transfer of an ill obstetric’s patient
TRANSCRIPT
TRANSFER OF AN ILL OBSTETRIC’S PATIENT
GOALS..
1. To learn proper ways to transfer an ill patient2. To ensure patient safely arrive in tertiary centre
INTRODUCTION
Sarawak is the largest state in Malaysia with a land mass almost equal to Peninsular Malaysia
CHALLENGES..1. TOPOGRAPHY 3. TRANSPORTATION
2. DISTANCES 4. LOGISTIC
INTER-HOSPITAL TRANSFER OF AN ILL OBSTETRIC PATIENTS POSES AN ADDITIONAL RISK TO THE PATIENT
DISTRICT HOSPITALS SARAWAK GENERAL HOSPITAL
1.DECISION TO TRANSFER
EARLY AND APPROPRIATE REFERRAL Early referral O&G specialist
DISTRICT MO BUDDY SPECIALIST HEALTH CENTRES without MO --> SPECIALIST
Occasionally simultaneous referral to other specialties may be necessary (eg:anaesthetist/ physician/ surgeon)
RISK OF TRANSFERRING? The decission to transfer patient in remote parts may
be decided on the risk involved in transferring (eg:night transfer)
O&G specialist may decide against transferring the patient or delay the transfer till the next day if the risk of transfer is higher than managing the case in the referring centre
2. STABILIZATION BEFORE TRANSFER
Ensure the patient is stabilised as best as possible prior to transfer IV lines/ branula IV infussion / bloods
Medications- anti HPT, MgSO4, Inotropes Oxygen support/ intubation In PPH- may need Bakri baloon
THE SPECIALIST SHOULD PROVIDE THE APPROPRIATE INSTRUCTIONS OR GUIDANCE
TO THE REFERRING DOCTOR/ NURSE
HASTY TRANSFER OF AN UNSTABLE PATIENT MAY CAUSE MORE HARM !!!
3. MODE OF TRANSPORTATION
The following needs to be considered when deciding on the best mode of transportation
a) Urgency of transferb) Condition of the patientc) Availability of ambulance/ other mode of transportd) Distance and estimated transit timee) Time of day & weatherf) MEDEVAC is an option but enquire first if it can respond
quickly enough
CHALLENGES IN DISTRICT !!!
LAND TRANSPORTATION Distance from the referring centre to tertiary
hospital
Condition of road
Availability of transport- ambulance or 4WD
Weather
AIR TRANSPORTATION MEDEVAC- Decision should be discussed with O&G specialist JKNS- Considerations include:1. Severity of the cases2. Availability of the helicopter3. Weather
LOCAL KNOWLEDGE IS ESSENTIAL!!
MO/ MEDICAL STAFFS POSTED TO REMOTE CLINICS OR
HOSPITALS SHOULD LEARN ABOUT THE AREA WHERE THEY ARE SERVING AND FIND WAYS
OF QUICKLY AND SAFELY TRANSPORTING THEIR PATIENTS
!!
LUNDU
BAU
SERIAN
SIMUNJAN
SRI AMAN
BETONG
KUCHING DIVISSION
1. BAU (45MINS)2. LUNDU (1 1/2H)3. SERIAN (45
MINS)4. SIMUNJAN (3H)5. SRI AMAN (3H)6. BETONG (5H)
SARATOK
SARIKEI
MUKAH
KAPIT
DARODALAT
SIBU DIVISSION
1. SARATOK (45 MINS)2. SARIKEI (1H)3. DALAT (1 1/2H0)4. DARO (1 1/2H5. MUKAH (3H)6. KANOWIT (1H)7. KAPIT (3H)
KANOWIT
BELAGA
BINTULU DIVISSION
1. BELAGA (3H)
LIMBANG
LAWAS
MARUDI
MIRI DIVISSION
1. MARUDI (3H)2. LIMBANG (4H)3. LAWAS (5H)
4. DRUGS & EQUIPMENT
Ensure the ambulance or transport have the required resuscitative equipments that is in good working order (availability of oxygen tank)
Ensure the staff escorting the patient knows how to operate the resuscitative equipments
Ensure the appropriate medications (eg:MgSO4, parenteral anti-HPT, sedatives, muscle relaxants) which are needed should be prepared in prefilled syringes
Crossmatch blood products to bring along if indicated
If the patient is intubated ensure the Oxylog is functioning or adequate oxygen tanks to ensure the oxygen supply is adequate
NG tube is inserted to avoid aspiration during transfer
5. PERSONNEL
Ensure that the relevant personnel are alerted early (eg:ambulance driver, escorting MO/SN, blood bank staffs)
In fact, obstetric drills may include scenario involving patient transfer
All escorting staff should have at least accreditation in BLS and ideally passed SALSO
They must be able to recognise and address any deterioration They must be familiar with drugs and equipment involved
during transfer
6. HANDING OVER
This should be done systematically throughout all levels
- Escorting MO Referral centre MO/ Specialist- Escorting SN/ MA Referral centre SN Proper communication & documentation is vital
CHECKLIST BEFORE DEPARTURES
1. INTUBATED PATIENT- Oxylog functioning- Adequate O2 supply- ETT anchored- Suction machine- Nasogastric tube- Oropharyngeal airways - High flow mask/ ambubag- Drugs-Muscle relaxant and
sedation
2. EQUIPMENT/ MONITORING
- SpO2/BP monitor battery charged
- Infusion pumps charged- Resuscitation bag complete
3.MEDICATIONS- IV MgS04- Anti- HPT- Inotropes- Crystalloids or
Colloids- Anti-emetic
4. BLOOD PRODUCTS- Packed cell- Whole blood
5. OTHERS-Case notes/ films/ charts-Emergency contact/ Relative
informed
Obstetric Emergency Retrieval Team - To retrieve ill cases from clinics, district or private
hospitals and bring them back to the specialist hospital
AIM- To provide assistance in the management of obstetric emergencies in other
health centre & improve management of very ill patient during transfer to tertiary hospital
BENEFITS- O&G team can perform surgery in district hospitals before taking patient’s back
to the specialist hospital- Team can optimize patient during transfer- Team can manage complications better during transfer- Additional blood products- Anaesthetic doctor could come along in the relevant cases
DISADVANTAGES- Longer time taken to transfer patient
CLINICAL INDICATIONS
- Dire obstetric emergencies which requires close monitoring & stabilisation during transfer
- Complications during surgery in district hospitals or private centre that unable to be manage effectively
ACTIVATION
- The specialist/ consultant would make the decission if the retrieval team should be activated and depends on case to case basis
- Team members1. O&G specialist2. O&G registra3. Labour ward staff nurse4. Anaesthetist/ anaesthetic medical officer5. Paediatrician/ paediatric MO
THANK YOU……..