GUIDELINE
Document No: A7
*All Sites
Maternal Obesity
TITLE
Version:
Maternal Obesity
2
Approved by:
Maternity Service Risk
Management Group
Date:
July 2011
Final Approval by: Maternity Service Risk
Management Group
July 2011
Date:
Author/lead responsible for guideline:
Midwife Consultant, Gill Sedgewick
Date Issued:
July 2011
Next Formal Review Date:
July 2014
Target audience:
All Midwifery and Obstetric Staff, Corporate
Risk and Medical Staff were applicable
Amendments and Additions
Addition of EqIA
Addition of Monitoring Tool
Replaces/supersedes
Version 1 Maternal Obesity
Associated Policies:
Equality Impact Assessed Y/N
Yes
CONTENTS PAGE
Page
DOCUMENT SUMMARY
1.
INTRODUCTION
5
2.
PURPOSE
5
3.
DEFINITIONS
5
4.
ROLES AND RESPONSIBILITIES (DUTIES)
6
5.
TRAINING AND IMPLEMENTATION
7
6.
EQUALITY IMPACT ASSESSMENT
7
7.1.
PROCEDURE FOR THE MANAGEMENT OF
7
WOMEN WITH OBESITY
7.2.
ANAESTHETIC ASSESSMENT and REFERRAL
8
7.3.
LABOUR WARD ANAETHETIC REFERRAL
8
7.4.
APPROPRAITE USE OF EQUIPMENT FOR WOMEn
WITH A HIGH BMI
8.
9.
9
MONITORING COMPLIANCE WITH AND
THE EFFECTIVENESS OF THE POLICY
9
REFERENCES
9
Appendices
APPENDIX 1 – BMI pathways of care
APPENDIX 2- Equality and Impact Assessment
APPENDIX 3- Consultation
APPENDIX 4- Approval
APPENDIX 5- Individual Manual Handling Risk Assessment
APPENDIX 6- Monitoring compliance table
APPENDIX 7- Maternity Patients with raised Body Mass Index (BMI) Equipment and
Environment Risk Assessment
4
Document summary
This guideline describes the process by which women with obesity (body mass index (BMI) > 30
Kg/m²) in pregnancy, labour and postnatal are managed and includes the following standards:

Anaesthetic Assessment of pregnant women

Clear pathway documentation of the care process for women with a of:
-BMI 30-34.9 Kg/m²
-BMI 35.39.9.Kg/m²
-BMI >40 Kg/m²
Introduction
In England, 1st trimester obesity (BMI>30kg/m2) has more than doubled from 7.6% to 15.6% in
the last 19 years, leading to an additional 47,500 women in England requiring high dependency
care in 2007 compared to 1989 ( Heslehurst et al 2010). The CMACE Report (2011) identified
that 49% of maternal deaths occurring within 2006-2008 were women who were overweight or
obese. Data from James Cook University Hospital shows that the incidence of maternal obesity
is higher than national average (Heslehurst et al 2007). Maternal obesity poses significantly
increased morbidity and mortality to the mother e.g. diabetes, hypertensive disorders, preeclampsia, thromboembolic complications, wound infections, post partum haemorrhage and in
the infant e.g macrosomia, shoulder dystocia, late fetal death and congenital abnormalities, as
well as causing significant burden on NHS resources . Health care professionals are therefore
required to adopt a more informed and pro-active approach in sustaining this client groups’
health, through the provision of multi disciplinary care that aims to maximise health gains and
reduce general health inequalities associated with maternal obesity and the development of
obesity in the infant. 10-13 (Acheson Report DoH 1998, CMACE 2011, CEMACH
2007,Heslehurst et al 2007, Kumari 2000, NICE 2006, Wells et al 2006).
2.
Purpose and objectives
To ensure that staff understand that pregnancy is a time when women will initiate life changes
and interventions can be applied to address obesity and behaviour change (Foresight 2007).
