A DesaiG SinghR ChoudharyB KapoorS Thacker

CNST Audit

11/06/2010

Why was the audit done?

What was monitored?

How was the data collected?

What are the findings?

Summary

Recommendations

Outline of presentation

CNST requirements• Show approved documentation• Show it is implemented• Show it is monitored

Audit• Use the approved documentation• Monitor its implementation

Introduction

Guidelines

Induction of labour Prolonged pregnancy Previous caesarean section

Maternal observation – during induction Fetal observations – during induction Process for dealing with maternal requests

Review 1% of cases for 1 year

Requirement of CNST (Level 3)

1) Prior to induction (prostin)

2) During Induction – 1st 6hrs

3) During induction – 2nd 6hrs

4) Post 12 hrs

Monitoring - Stages

Monitoring – prior to induction

Monitoring – during 1st 6hrs

Monitoring – during 2nd 6hrs

Monitoring – after 12hrs

Information Sources

Collection Form

Reason-Post term-Previous c-section

Induction Method-Prostin-ARM-Cook’s Catheter-Foley’s Catheter

Fetal Assessment-Auscultation-Movement-Both

Total number of cases = 40

Case Notes Reviewed

Reason for Induction

Parity

Gestation

Risks Explained

Membrane Sweep

Method of Induction

Pre Induction CTG

Observations – Admission

Maternal Examination

ARM on Admission

During 1st Prostin (0-6hrs)

Fetal Assessment Observations

Post 6hrs Prostin CTG

All Prostin Patients Pre 2nd Prostin

Post 6hrs Prostin - Assessment

ARM post 6hrs prostin

Post 6hrs – Pre 2nd Prostin

During 2nd 6hrs – not ARM

Fetal Assessment Observations

During 2nd 6hrs – 2nd Prostin only

Fetal Assessment Observations

Post 12hrs - Assessment

ARM post 12hrs

Prostin Needed

Delivery Outcome

Reason for induction Method of induction

CTG Stickers missing in notes

Summary of findings

35% had risks explained

35% had risks explained

98% had assessments

98% had assessments

92% had CTG92% had CTG

88% had assessments

88% had assessments

31% had regular observations

31% had regular observations

80% had CTG80% had CTG

80% had assessment

80% had assessment

~50% had maternal assessment

~50% had maternal assessment

60% had fetal assessment

60% had fetal assessment

78% had fetal assessment

78% had fetal assessment

20% had regular observations

20% had regular observations

80% had assessment

80% had assessment

1) Risks explained to mother needs documentation on

induction prescription form

2) Fetal assessments need to noted regularly after

administration of prostin

3) Maternal observation and abdominal examination

needs to be repeated before administration of prostin

4) CTG stickers must be include in the notes

5) Re-audit before end of November

Recommendations