Welcome to our Presentation Presentation Outline Introduction Background Rationale Research Question Limitations Literature Review Ethical Consideration Aim & Objectives Methodology Results and Discussion Conclusion Recommendation References TITLE: EQUIPPING THE MATERNITY UNITS OF THE NATIONAL REFERRAL HOSPITAL (NRH) WITH EMERGENCY KITS Topic : Capacity of the Maternity units at the National Referral Hospital (NRH), Honiara to manage obstetric complication and emergencies: A case study on the availability of proper emergency kits. Presenter: Betty Manehanitai Senior Lecturer /RN,Midwife Midwifery Program Solomon Islands Nursing Symposium May 10 2012 1. INTRODUCTION Management of Obstetric Complications and Emergencies ongoing challenge almost every places of birth around the globe especially in the developing countries common phenomenon occurring mostly in the laboring and birthing rooms and including the antenatal and post natal units. Equipping with emergency kits enhances the efficient management of complications and emergencies to save lives. ‘Be prepared at all times for the worst’. way forward to improve maternal health in our country as we are working towards achieving MDG5 Maternal Health by 2015. Background This small case study was designed and carried out in the maternity units of the National Referral Hospital It was conducted over a period of three weeks. ( March - April 2012) Background cont… The National Referral Hospital (NRH) the nation’s highest referral and teaching hospital. serves the total population of approximately 600,000 people (2009 census) receives referral cases from Honiara city and Provincial patients around the country. Background cont.. The Hospital has about 10 wards Total number of 305 beds 298 nurses working in this Hospital. The maternity unit has a total of 54 nurses and midwives along with 3 obstetricians and gynecologists’ consultants and 4 obstetricians and gynecologists’ registrar. Rationale “Over 350,000 women and over 2 million infants around the world die each year as a result of preventable complications in pregnancy and childbirth”(ICM, 2012) NRH maternity units continued to record such incidences. According to the delivery registry at the NRH birthing unit for the month of Aril 2012, a total of 397 births was recorded. 74 deliveries out of 397 encountered complications Rationale Cont… Unavailability of proper emergency kits contributes in delaying efficient management Study was conducted to determine if the maternity units at the NRH are equipped with proper emergency kits. Research Question Does the Maternity unit have proper emergency kits to manage these complications? LITERATURE REVIEW Emergency kits are very important tools to be in the place of birth as it is handy to have them and use whenever emergencies arise. It can save a life if it has all the necessary drugs and equipments in place. (Dr. Miriam O’Connor (PEMOC) training in July 2011 ,Honiara) Be Prepared...for the worst .... Most Obstetric Complications Occur Suddenly Without Warning! If women do not receive medical treatment in time, they will probably suffer disability… LITERATURE REVIEW Cont… The maternity department should be fully equipped despite the rare occurrence of CPR” (Boyle 2002, p 7). ‘Every maternity setting should have protocols in place for the management of emergencies such as post partum hemorrhage, shoulder dystocia and eclampsia ‘(Pairman et al 2008). LITERATURE REVIEW Cont… Emergency kit is a kit box/container In the boxes……. put stuff you will need Copy of unit protocols/clinical guidelines Box-content check-lists (dated and signed) Up to date on-call roster and phone numbers Other ‘frequent-flyer’ numbers( eg labs, theatres) Most recent relevant STMs Assign the job in job descriptions/roster duties Aims and Objectives AIM The aim of the study was to explore whether: The Maternity Unit of the National Referral Hospital have the capacity to manage obstetric complications and emergencies with the availability of proper emergency kits. OBJECTIVES: To ensure that the identified study sites are fully equipped with emergency kits and are available. To ensure the staff working in these identified studied sites have the knowledge and skills of setting and using emergency kits. METHODOLOGY Study Design Combination of Qualitative exploratory study and Quantitative counting of numbers Qualitative Questionnaire Focus Group Discussion Key Informant Interview Quantitative : Blind observation Study sites Postnatal unit, Birthing unit, Antenatal unit Study Population and Sampling Study Population - 51 (total pop of 3 units) Questionnaire – 51 Response – 21 Sampling method – purposive sampling which includes individuals who know the relevance for the purpose of the study Study Population and Sampling cont… Key Informant Interview (KII) – 9 Available for interview – 6 Study sample – nominated sampling was used to identify individuals who possess the necessary characteristics or experiences. Doctors/Nurse Managers/CNC Focus Group Discussion (FGD) – 10 Participated – 7 Study sample - convenience sampling identified