The NICE obesity guidelines state that advice should be tailored to different groups, particularly
people at vulnerable life stages for increased risk of weight gain such as during and after
pregnancy (NICE 2006) . The NICE behaviour change guidelines recommend partnership work
in interventions, and should consider the needs of service users, account for cultural and
socioeconomic differences in populations, assess potential barriers to change, and use key life
stages when people are more open to change, such as pregnancy (NICE 2007). The obesity
BMI pathways have been developed to support this intervention (Appendix 1).
3.
Definitions
The Body Mass Index (BMI) provides a simple numeric measure to estimate over or under
weight estimations; the BMI is defined as the individuals body weight divided by the square of
her height e.g.
BMI= mass (kg)
(Height (m)) ²
5
WHO General population BMI³
Underweight
<18.5kg/m²
Ideal
18.5-24.9kg/m²
Overweight
25-29.9kg/m²
Obese
>30kg/m²
Morbidly obese
>40kg/m²
The Body Mass Index estimation is undertaken as the woman’s first midwifery booking
appointment and recorded in the hand held notes and entered into the Information Technology
system. If the woman’s BMI is greater than 30Kgm² she will be commenced on the appropriate
BMI pathway (Appendix 1) see section 7.1.
4.
Roles and Responsibilities (Duties)
(Add to or Delete as appropriate, list is not exhaustive)
ROLE
RESPONSIBILITIES
Chief of Service, Clinical Director, Head of Overall responsibility for the implementation
Midwifery Divisional , Directorate Managers of this guideline and its application in practice
and Consultant Midwife
 Identifying training needs and
endeavour to meet them within
agreed timescales
 Ensuring that all new members of
staff (including temporary staff) are
informed of their responsibility to keep
up to date with this guideline.
Team leaders
Midwives
Lead on and have responsibility for the
implementation of this guideline to provide
professional support to the midwife/medical
professional providing care for the woman.
All staff are responsible for:

Their own compliance with procedural
documents and supporting documents.
 Identifying training needs and drawing
them to the attention of their line
manager.
Awareness of procedural documents which
apply to their working practice.
Obstetric obstetricians
Are responsible for:


Their own compliance with procedural
documents and supporting documents.
Identifying training needs and drawing
6
them to the attention of their line
manager.
Awareness of procedural documents which
apply to their working practice.
Obstetric registrars
It is the responsibility of the Consultant on
call to provide guidance to the obstetric
registrar when requested.
Anaesthetist
It is the responsibility of the anaesthetist to
provide assistance for the management of
women with obesity during pregnancy, labour
and postpartum.
5.
Training and Implementation
Registered midwives, obstetricians and clinical staff working within the maternity directorate are
required to attend as three day mandatory obstetric Emergency Training programme (OTEC) in
order to maintain professional responsibility and competency on a yearly basis. Staff attendance
is monitored through the training data base.
6. Equality and Impact Assessment
This policy aims to demonstrate that services are designed and implemented that provide a
structured, systematic, safe approach within the directorate and that an approved
documentation for managing risk and assessing the diverse needs of our service, population
and workforce are undertaken, ensuring that people are not placed at a disadvantage over
others (See Appendix 2).
7. 1. Procedure for the management of women with a body mass index > 30 kg/m²
All women should have assessment of their weighted and height at the booking appointment
and a Body Mass Index (BMI) calculated and documented in their health care records and the
electronic patient information system.
Women with a BMI >than 30kg/m² are to be placed onto the following BMI pathways (see
Appendix 1):
1. 30-34.9kg/m²
2. 35-39.9kg/m²
3. >40kg/m²
All women with a BMI>30kg/m² are to be commenced on the relevant BMI pathway; the
appropriate BMI pathway is placed into her health care records. Women with a BMI 30-34.9
kg/m² will receive maternity team based care and given relevant information sheets on healthy
life styles, possible complications and appropriate referrals are made into services as per care
pathway; the care pathway is referred to throughout pregnancy, labour and the postnatal period
in discussion with the woman.
All women with a BMI >30kg/m² must have a documented antenatal discussion regarding
intrapartum complications (See Appendix 8).
