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.