Hyperemesis Gravidarum - royalberkshire.nhs.uk protocols and...©RBFT Hyperemesis Gravidarum Inpatient ICP (V5.0 June 2019) Page 1 of 14 Hyperemesis Gravidarum In-patient Care Pathway

©RBFT Hyperemesis Gravidarum Inpatient ICP (V5.0 June 2019) Page 1 of 14

Hyperemesis Gravidarum In-patient Care Pathway

Likes to be known as

Admission no.

Consultant Expected date of delivery

Named Midwife Gestation at time of referral

Ward Day Assessment Unit Date of discharge

Discharged from Day Assessment Unit Iffley ward

CODE

Midwives responsibility Yellow Admission

TX Doctors responsibility

Version 5.0 June 2019 Review before June 2021

Approval Group Date

Maternity Clinical Governance 7th June 2019

Change History

Version Date Author(s), Job title Reason

Version 3.0 December 2014 Locum Consultant Obstetrician Reviewed

Version 4.0 February 2017 AN Services Manager Reviewed

Version 5.0 February 2019 AN Services Manager Reviewed


All members of staff who are using this Pathway use black ink and fill in this section. You can then use initials when recording care

Print Name Designation Signature Initials

How to use an Integrated Care Pathway (ICP)

Firstly, if you are going to write in the ICP you need to state your Name, Job Title and give a sample signature and initials on the front of the ICP cover

If you are recording an event which is predicted by the ICP, then you just sign against that predicted intervention in the column provided.

If your intervention is not in line with the pathway, you must record this as a variance in the variance column with the action you will take to try to bring the patient back onto the pathway.

Care given by health care assistants and student nurses must be countersigned by a registered nurse.

There are many ‘NOTES’ pages for you to write free text about the care given to the patient by you. These notes should always be dated and timed.

The ICP has been colour coded to make it easier to document your aspect of care. Black background relates to Doctors, Clear background relates to nurses and grey background relates to PAMS but check the key prior to writing.

All ICPs are chronological so you should be able track the care given very easily

Date


Admission

Intervention Initial Reason for variance and action

taken Early Late Night

Clinical assessment Clerking completed Yes □ No □

No clinical signs of impaired liver function Yes □ No □ No clinical signs of thyrotoxicosis Yes □ No □ TPR and BP within normal range, recorded on MOWs chart (pg

Yes □ No □

Weight recorded Yes □ No □ No complaints of vomiting Yes □ No □ No complaints of nausea Yes □ No □ IV cannula site observed 4 hourly for swelling and leakage

Yes □ No □

VIP and fluid balance chart commenced (pg Yes □ No □

Investigations Urinalysis performed Ketones present

Yes □ No □ Yes □ No □

Bloods for FBC, U&E, LFT, TSH, Free T4 sent

Yes □ No □

Booking bloods and MSU sent with family origin questionnaire

Yes □ No □

(If first admission) USS requested / performed

Treatment Electrolyte replacement required Yes □ No □

Intravenous cannula sited Yes □ No □

Intravenous fluids prescribed Yes □ No □

Anti-emetics prescribed as per protocol Yes □ No □

(Diabetic women only) Blood biochemistry repeated 12 hourly. Medical staff informed of abnormal results

Yes □ No □

Yes □ No □

Anti-emetics administered Yes □ No □

Route of administration

PO IM PR PO IM PR PO IM PR

DVT prophylaxis given as prescribed Yes □ No □

Consideration given to the administration of Pabrinex and/or hydrocortisone if unable to tolerate oral fluids

Yes □ No □

Activities of daily living E L N Woman tolerating oral fluids

Tolerating usual diet

Passing good volumes of urine

Fluid balance chart in progress

Teaching and support Woman orientated to the ward Yes □ No □

Dietary advice and hyperemesis leaflet reinforced

Yes □ No □

Discharge planning Confirm demographics and existing support arrangements


Goals for this phase: Woman hydrated, tolerating usual diet and fluids

Date / time Multi-disciplinary free text Initial

Date


Daily Record – Day 1



Clinical assessment Reviewed by Obstetric Registrar

FBC, U&Es, LFT’s & TFT’s results within normal range (see page 11)

Yes □ No □

IV fluids to continue Yes □ No □

Anti-emetics reviewed Yes □ No □

TPR & BP (recorded daily) within woman’s normal range

Yes □ No □

No complaints of nausea or vomiting Yes □ No □

DVT risk re assessed and actioned accordingly

Yes □ No □

VIP score 0


Yes □ No □

U&E’s repeated if large amount of ketones or patient still vomiting

Yes □ No □

Treatment (Diabetic women only) Blood biochemistry repeated 12 hourly.