7
Women with a BMI 35-39.9kg/m² will receive maternity team based care and referred to the high
dependency antenatal clinic if other co-morbidities are present for consultation; they are given
relevant information sheets on healthy life styles and appropriate referrals are made into
services as per care pathway; the care pathway is referred to throughout pregnancy, labour and
the postnatal period. Woman with a BMI of > 35kgm² should be advised to deliver in an
obstetric-led care unit.
Women with a BMI >40kg/m² are referred to the high dependency antenatal clinic for
consultation; they are given relevant information sheets on healthy life styles and appropriate
referrals are made into services as per care pathway; the care pathway is referred to throughout
pregnancy, labour and the postnatal period in consultation with the woman. An individual
moving and handling risk assessment is completed between 28- 32 weeks gestation (Appendix
5) on women with a BMI greater >40kgm² with a plan to assess a tissue viability on admission
using Braden tool assessment.
7.2. Antenatal anaesthetic referral and assessment
Pregnant women with some conditions need to be seen by an anaesthetist as early as practical
in pregnancy to enable sensible planning of care, even if no anaesthetic intervention is
expected. After assessment, an obstetric anaesthetic management plan for labour and delivery
should be documented in the notes and discussed with the woman.
Women in the following categories must be referred to the obstetric anaesthetic team for an
antenatal consultation as early as possible in pregnancy.








History of previous problems with anaesthesia (patient or close blood relatives)
Potential airway problem, such as difficulty with mouth opening or neck movement or having
a receding chin
Current or previous:
o Cardiac disease
o Respiratory disease
o Central nervous system disease
o Renal disease
o Liver disease
o Spinal abnormalities
Coagulation disorders, including medically induced e.g. heparin (treatment dose)
Placenta praevia
Jehovah’s Witnesses
Needle phobia (of sufficient severity to compromise care)
Obesity all women with a BMI >40 kgm²
Referrals are to be written and can be made by obstetricians and midwives (including
community). If gestation is too advanced to allow a written referral, the case can be discussed
by contacting:

Anaesthetist on duty on Central Delivery Suite

Phone the maternity anaesthetists’ office on 53758

Page the on-call anaesthetist on bleep 1527
7.3. Labour ward anaesthetic referral
The anaesthetist on duty should be informed of the arrival or presence on labour ward of any
woman in the following categories:
8






Any woman previously referred for anaesthetic opinion in pregnancy
Any woman in any of the ‘Antenatal Referral’ categories above, whether or not previously
referred
Significant haemorrhage
Severe pre-eclampsia/eclampsia
Sepsis
BMI greater than 35 who are on the high dependency pathway
7.4. Appropriate use of equipment for women with a high BMI.
A risk assessment is undertaken on suitable equipment to use on women with a high BMI in all
care settings on an annual basis (Appendix 7).
8. Monitoring Compliance With and the Effectiveness of the Policy
A datix form should be completed for all women that have a BMI > than 30 and are not placed
on the appropriate BMI pathway, or a BMI is not calculated, refer to monitoring table for a
detailed description for monitoring compliance see Appendix 6. The BMI pathways will be
audited annually to address pathway compliance and pregnancy outcomes
9. References and Bibliography
CEMACH. 2009. Perinatal mortality 2007: England, Wales and Northern Ireland. London:
CMACE. www.cmace.org.uk
Centre for Maternal and Child Enquiries (2010) Maternal Obesity in the UK: Findings from a
national project. London:
Foresight, Tackling Obesities: Future Choices – Project Report. 2007, Government Office for
Science.
Heslehurst et al (2007) Trends in maternal obesity incidence rates, demographic predictors, and
health inequalities in 36 821 women over a 15-year period. BJOG. 114.
