Managing Medical and Obstetric Emergencies and Trauma. Группа авторов

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СКАЧАТЬ having difficulty breathing and their preconceived ideas that this is due to PPH mean that the remainder of the assessment is completed without due attention and more as a rehearsed exercise rather than an open‐minded exploration. In this case the eventual diagnosis was pulmonary embolism which was a very late consideration in the diagnostic pathway.

      Apart from thorough history and clinical assessment, using the expertise within your team by carefully listening to alternative views or challenges can minimise the effects of these cognitive biases.

      Cognitive aids: checklists, guidelines and protocols

      Cognitive aids such as guidelines or checklists are important because the human memory is not infallible. They also confer team understanding through the use of a standardised response. This reduces stress. This is especially true where an uncommon emergency event occurs. The team may be unfamiliar with one another and each member will be trying to remember what to do, what treatments are required and in what order. A good team leader will use the available cognitive aids as a prompt and the team’s members can use it as a resource so that they can plan ahead. Safe practice is promoted through the use of these tools in an emergency rather than relying on memory.

      Calling for help early

      Trainees in all disciplines are often reluctant to call for senior help, partly due to not recognising the severity of the situation and partly due to concerns about wasting the time of seniors. With all emergency events, and in particular with obstetric emergencies, escalation and appropriate help should be summoned as soon as possible. Remember, help will not arrive instantly.

      Using all available resources

      Team resources include staff, observations, equipment, cognitive aids and the facilities in the local area. It is the team leader’s role to continually consider the appropriateness of utilising available, untasked staff or equipment to optimise the patient’s care and prevent a bottleneck in the treatment pathway.

      Debriefing

      Wherever possible it helps to have a facilitated debrief following an adverse clinical event. It is best if the debrief is viewed as a normal part of the process of dealing with all obstetric emergencies rather than being reserved for catastrophic events. The aim of a debrief is to summarise any particular issues or problems that the team had, and reflect on how the team performed. Some organisations have set templates to facilitate this. It gives the opportunity for individuals, teams and organisations to continually develop.

      Whilst a ‘hot’ debrief immediately after the event may be useful in certain situations, it is not always ideal. Some situations in obstetrics can be emotionally draining, especially when maternal or neonatal outcome is poor. A balance must be established whereby formal debrief and feedback to all involved team members occurs within a reasonably short timeframe. All team members must be aware of looking out for the emotional needs of colleagues who may have been particularly emotionally traumatised during an emergency situation.

4.10 Summary

      In this chapter we have given a brief introduction to human factors and described how lack of awareness about the importance of communication, situation awareness, leadership, team working and decision making can lead to patient harm and adverse events. It is really important for you to use every opportunity to reflect on and develop your own performance and influence the development of others and the team. Appropriate debriefing is included in the scenarios for the mMOET course, which may be used to help you to incorporate this process into your own clinical practice.

4.11 Further reading

      1 Bromiley M. Just a Routine Operation. https://vimeo.com/970665. Clinical Human Factors Group, www.chfg.co.uk (last accessed February 2022).

      2 Flin R, O’Connor P, Crichton M. Safety at the Sharp End: A Guide to Non‐technical Skills. Abingdon: CRC Press, 2008.

PART 2 Recognition

CHAPTER 5 Recognising the seriously sick patient

      

Algorithm 5.1 Scottish national MEWS chart: (a) front of MEWS chart

      Source: Scottish patient safety programme, Maternity and Children quality Improvement programme. © The Improvement Hub

      Learning outcomes

      After reading this chapter, you will be able to:

       Identify the current causes of maternal mortality and morbidity and the issues with their detection and treatment

       Describe a systematic approach to monitoring using early warning charts to aid recognition of women at risk

       Recognise ‘red flag’ symptoms and their need for an urgent response by the obstetric team and other specialties

5.1 Introduction

      Recurrent themes in mortality and morbidity reports identify that suboptimal care may have contributed to the deaths described in these reports. With more than two thirds of cases having pre‐existing co‐morbidities and indirect deaths exceeding direct, the importance of coordinated care across specialties is emphasised. Failure to recognise symptoms and signs of potentially life‐threatening conditions, delay in acting on findings and delay seeking help from appropriate specialists are all of particular concern. Attention is therefore focused on ways to improve the recognition of, and timely response to, clinical signs of the deteriorating patient.

      The diagnosis of a severe life‐threatening condition in a pregnant or recently pregnant woman is challenging when the onset is insidious or atypical. This is compounded by the sick pregnant woman presenting to a non‐obstetric area such as the emergency department where staff are not familiar with pregnancy physiology. The different response to impending critical illness through vital signs can be missed in these circumstances.

      Not only ‘high risk’ women become critically ill. Often it is not possible to predict if or when this might happen to any obstetric patient. The relative rarity of life‐threatening events in pregnancy reinforces the need for multiprofessional working and training involving emergency department staff and acute physicians.

      The lessons that apply to all health professionals dealing with pregnant women can be summarised as follows:

       Understand the physiological adaptations of pregnancy in order to be able to recognise the pathological changes of serious illness – it is important to be able to distinguish between common discomforts of pregnancy and the signs of serious illness so that these signs are not missed (Table 5.1)

       Focus СКАЧАТЬ