 

 

Perineal/Abdominal wound complications

 

 

Medication Error

 

 

Return to theatre

 

Gynaecology Trigger List

ACS hyperstimulation

Unexpected readmission

Anaesthetic complications

Blood loss >500ml

Potential Service User Complaint

Conflict over case management

Unexpected patient death

Delayed diagnosis

DVT/PE

Failed procedure e.g. TOP/Sterilisation/Laparoscopy

Post op GI problems

Post op GU problems

Incorrect information IDL

Intra-operative injury to structures e.g. perforated uterus

Admission to ITU

Medication Error

Missed diagnosis e.g. ectopic pregnancy, malignancy

Omission of planned operative procedure/ consent

Post op wound problems

Protocol/Guideline violation

Retained foreign body e.g. swab/instrument

Unplanned return to theatre

Wrong site surgery

Appendix 8: The Queen Elizabeth University Hospital Maternity Unit - Our Values

  • We are a WELCOMING unit and aim to
    • acknowledge you when you come into an area
    • make you feel welcome, smile and put you at ease
  • We are a RESPECTFUL unit and aim to
    • be polite
    • listen and acknowledge each other
    • express gratitude
    • value the contributions made by each other
    • respect each other’s opinions 
  • We are a PROFESSIONAL unit that
    • puts patients first
    • works as a team and supports each other
  • We are RESPONSIBLE for
    • the safety of our patients, families and staff
    • our behaviours and actions
    • our development
  • We are an ASPIRATIONAL unit that
    • delivers continuous improvement and innovation
    • measures and shares outcomes
    • celebrates success

Appendix 9: Labour Suite Surgical Brief Checklist

Last reviewed: 25 July 2022

Next review: 01 July 2023

Author(s): Dr. Sarah Woldman, Dr Lynne Thomson

Version: 2