Heslehurst et al (2010) A Nationally Representative Study of Maternal Obesity in England, UK:
Trends in Incidence and Demographic Inequalities in 619 323 Births, 1989-2007. International
Journal of Obesity, Volume 34, No 8, 1353-1355
Lewis G. 2007. The confidential enquiry into maternal and child health (CEMACH). Saving
mothers lives: reviewing maternal deaths to make motherhood safer. 2003-2005. The seventh
report on confidential enquiry into maternal deaths in the United Kingdom. London: CMACE.
www.cmace.org.uk
NICE (2006) Guidance on the prevention, identification, assessment and management of
overweight and obesity in adults and children, guidance no. 43. www.nice.org.uk
NICE (2007) Behaviour change at population, community and individual levels. Public Health
Guidance 006. www.nice.org.uk/PH006
NICE (2010) Weight management before, during and after pregnancy, Public Health Guidance
27, July.
9
Appendix 1 BMI Care Pathway
Please indicate which BMI pathway is being followed:30-34.9, 35-39.9, >40
Visit
√ Tick or add when
complete or N/A
Action
Antenatal
BMI
30-34.9
Booking
Calculate and record BMI
BMI
35-39.9
Signature/
Date
BMI≥
40
Wt
BMI:
TICK appropriate BMI pathway
to be followed √
→
Explain Body Mass Index (BMI)
Book for maternity team based care
Refer to:
-High Dependency Antenatal Clinic if
other co-morbidities present
-Healthy Life style clinic if BMI ≥40 & no
co-morbidities present
Booking BMI≥35 advised to deliver in
obstetric led unit
Discuss Healthy Life Style information
leaflet/web pages
Initiate
discussion
on
management in pregnancy
weight
Exercise advise given
Offer Folic acid 5mg
Offer & discuss Vitamin D 10g
(Healthy Start Women’s Vitamins)
10
Book OGTT screening on :
Previous gestational diabetes
Screen 1. at 16-18weeks
Screen 2. at 28 weeks
All other women
Screen between 24-28weeks
Complete VTE risk assessment
Complete Thyroid function test
Discuss the risks of raised BMI document
possible
intrapartum
complications
Use appropriate BP cuff document size
High
dependen
cy care /
ANC
Discuss weight management
exercise in pregnancy
and
Undertake MRSA screening as per
protocol.
Review VTE
enoxaparin
score
and
need
for
Complete alert card in hand held notes:
BMI, antenatal plan, delivery plan
Arrange 20 week anomaly scan
11
Please indicate which BMI pathway is being followed:30-34.9, 35-39.9, >40
Visit
√ Tick or add when
complete or N/A
Action
Antenatal
BMI
30-34.9
20
wks
BMI
35-39.9
Signature/
Date
BMI≥
40
USS for fetal wellbeing
Provide infant feeding information
Discuss signs & symptoms of
eclampsia & advice line
pre-
Refer for Anaesthetic consultation
Arrange USS for 32 & 36 weeks
Check GTT is booked
Follow up investigation results
Discuss
weight
management
exercise in pregnancy
32-34
wks
and
USS for growth and fetal wellbeing
Weigh and calculate weight gain
Antenatal examination
Individual
manual
handling
risk
assessment and tissue viability issues –
advice and action plan
Discuss
weight
management
exercise in pregnancy
and
Follow up investigation results
36-38
wks
USS for growth and fetal wellbeing
Weigh and calculate weight gain
12
Antenatal examination
Discuss
weight
management
exercise in pregnancy
and
Follow up investigation results
Review
and
discuss
Anaesthetic
labour/delivery management plan
Discuss
possible
complications
intrapartum
Ensure infant feeding check list has been
fully completed
Positions in labour discussed to support
normal birth/ birth plan
Advise to withhold enoxaparin at onset of
labour or day of LSCS
Liaise with labour/theatre unit if booked
for IOL or LSCS to ensure appropriate
equipment available
13
Please indicate which BMI pathway is being followed:30-34.9, 35-39.9, >40
Action
Labour
√ Tick or add when
complete or N/A
BMI
30-34.9
BMI
35-39.9
Signature/
Date
BMI>40
Place of delivery –Low dependency- follow low
dependency protocols
Place of delivery – High dependency
If high dependency with no other risk factors can
follow low dependency protocols on delivery
suite
Insert
IV
cannulae
if
Antenatal
Thromboprophylaxis administered, H/O APH or
previous PPH obtain FBC, group & save
BMI> 40 insert IV cannulae
FBC, group & save
IV cannulae commence VIP chart
Continuous CTG monitoring, may need FSE
