© 2004-2007 Grey Bruce Health Network

Education Workshop (click to go to the desired section)

Introduction to Workshop/Instructions Evidence-Based Care Program C-Section Pathway Workshop

Caesarian Section

© 2004-2007 Grey Bruce Health NetworkIntroduction

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 ProgramThese 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

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 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

There are 2 sets of pre-printed orders for this pathway package: (No C-Section Orders)

Newborn orders

Newborn Circumcision orders

These orders can be found on the unit or on the GBHN website gbhn.ca

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© 2004-2007 Grey Bruce Health NetworkPatient Materials 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.

There are 4 pieces – “Let’s Grow a Healthy Baby”, “Community Resources for Parents” order from Public Health Unit at (519) 376-9420 x 433, and “Hearing Screening for your New Baby” Hearing Foundation at 866-HEAR-YOU) Back To Sleep (613) 954-5995 or visit the website at: www.hc-sc.gb.ca/hppb/childhood-youth

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© 2004-2007 Grey Bruce Health Network

Caesarian Section Clinical Pathway

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

The first page of the pathway covers Postpartum (3-24hrs) 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

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.

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

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.

This pathway is a day-style pathway, and follows the baby’s stay for the 48 hours in hospital.

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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© 2004-2007 Grey Bruce Health NetworkEnd of Caesarian Section

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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© 2004-2007 Grey Bruce Health NetworkSimulationTry 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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© 2004-2007 Grey Bruce Health NetworkSimulation Cont’d Our sample patient Nancy is pregnant and

has arranged for a hospital visit and pre-admission 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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© 2004-2007 Grey Bruce Health NetworkSimulation Cont’d 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/A2. Breastfeeding initiated within 1st hour postpartum □ Met □ Not Met □N/ADo 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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© 2004-2007 Grey Bruce Health NetworkSimulation Cont’dThe first page of the pathway is the rest of the first postpartum day(3-

24hrs). 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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© 2004-2007 Grey Bruce Health NetworkSimulation Cont’dThe 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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© 2004-2007 Grey Bruce Health NetworkSimulation Cont’dOn 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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© 2004-2007 Grey Bruce Health NetworkSimulation Cont’dAt 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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© 2004-2007 Grey Bruce Health NetworkNewborn Clinical PathwayOnce 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-birth2. Breastfeeding assessed using latch assessment

tool

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© 2004-2007 Grey Bruce Health NetworkSimulation Cont’d

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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© 2004-2007 Grey Bruce Health NetworkCaesarian Section Quiz

1. What are the inclusion/exclusion criteria for this pathway?

2. What patient education materials are used for this pathway? When are they handed out?

3. What is the Breast/Latch Assessment tool and how is it used?

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© 2004-2007 Grey Bruce Health Network

Answers: Caesarian Section Quiz1. What are the inclusion/exclusion criteria for this pathway? This pathway is used for

all women who deliver via caesarian section .2. 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.

3. 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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