those at hand who have the necessary information relevant for the purpose of the study Data Collection Questionnaires - designed and structured according to the relevant information required for the purpose of the study. FGD – developed some relevant questions and were used for discussion to get required information. KII – questions were designed and structured and were used for face to face interview. Data Analysis Collected information from questionnaire, key informants – tabulated and converted to bar graph and pie chart for comparison Manual calculator was also used. Key informants and focus group discussions, information was transcribed and coded into common themes. Other qualitative information from the focus group discussions and the Key informants’ interview were all transcribed and organized to relevant common themes. Ethical Consideration Consent granted from the Assistant Director of Nursing, National Referral Hospital (NRH) followed by a letter to the Ethical Research and Organizing of the Nurses Symposium committee . Following approval, a written letter and consent forms were distributed to the participants of this study. A signed consent form was obtained from the participants of the Key Informants once the interview was accepted. confidentiality be maintained RESULTS AND DISCUSSIONS 81% of the questionnaires responded that there was no availability of different types of emergency kits 100% of both the key informants interviewed and blind observations done indicated that there are no emergency kits available in their units. Availability of different types of emergency kits in the maternity unit 100% 100% 100% 90% 81% 80% 70% 60% 50% Available Not Available 40% No response 30% 20% 10% 0% Questionnaires responses Key Infromant Interview Responses Blind Observation responses • Results and Discussion Reason why not equipping the units 72 % stated that there was no support from their with emergency kits superiors • 14% stated it is unnecessary because of the general emergency trolley • 14% did not respond • Participants have the knowledge and time available but the main reason was due to the above 72%. Not responded 14% No knowledge 0% Not neccesary because of emergency trolley 14% No time 0% Questionnaire No support from superior 72% Results and Discussion • 52% of respondents stated that Post Partum Haemorrhage due to atonic uterus • 29% Post Partum Haemorrhage from deep tears • 24% accounts for both PET and APH • Shock accounts for 14% • delay in second stage was 5%. Higest rated common obstetric complication & emergency encountered 60% 52% 50% 40% 29% 30% 24% 24% RATE 1 Commonly encountered 20% 14% 10% 5% 0% 0% Results and Discussion Questionnaire – 90% used the general emergency trolley 48% collect equipment from ward stock, 29% borrowed from other wards, 14% stated that they ring pharmacy for equipment. 90% 90% 80% 70% Borrow 60% 50% Key informants’ responses, 83% stated that they managed obstetric complications by using the general emergency trolley and collected from the ward stock. 16% key informants responded by borrowing from other wards. General Trolley 83% 83% Collect From W/stock 48% 40% 30% Ring Pharmacy 29% 20% 14% 10% 16% Not Respond 9% 3% 0% 0% Questionnaires Responses Key Informant Interview Responses Results and Discussions • 100% key informant interview general trolley was not sufficient Questionnaire • 48% responded general trolley not sufficient • 38% stated general trolley sufficient • 14% no response Sufficiency of general emergency trolley to Manage obstetric complications 100% 100% 90% 80% 70% 60% 48% 50% 40% sufficient Not sufficient 38% Not responded 30% 20% 14% 10% 0% 0% 0% Questionnaires Responses Key Informant Interview Responses Results and Discussion Utilization the current emergency trolley Key informants • 83% unutilized • 17 % responded that they fully utilized them. Questionnaires responses, • 24% unutilized • 43% stated that they fully utilized 90% 83% 80% 70% 60% 50% 43% Fully Utilized Partly Utilized 40% Unutilized 30% 29% No responses 24% 20% 17% 10% 5% 0% Questionnaires Responses 0% 0% Key Informant interviewed Responses Results and Discussions Importance of equipping the 3 units with different types of emergency kits Questionnaire 67% stated the importance of having different types of emergency kits 24% no response 10% agreed to have one emergency trolley 70% 67% 60% Differrent types of emergency kits 50% 40% 30% 24% One emergency trolley 20% 10% 10% Not responded 0% questionnaires Responses Results and Discussions 88% of questionnaire responses strongly agreed . 10% Agree 0% Disagree key informants’ responses, 100% strongly agreed as well. Agree to equip their units with different types of emergency kits 100% 100% 90% 86% Strongly Agree 80% Agree 70% 60% disagree 50% 40% not responded 30% 20% 10% 0% Questionnaires Responses Key Infromant Responses Results and Discussions • 81% of checks is done by the Clinical Nurse Consultant, • 29% by the Nurse Managers • 19% by Registered Nurses Person responsible for checking trolley 90% 81% 80% 70% 60% 50% Person responsible 40% 29% 30% 20% 19% 10% 0 0 0% RN CN CNC NM NA Results and Discussions Questionnaires • 48% stated they check it anytime after use • 24% stated that they did daily checks • 10% stated that they either checked once every shift or weekly. • 10% did not respond. How often do you check and restock emergency trolley? 