Inform duty anaesthetist need for anaesthetic
review
Inform consultant obstetrician of admission
Ranitidine as per protocol
Pressure care guidelines
TED stocking to be worn throughout labour
Active management of 3rd stage of labour
recommended and documented in notes
If LSCS delivery -commence LSCS pathway
14
Please indicate which BMI pathway is being followed:30-34.9, 35-39.9, >40
√ Tick or add when
complete or N/A
Action
Postnatal
BMI
30-34.9
Individualised
documented
postnatal
plan
of
BMI
35-39.9
Signature/
Date
BMI
>40
care
Record observations as per guidelines
Discuss analgesia requirements
Postpartum thromboprophylaxis assessment,
encourage early and regular ambulation
If LSCS delivery -complete caesarean section
checklist for inspection of wounds proforma- to
support strict attention to wound care
Provide bladder care as per guideline
Continue Vitamin D 10g
(Healthy
Start
Breastfeeding
Women’s
Vitamins)
if
Contraceptive advice offered
Provide pre conceptual information on
commencing folic acid 5 mgs 1 month before
stopping conception
Healthy life style advice given
Sign post to community weight management
services
Opportunity to talk about birth offered
Discharge check list completed
15
References
Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK: Findings from a
national project. London: CMACE, 2010.
Centre for Maternal and Child Enquiries (CMACE) Royal College of Obstetricians and
Gynaecology Joint Guideline (2010) Management of women with obesity in pregnancy
march.
Centre for Maternal and Child Enquiries. Saving Mothers’ Lives: reviewing maternal deaths to
make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into
Maternal Deaths in the United Kingdom. BJOG: an International Journal of Obstetrics &
Gynaecology 2011;118(Supplement 1):1-203.
NICE (2008) Diabetes in pregnancy Clinical Guidance 63. www.nice.org.uk
16
APPENDIX 2
South Tees Hospital NHS Foundation Trust
Equality Impact Assessment Screening
Title: Maternal Obesity
Department
Manager responsible for this policy (Policy Lead)
Gill Sedgewick
Guideline Title
Please state if this impact assessment is being carried out
due to the guideline being new, revised or has it been
identified due to another source
Revised
1. What are the aims and This policy aims to satisfy the requirement that the organisation
purpose of the policy / has a structured , systematic, safe approach that has approved
procedures / services?
documentation for managing the risks associated with pregnant
women with a body mass index greater than 30kg m²
2. Who does this policy / All pregnant women with a body mass index > 30kg m²
procedure / service target?
3. What are the desired The policy sets out defined practice for all pregnant women with a
outcomes of this policy / body mass index >30kg m² to ensure their safety, dignity and
procedure / service?
comfort is maintained during maternity care
4. What factors may cause Non compliance
the policy / procedure /
service to not meet the
desired outcomes?
5. Who will be responsible Chief Executive (as defined in roles and responsibilities within the
for implementing the policy policy document)
/procedure / service?
6. Please indicate which
sources of information, if
any, have been taken into
account
regarding
this
Impact Assessment.
17
7. Are there any concerns
that this policy / service /
function
may
have
a
differential impact due to a
person’s
Y?
N?
i. Racial group?
No
ii. Gender?
Women
iii. Disability?
N
iv. Sexual Orientation?
No
v. Age?
No
vii. Religion or faith?
No
8. Does any monitoring take
place that looks at the
impact on these groups
Yes
9. Describe any additional
or improved monitoring that
would help to explain the
impact of this policy /
function / service
Focus groups undertaken as part of healthy
life style clinic may identify issue for these
groups
Monitoring will be undertook annually to
measure 100% compliance with completion
of risk assessments
10. Has there been any
consultation
with
the
groups identified above
during the formulation of
the policy?
Yes
11.
Does
this
policy,
procedure,
function
/
service require a full impact
assessment
No
12. Can any adverse impact
that you have identified be
justified on grounds that
outweigh equality issues?
