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Chelsea and Westminster Hospital

Information Governance Team

Chelsea Harbour

Harbour Yard

Unit 111, 1st Floor

London

SW10 0XD

www.chelwest.nhs.uk

Date: 01 December 2015

Our Ref: FOI 2015-507

Dear Requester

Thank you for your information request received by us in letter format on 15 October 2015

This request has been handled under the Freedom of Information Act 2000.

Please note that Chelsea and Westminster Healthcare NHS Foundation Trust merged with West Middlesex University Hospital in September 2015, for this reason our response covers both sites.

Your request

1. It was noted that there was no system in place in the Simpson Unit for monitoring motor block

and confirming that a regional anaesthetic is wearing off. please provide details of the system

that is currently in place to detect these

2. There was a delay in referring the Claimant for urgent radiology to Charing Cross Hospital. We

request information pertaining to the procedure which now exists for urgent transfers 3. In relation to observation charts, we seek information as to whether Bromage score is being

monitored and recorded

4. We request details regarding the training which you have in place for employees utilising the

Bromage score.

5. We also seek information regarding the extent to which your employees are knowledgeable

about monitoring blocks and alerting medical staff where appropriate.

Our response:

1. Response: We are using a motor block scoring a copy is attached. It is currently being used as a

singled assessment document in conjunction with the MEWS chart. The assessment is part of the

neurological deficit guideline which has been added to the Simpson unit guideline.

2. Response: We are not able to comment about your client’s allegations. We can confirm that, for

patients with a neurosurgical emergency (eg suspected epidural haematoma or abscess) contact is

made to the on call Consultant Neurosurgeon at Charing Cross Hospital immediately. Please see

attached Obstetric Neurological Deficit after Central Neuraxial Blockade Guidelines, para 8.2.1

3. Response: We use the ‘motor block score’ rather than the Bromage score, to bring us in line with

what is already used throughout the rest of the hospital for non-obstetric patients undergoing central

neuraxial blockade.

We have the obstetric neurological deficit neuraxial Blockade Guideline with pathways that the

anaesthetist will follow if any concerns regarding the motor block. This guideline has been live since

November 2014. The unit does record and monitor the score from the motor block score.

4. Response: All Simpson unit staff have been trained by the lead midwife and half of them have

attended the Simpson unit study day with a lecture on Motor block by an anaesthetist. We are running

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a Simpson unit update day (anticipated to be held yearly, there will be a refresher on motor block

scoring). Training for Simpson Unit nurses will be help in April 2015

5. Response: in May 2015 organised a study day for the Simpson unit nurses that included motor block

assessment and regional anaesthesia. The presentation was done by one of the maternity

anaesthetic registrars. The training involved explanation of the motor block scoring to whom when

and why to escalate. Also included what to expect when you escalate and introduction to obstetric

neurological deficit after central neuraxial blocade guidelines.

9.5 Monitoring of women after regional anaesthesia

9.5.1 All women who have had regional anaesthesia for any reason should be monitored using the

motor block chart (Appendix 3). This is in addition to the vital signs measurements outlined above.

9.5.2 Motor block should be recorded on admission to Simpson Unit and every hour thereafter until

the score is recorded as 0.

9.5.3 The anaesthetic registrar should be contacted immediately if the score does not decrease over a

2 hour period (ie 3 hourly measurements) or if the score increases at any point. This could be a sign of

an emergency and the anaesthetist must therefore be contacted without delay.

If you are not satisfied with this response

If you are not satisfied with how your request has been handled then please either

1. Respond to this email and we will review our answers and get back to you or

2. Write directly to:

The Chief Executive Chelsea and Westminster Hospital NHS Foundation Trust 4 Verney House 1B Hollywood Road London SW10 9HS

If, after we have addressed your complaint, you remain dissatisfied with how we have responded, you are entitled to appeal to the Information Commissioner at:

The Information Commissioner's Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF.

Telephone: 08456 306060 or 01625 545745

Website: www.ico.org.uk There is no charge for making an appeal. Re-use of information and copyright

You are free to re-use the information contained in our response under the terms of the Open Government Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

You must take into account the exemptions and any other conditions such as the non-endorsement condition below

This licence does not grant you any right to use the Information in a way that suggests any official status or that Chelsea and Westminster Hospital NHS Foundation Trust, the Information

Provider and/or Licensor endorse you or your use of the Information

Further information can be found at:

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http://www.opsi.gov.uk/advice/psi-regulations/index.htm

Yours sincerely

The Information Governance team

Chelsea and Westminster Hospital NHS Foundation Trust Email: foi@ChelWest.nhs.uk