48% 50% 45% 40% 35% 30% 24% 25% checking time 20% 15% 10% 10% 5% 0% 10% 10% Results and Discussions 62% responded needed assistance to set up their emergency kits. 19% stated that they are either very confident or confident to set up their own emergency kits. confident to set up emergency kit Very confident Confident Some what confident Need assistant 2.Results Findings of the FGD Theme 1. Opinion having different types emergency kit in their units. Participants comments: All participant agreed that it is a good thing to have in place for the following reasons; saves time running around looking for missing equipments, specific for different complications and saves lives. 2.Results Findings of the FGD Theme. 2. current status of their emergency trolley. Participants Comments: Has limited stocks and not in good condition. In the birthing unit they only have an ambu bag which is not in its good condition as well, they also stated that they have oxygen for babies only. They do not have an oximeter as well – out of stock in the pharmacy. They stated borrowing oxygen from post natal ward. 2.Results Findings of the FGD Theme.3. Who does the checking the trolley Comments of the group. The majority of participants in the focus group discussion clearly stated that they have not been allocated to check the emergency trolley daily Only the boss does the checking and it was noted that it was not checked accordingly as well. 2.Results Findings of the FGD Theme. 4. Sharing experiences encountering and managing obstetric complications Participants responses. Participants from the birthing unit and post natal ward shared their experiences on encountering Post Partum Hemorrhage in the National Referral Hospital as well as in the Area and Rural Health centers. Difficulty and life threatening situations Managing obstetric complications with no emergency kit or proper emergency equipments available. they recommended that there is a need to have a proper emergency kit specifically for a particular case and it must be available at all times. Study Limitations Researchers time other work related commitments, money, power interruptions and network congestions. Virus Limitations cont... participants -different shifts communication Transport difficulties for others monetary issues – no bus fare. CONCLUSION To conclude, this study has identified important gaps in the availability of proper emergency kits in the Maternity unit of the National Referral Hospital The importance of having proper emergency kits in the 3 study sites is crucial. Evidence has shown that there are no proper emergency kits available at this point in time when they encounter emergencies and obstetric complications. Post Partum Haemorrhage due to atonic uterus and deep tears are the most common obstetric complications encountered. However, this study has shown that there are no proper emergency kits available to manage them. CONCLUSION Although, the nurses and midwives already have the capacity to set up and use these emergency equipments, there is clear evidence that they needed support and assistance in setting their emergency kits. The need of addressing this issue is a priority because the current emergency trolley is insufficient to manage obstetric complications and leads to borrowing of emergency equipment from other wards. Thus ,delays managements. Therefore they strongly agreed to equip the maternity unit with different types of emergency kits for efficient and effective management. RECOMMENDATIONS The following recommendations should be considered: Emergency and Obstetric Training be provided for all nurses in the Maternity unit by the responsible authorities Develop Updated protocols and listing for each emergency kit. There should be collaboration between other health service providers example; pharmacy, theatre, doctors to set up proper emergency kits. Nurse Managers and Clinical Nurse Consultants to allocate nurses/midwives for checking the emergency trolleys on every shift. Seek funding for emergency kits. •ACKNOWLEDGEMENT The symposium committee for the opportunity to present this small study Research and Ethical Committee Assistant Director of Nursing NRH for granting us permission to use the NRH facilities to conduct the study Nurse Managers of the Maternity Unit Participants of the study Thank you very much for your understanding, support and cooperation in assisting us to complete this study. REFERENCES Boyle. M, 2002, EMERGENCIES AROUND CHILD BIRTH, Radcliffe Medical Press, British. International Confederation of Midwives Key Message 2012 O’Connor. M, 2011, V3 PEMOC FOR HONIARA, SOLOMON ISLANDS,BASIC EMERGENCY OBSTETRIC CARE, PNG Pairman.S, et al, 2008, MIDWIFERY PREPARATION FOR PRACTICE, Elsevier, NSW. Ree,C, 2003,Introduction to Research for Midwives, BfM, London.