Please give details of the concerns in the
boxes below
Focus group to review Healthy life style
service
No adverse impact identified
18
APPENDIX Three
CONSULTATION ON: Maternal Obesity
Consultation process – Use this form to ensure your consultation has been
adequate for the purpose.
Please return comments to: Maternity service clinical guidance and audit
monitoring group
By date:
Name
Date
Sent
Reply
date
Modification
suggested?
Modification
made?
Y/N
Y/N
Head of Midwifery
June
2011
June
2011
N
All Obstetric Consultants
June
2011
June
2011
N
All Midwifery Managers
June
2011
June
2011
N
All
Consultant June
anaesthetists
2011
June
2011
N
Supervisor of midwives
June
2011
N
June
2011
The role of those staff being consulted upon as above is to ensure that
they have shared the policy for comments with all staff within their sphere
of responsibility who would be able to contribute to the development of
the policy.
Appendix Four: Approval Document
Guideline Agreement / Approval
The following groups/ committees/individuals have reviewed and agreed this
procedural document
Author to Complete
Date Circulated
Circulated to for comments:





Head of Midwifery
All Consultant obstetricians
All Maternity Managers
Obstetric Consultant Anaesthetist
Supervisor of Midwives
Author to Complete
June 2011
Date Agreed
Approved By
Maternity Service Risk Management Group
July 2011
Maternity Service Risk Management Group to Date Agreed
Complete
Date
Review
for
Final Approved by
Maternity Service Risk Management Group
July 2011
July 2014
20
Appendix 5
PATIENT MOVING AND HANDLING RISK ASSESSMENT
Patient
Name:
SIGN NAME
ASSESSMENT
Body
Weight:
WHEN
YOU
CHANGE
ANY
Initial
Assess
Date
Sign
D
Number:
&
Review
Date
Sign
&
Review
Date
Sign
&
Movement in Bed
(1)
1 – Hoist Only (NB Ensure correct hoist is
used to support the weight of the patient)
Complete the
columns
by
placing a tick and
signature in the
appropriate box.
When no boxes
are left for that
activity transfer all
activities to a new
column.
2 – Glide Sheet with ………………… staff.
3 – Single person assist.
4 – Independent.
Bed to Chair/Chair to Chair
1- Hoist only (NB Ensure correct hoist is
used to support the weight of the patient)
2 – Assistance with ……………… staff and
following
equipment
…………………………………..…………
3 – Single person assist.
4 – Independent.
Toileting
1 – Bed pan only.
2 – Commode with ………………. staff and
following
equipment
……………………………………………..
(2) Each
column
can be used to
capture
a
patient’s moving
and
handling
needs over a 24
hour period.
1 –Bed Bath Only.
(3) Complete
the
review columns
accordingly
every 24 hours
or
when
the
patient’s moving
and
handling
needs alter.
2 – Hoist only with ………. staff. (NB Ensure
correct hoist is used to support the weight
of the patient).
NB:
3 – Assistance with ……….………….. staff.
4 – Independent
Bathing
3 – Assistance with ………………….. staff.
4 – Independent.
Walking
Ensure correct
equipment
is
selected
to
assist
with
moving
and
21
handling.
1 – Not to be attempted.
2 – Assistance with …………………………..
staff
and
………………………………………….….
equipment.
Comments
3 – Independent.
Standing
1 – Cannot weight bear.
2 – Assistance with ……………..………….…
staff
&
………………………………………….…
equipment.
3 – Independent.
Recover from Floor
1 – Hoist only (NB Ensure correct hoist is
used to support the weight of the patient).
2 – Independent.
NB: This document must be filed in Section 4 of the Patient’s case notes on discharge.
October 2003.
Review
Page 2
SIGN NAME
ASSESSMENT
WHEN
YOU
CHANGE
ANY
Review
Date
Sign
/
/
&
Review
Date
Sign
/
/
&
Review
Date
Sign
/
/
&
Review
Date
Sign
/
&
Review
Date
Sign
/
/
Movement in Bed
1 - Hoist Only (NB Ensure correct hoist is
used to support the weight of the patient).
2 – Glide Sheet with …………………………
staff.
