Induction of Labour

1. CNST Audit InductionofLabour A Desai G Singh R Choudhary B Kapoor S Thacker 11/06/2010

2. Outline of presentation Why was the audit done? What was monitored? How was the data collected? What are the findings? Summary Recommendations

3. Why was the audit done?

4. Introduction • CNST requirements • Show approved documentation • Show it is implemented • Show it is monitored • Audit • Use the approved documentation • Monitor its implementation

5. Guidelines

6. Requirement of CNST (Level 3) • 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

7. What was monitored?

8. Monitoring - Stages Prior to induction (prostin) During Induction – 1st 6hrs During induction – 2nd 6hrs Post 12 hrs

9. Monitoring – prior to induction

10. Monitoring – during 1st 6hrs

11. Monitoring – during 2nd 6hrs

12. Monitoring – after 12hrs

13. How was the data collected?

14. Information Sources

15. Collection Form • Reason • Post term • Previous c-section • Induction Method • Prostin • ARM • Cook’s Catheter • Foley’s Catheter • Fetal Assessment • Auscultation • Movement • Both

16. What are the findings?

17. Case Notes Reviewed Total number of cases = 40

18. Reason for Induction

19. Parity

20. Gestation

21. Risks Explained

22. Membrane Sweep

23. Method of Induction

24. Pre Induction CTG

25. Observations – Admission Maternal Examination

26. ARM on Admission

27. During 1st Prostin (0-6hrs) Fetal Assessment Observations

28. Post 6hrs Prostin CTG All Prostin Patients Pre 2nd Prostin

29. Post 6hrs Prostin - Assessment

30. ARM post 6hrs prostin

31. Post 6hrs – Pre 2nd Prostin

32. During 2nd 6hrs – not ARM Fetal Assessment Observations

33. During 2nd 6hrs – 2nd Prostin only Fetal Assessment Observations

34. Post 12hrs - Assessment

35. ARM post 12hrs

36. Prostin Needed

37. Delivery Outcome Reason for induction Method of induction

38. CTG Stickers missing in notes

39. Summary

40. Summary of findings 35% had risks explained 98% had assessments 92% had CTG 88% had assessments 78% had fetal assessment 31% had regular observations 80% had CTG 80% had assessment ~50% had maternal assessment 60% had fetal assessment 20% had regular observations 80% had assessment

41. Recommendations

42. Recommendations Risks explained to mother needs documentation on induction prescription form Fetal assessments need to noted regularly after administration of prostin Maternal observation and abdominal examination needs to be repeated before administration of prostin CTG stickers must be include in the notes Re-audit before end of November

43. Discussion