Training--teamwork-and-the-structure-of-the-NHS课件.ppt

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1、Training,teamwork and the structure of the NHSDr Lisa Joels MD FRCOGRoyal Devon&Exeter NHS TrustSept 2012 Royal College of Obstetricians and GynaecologistsAimsTo understand the role of the O&G ST5 registrar in UK practiceTo understand teamwork and what a multidisciplinary team doesTo gain an insight

2、 into the structure of the NHSHomework:To work through the following clinical scenarios which will be discussed in the first virtual classroom answers to be sent to the RCOG as belowDeadline:4pm UK/8.30pm India timeFax to RCOG at 0044 207 7772 6388 or email to The labour ward boardYou are the regist

3、rar(ST5)on call for the delivery unit.You have arrived for the hand over at 8.30am.Attached you will find a brief resume of the 10 women on delivery suite as shown on the board.Decide on the priorities for managing each patient and delegate tasks as appropriateRM NAMEGESTLIQUOREPIDSYNT COMMENTMW1MAR

4、SHALL038-YESYESLSCS for Breech yesterday afternoon,taken back to theatre for bleeding at 2am.Angle oversewn and drain sited.Blood loss 2500mls SW2FORD241Clear.NONOSpontaneous labour6cm at 3am.COMMW3OLDHAM020Membr IntactNONOCervagem TOP for Edwards SyndromeStoppd contracting at.R/V for oxytocinCK4SCO

5、TT540ClearNONOContracting Spontaneous labour7cm at 8am?urge to push.MC5GRANT026Membr IntactNONOTightening,loin pain,abdominal discomfortCTG normal.Booked for ultrasound scanCK6CHOPRA140-NONODiabetic insulin dependantFor I.O.L.MC7MURRAY038-NONOContracting.4cm at 0400hRepeat VE at 0700h still 4cmVM8ST

6、OTT039-Delivered at 6amAwaiting suturing PL9BRYAN3+1 41-NONOFor elective CS.Now contractingVM10HUGHES138Blood StainedNONOAPH,Contracting 2 in 10&complaining of pain between contractionsEarly decelerations on CTG.DBRM NAMEGESTLIQUOREPIDSYNT COMMENTAllocation1MARSHALL038-YESYESLSCS for Breech yesterda

7、y afternoon,taken back to theatre for bleeding at 2am.Angle oversewn and drain sited.Blood loss 2500mls ST1&Anaesth2FORD241Clear.NONOSpontaneous labour6cm at 3am.SW or ST53OLDHAM020Membr IntactNONOCervagem TOP for Edwards SyndromeStoppd contracting at.R/V for oxytocinST5 semi-urgent4SCOTT540ClearNON

8、OContracting Spontaneous labour7cm at 8am?urge to push.VM5GRANT026Membr IntactNONOTightening,loin pain,abdominal discomfortCTG normal.Booked for ultrasound scanST1&PL6CHOPRA140-NONODiabetic insulin dependantFor I.O.L.DB&ST5 routine7MURRAY038-NONOContracting.4cm at 0400hRepeat VE at 0700h still 4cmPL

9、&ST5 semi-urgent8STOTT039-Delivered at 6amAwaiting suturing MC9BRYAN3+1 41-NONOFor elective CS.Now contractingCK&ST5 semi-urgent10HUGHES138Blood StainedNONOAPH,Contracting 2 in 10&complaining of pain between contractionsEarly decelerations on CTG.DB&ST5 urgentThe labour ward teamMidwives:Independent

10、 practitionersAdvanced skills:cannulation,suturing,prescribingSHOVariable level of skillsNeed to be explicit in instructions for delegationAnaesthetistEpidural,spinal and GAsInput in managing critically ill obstetric patients e.g.Severe PET,massive obstetric haemorrhageConsultant 40 hour cover(or mo

11、re)MEOWS chartModified obstetric early warning score/systemRespirations,saturations,pulse,BP,temperature,urine output,pain score,neuro response(AVPU)Clinical governanceStandardised risk management tool to recognise the sick patient in all clinical specialtiesModified algorithm for use in obstetrics

12、to reflect referral pathways in MDTRef:Saving mothers lives 2003-05 page 247,Standards for Maternity Care RCOG 2008(RCOG working party reports)Obstetric triageAConsultant led care with 4 weekly scans from 24 weeks gestationBConsultant led care with 2 weekly scans from 22 weeks gestationCConsultant l

13、ed care in a tertiary unitDGeneral Practitioner led careEShared care between consultant obstetrician and consultant physicianFShared care between consultant and perinatal mental health teamGShared care between consultant and general practitionerHShared care between midwife and consultant visits at 1

14、2 weeks and termIShared care between midwife and consultant visits at 20 weeks and termJShared care between midwife and perinatal mental health teamKMidwifery led care throughoutOption listYou are triaging the referrals to the antenatal clinic.For each of the following clinical scenarios select the

15、most single most appropriate pattern of antenatal care.Each option may be used once,more than once or not at all.Obstetric triage1.Dear Doctor,Please would you book Mrs Twigg for antenatal care.She is 28 years old and is currently 10 weeks gestation in her third pregnancy.The first was a normal deli

16、very and the second was an elective caesarean section for breech.She would like to discuss vaginal delivery.AnswerHShared care,consultant visit 20/40 and term2.Dear Doctor,Please will you book Mrs Haldon for antenatal care.She is in her first pregnancy and was seen last week in the early pregnancy u

17、nit with a threatened miscarriage.She had a scan which confirmed a viable monochorionic,diamniotic twin pregnancy of 10 weeks gestation.Answer BCons led care fortnightly scansObstetric triage3.Dear Doctor,Please arrange antenatal care for Mrs Gwyn who is now pregnant for the third time.Both her chil

18、dren were born by normal vaginal delivery but after each pregnancy she suffered postnatal depression.She is no longer taking antidepressants and although a little anxious is coping well.AnswerIMLC+perinatal mental health team4.Dear Doctor,Please would you arrange antenatal care for Mrs Doublegood wh

19、o finds herself pregnant again.This is her third pregnancy,her two children were born normally but this is a new relationship.She is a smoker and has a body mass index of 28.AnswerJMidwifery led careSummaryOSCE question preparatory stationEMQ application of clinical knowledge to specific scenario givenYour questions Homework:Online lectures on SAQs,EMQs&MCQsRefer to NICE guideline CG132:Caesarean section&submit answers to cases Deadline:Thu 4 Oct 2012,4pm UK/8.30pm India timeFax to RCOG at 0044 207 7772 6388 or email to Thank you for attending and see you next Sunday!