3 – Single person assist.
4 – Independent.
Bed to Chair/Chair to Chair
1- Hoist only (NB Ensure correct hoist is
used to support the weight of the patient).
2 – Assistance with ……………… staff and
following
equipment
….…………………………..…..…………
22
/
&
3 – Single person assist.
4 – Independent.
Toileting
1 – Bed pan only.
2 – Commode with ………………. staff and
following
equipment
……………………………………………..
3 – Assistance with ………………………….…
staff.
4 – Independent.
Bathing
1 – Bed Bath Only.
2 – Hoist only with ………. staff. (NB Ensure
correct hoist is used to support the weight
of the patient).
3 – Assistance with ………………………..
staff.
4 – Independent
Walking
1 – Not to be attempted.
2 – Assistance with ……………….……….
staff and
………………………………………..….
equipment.
3 – Independent.
Standing
1 – Cannot weight bear
2 – Assistance with …………………………..
staff &
……..……………………………………..
equipment.
3 – Independent
Recover from Floor
1 – Hoist only (NB Ensure correct hoist is
used to support the weight of the patient)
2 – Independent
23
24
APPENDIX 6 . More detailed monitoring is described in the following monitoring table
Objective
monitored
to
be
Clear
documented
evidence that the
woman’s BMI has
been calculated and
documented in the
Health care records
and electronic patient
information system.
Measure/Tool
Frequency
Lead
Reporting Arrangements
Actions arising including identifying
leads to take actions forward in agreed
timescales
Changes to practice and lessons learned
Audit minimum 1%
of women with BMI
> 30 kg/m² and
inspection of all
health care records,
plus
Annually
Consutant Midwife
Maternity Services Risk Management
group
Any deficiencies identified including
identification of training needs and
individual feedback to be given to relevant
health care professional
As identified in action plan from audit results.
Clinical Guidance and
Audit monitoring group
Clinical Guidance & Audit Monitoring
Group
Electronic
patient
information system
query undertaken
on all women with a
BMI > 30 kg/m².
Action plans will be developed and
reviewed as reasonably required
Required changes to practice will be
identified by the clinical risk management
groups, and a lead member of the clinical
guidance and audit monitoring group will be
identified to take the change forward
Lessons will be shared with all the relevant
maternity staff via Maternity services risk
management group
Clear evidence of the
use of BMI Care
pathways to identify
and document the
management
of
women with a BMI >
30 kg/m²
Clear
documented
evidence
that
a
referral has been
discussed
to
an
obstetric anaesthetist
and a management
plan is documented
on all women with a
BMI > 40 kg/m²
All as above
All
above
as
All as above
All as above
All as above
All as above
Clear
documented
evidence that a risk
assessment
is
undertaken
on
suitable equipment in
all care settings on
women with a high
BMI
Clear
documented
evidence
that
an
individual moving and
handling
risk
assessment has been
completed.
Clear
documented
evidence that women
with a BMI of over 30
kg
have
a
consultation with an
appropriate
health
professional
to
discuss
intrapartum
complications
26
gsedgewick
Page 27
08/02/2016
APPENDIX 7
Maternity Patients with raised Body Mass Index (BMI) Equipment and
Environment Risk Assessment
Ward /Department:
Speciality:
Typical number of patients per shift:
27
Assessment By:
Name:
Signature
Name:
Signature
Name:
Signature
Assessment Number:
Assessment Date
EQUIPMENT
Equipment used or available in your ward/dept. whether your own or regularly borrowed
Name
equipment
of How many?
Is it based on Where
your ward?
stored
is
it If not where is it Is it completed and Is it suitable?
borrowed from? functional
(e.g. safe working
loads-re kgs))
28
Examples of equipment required:
commodes
sit on weighing scales
large ultrasound scan couches
large blood pressure cuffs
large chairs without arms
large wheel chairs
electric ward and delivery beds that accommodate large patients
operating theatre tables
large
large theatre trolleys
lifting and lateral transfer equipment e.g. hoists, adjustable height mechanisms
29
on trolley’s, couches, beds, pat slides
appropriate sized theatre gowns
EQUIPMENT
Additional equipment required to reduce risk to staff/patients
30
ENVIRONMENT
Bathing
What types of bath or showers How many?
are on the ward?
