Elective Caesarean Section……improving the woman’s birth ... › media › 3277328 ›...

 Our clinical team recognised that women requiring elective LUSCS had limited choices surrounding their birth.

z  The aim of this project is to enhance the birth experience of women undergoing elective caesarean section, ensuring the provision of safe, effective, person-centred care

Primary Drivers

• Enhance support for a close relationship between mother and baby and initiation of feeding as soon as possible after birth

• Improve the birth environment

• Reduce incidence of Surgical Site Infection (SSI)

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Secondary Driver • Improve information and preparation of women • Improve theatre etiquette with ALL staff • Implementation of theatre bundle (pre incision antibiotics,

wound preparation, preoperative catheterisation) • Use of surgical brief and theatre safety brief • Promotion of teamwork within the multidisciplinary team • Initial care of baby completed in theatre prior to transfer

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Project Processes  

• Our clinical team recognised that women requiring elective caesarean section had limited choices surrounding their birth.

• The Quality Strategy (2010), The Refreshed Framework for Maternity Services (2011) and UNICEF Baby Friendly Initiative (2012) provided the basis for our focus on improving women’s birth experience.

• A collaborative approach was established with the multidisciplinary team.

• I engaged with women through face to face discussion. • Various reports were collated and reviewed e.g. SSI rates, theatre

audit, Clinical Quality Indicators. • I gathered relevant information from other sources such as • Gynaecology, Obstetric and Neonatal Effectiveness Committee

(GONEC), NICE Guidelines, SPSP, HPS and HIS. • A Driver Diagram was developed and used as the improvement tool. • A personal coach provided ongoing support and encouragement in self

development which confirmed that leadership comes from within.  

Actions • Improved information leaflet • Earlier time of admission • Reduced fasting times • Women’s choice of music • Reduced unnecessary noise in theatre • Surgical safety brief • Hair clipping on table • Catheterisation by circulating staff • MW receiving baby scrubbed • Betadine left to dry for 3 minutes • Pre-incision antibiotics • Baby weighed and examined in front of

parents in theatre allowing immediate skin-to-skin in recovery

• Improved use of MEWS • Staff seconded to theatre for 4 month blocks • Anaesthetic nurses participate in pre op, intra

op and post op care Evaluation

• A staff discussion group showed that staff felt more satisfied, team work was improved, theatre ran more smoothly and roles were more defined

• SSI 4% in Aug 2012. 2% in Dec 12. • Women reported a positive birth experience

while having an elective caesarean section

Elective Caesarean Section……improving the woman’s birth journey at Royal Alexandra Hospital, Paisley Project Leader: Jacqueline Crawford