Suitable for obese patients
Are there any problems when bathing related to transportation, circulation space, access, doorway
widths and thresholds e.g. strength of floors
31
Additional measure which may reduce risk to staff/patients
Toileting
How many?
Are they suitable for obese patients?
32
Are there any problems when using the toilet related to transportation, circulation space, access,
doorway widths and thresholds e.g. strength of floors?
Additional measure which may reduce risk to staff/patients
STAFFING
Do you roster extra staff on duty when you have large BMI dependant patients that require support from
staff to mobilize
33
YES
NO
If yes how many extra staff do you roster per shift?
Women who are admitted and weigh > 120kgs (>40 BMI) at any one time in pregnancy do you complete
the Individual Moving and Handling Risk Assessment Performa?
YES
NO
Women who are admitted and weigh > 120kgs (>40 BMI) at any one time in pregnancy do you refer to
manual handling lead?
34
YES
NO
Women who are admitted weigh >120kgs (>40 BMI) do you refer to tissue viability services?
YES
NO
OTHERS AREAS OF CONCERN
Describe other problem areas associated with obese women
Problem areas
Additional measures needed to be considered
35
SUMMARY OF NEEDS AND ACTION PLAN
Please summarise below the additional measures which you recommended in the earlier sections.
Work/change
recommended
Action by
Target Date
Completed
(Name)
36
Healthy Life Style Information Appendix8
To achieve healthy outcomes in your
pregnancy, delivery and postnatal
period, it is important you do NOT
gain too much weight.
1. It can help both you and your
baby:
For you:
• Make you feel better
• Feel less tired
• Move about more easily
• Reduce back and joint pain
• Lower blood pressure
• Reduce the risk of pre-eclampsia
• Reduce the risk of diabetes
• Reduce the risk of blood clotting
problems
• Reduce the risk of wound infection
• Reduce the risk of serious bleeding
after birth
• Reduces the risk of anaesthetic
complications
• Reduces the risk of delivery
complication
• Reduces the risk of emergency
caesarean section
For baby:
• Increases breast feeding success
• Increases average birth weight
• Reduces delivery complications for
baby
• Reduces the risk of a premature baby
Tips for getting started:
Better eating ...
• Eat three meals each day and consider
the size of the portions.
• Start the day with cereal and a piece
of fruit or glass of fruit juice.
• Have a least 5 portions of fruit or
vegetables every day.
• Take a packed lunch if this helps you
37
to have a healthier meal.
• Plan ahead for your family food
shopping and meals.
• Avoid extra snacks and drinks
continuing fat and sugar.
• Have plenty to drink, including water.
• Try to avoid using food as a reward or
for comfort.
• Try to avoid thinking you are eating
for two.
Web sites:
http://www.dh.gov.uk/change4life
http://www.dh.gov.uk/start4life
http://www.nhs.livewell/pregnancy
http://www.tommys.org.uk
http://www.middlesbrough.gov.uk
http://www.redcar-cleveland.gov.uk
http://www.hambleton.gov.uk
early, walk up escalators.
• Find times in the day when you can
take a brisk walk several 10 mins walks
are as beneficial as one long walk.
• Identify ways of becoming more active
as a family – try walking, swimming,
cycling, dancing or playing together in
the park.
• Make activities part of your social life
– meet up with a friend or neighbour
for a daily walk
• Think of ways of becoming more
active that you will enjoy, like
dancing, aqua-natal, gardening.
If your initial weight is the ideal weight
at the beginning of your pregnancy and
you gain more than12kgs/24lbs you
may find it difficult to lose weight after
birth
2. To support healthy weight gain in
pregnancy.
Think about small changes to your
everyday life.
Becoming active ...
• Aim to cut down on activities that
involve little movement such as
watching TV or using the computer.
• Add a little activity as part of your
daily routine – use the stairs rather
than the lift, get off the bus one stop
38