Yes □ No □

Medical staff informed of abnormal results Yes □ No □

Anti-emetics administered regularly Yes □ No □


Activities of daily living E L N Increased fluid intake continued


Has had bowels open since admission


Fluid balance chart continued

Hygiene needs have been met

Teaching and support Woman and carer aware of progress plan Yes □ No □

Dietary advice continued Yes □ No □

Woman confirms understanding of future symptoms to observe for /actions to be taken

Yes □ No □

Discharge planning Discharge date and time given to woman as . . . . . . . . . ……………………………………….

Administration TTO’s ordered Yes □ No □

Goals for this phase: Woman hydrated; tolerating good amounts of diet and fluids Date / time Multi-disciplinary free text Initial

Date





Clinical assessment Reviewed by Obstetric Registrar Yes □ No □


Yes □ No □




Yes □ No □



Yes □ No □

VIP score 0


Yes □ No □


Yes □ No □


Yes □ No □













Yes □ No □




Date







Yes □ No □




Yes □ No □


DVT risk re assessed and actioned accordingly Yes □ No □

VIP score 0


Yes □ No □


Yes □ No □


Yes □ No □













Yes □ No □




Date







Yes □ No □




Yes □ No □



Yes □ No □

VIP score 0


Yes □ No □


Yes □ No □


Yes □ No □













Yes □ No □



Goals for this phase: Woman hydrated; tolerating good amounts of diet and fluids


Date




Date …….…….

Time …..…..…

of assessment

Pressure relieving equipment Needed / Provided

Date of next planned assessment

Midwife/Nurse Signature

Comments

ADAPTED MATERNITY WATERLOW

PRESSURE ULCER RISK ASSESSMENT

Patient details sticker here

Date

Time

BUILD WEIGHT FOR HEIGHT

Average BMI = 20 - 24.9 Above Average BMI = 25 - 29.9 Obese BMI = > 30 Below Average BMI = < 20

0 1 2 3

MOISTURE DAMAGE Liquor or lochia Visible perspiration

1 1

VISUAL RISK AREAS SKIN TYPE

Healthy Dry/Oedematous Discoloured/Grade 1 Grade2-4

0 1 2 3

MOBILITY

Fully Restricted i.e. PGP/CTG Epidural Spinal

0 3 3 4

HYDRATION RISK FACTORS

In labour Paralytic Ileus Hyperemesis

1 2 3

SPECIAL RISKS

TEDS Gestational Diabetes Smoking Diabetes (type i, type ii) MS/Paraplegia/Motor Sensory HDU (pre-eclampsia/MOH/Sepsis)

1 1 1 5 5 5

MEDICATION Long term/high dose steroids 4

PROLONGED SURGERY On operating table >2hrs 3

SEX AGE

Female 14 - 49

2 1

TOTAL SCORE

MIDWIFE'S INITIALS

10+ = At Risk = Repose Companion 15+ = High Risk = Bi-wave 20+ = Very High Risk = Bi-wave Companion

Date

Time

BUILD WEIGHT FOR HEIGHT

Average BMI = 20 - 24.9 Above Average BMI = 25 - 29.9 Obese BMI = > 30 Below Average BMI = < 20

0 1 2 3

MOISTURE DAMAGE Liquor or lochia Visible perspiration

1 1

VISUAL RISK AREAS SKIN TYPE

Healthy Dry/Oedematous Discoloured/Grade 1 Grade2-4

0 1 2 3

MOBILITY

Fully Restricted i.e. PGP/CTG Epidural Spinal

0 3 3 4

HYDRATION RISK FACTORS

In labour Paralytic Ileus Hyperemesis

1 2 3

SPECIAL RISKS

TEDS Gestational Diabetes Smoking Diabetes (type i, type ii) MS/Paraplegia/Motor Sensory HDU (pre-eclampsia/MOH/Sepsis)

1 1 1 5 5 5

MEDICATION Long term/high dose steroids 4

PROLONGED SURGERY On operating table >2hrs 3

SEX AGE

Female 14 - 49

2 1

TOTAL SCORE

MIDWIFE'S INITIALS

10+ = At Risk = Repose Companion 20+ = Very High Risk = Autologic Mattress


N.B If the woman develops pressure damage between assessments use the grids above to

record this. If the woman is wearing TED stockings then her heels should be checked daily for

pressure damage. N.B Electronic Clinical Incident to be completed for new/existing

pressure ulcers Grade 2 or above

Please use this assessment in conjunction with Pressure Ulcer Prevention and Management

Care Bundle

C Bell, H Inkster & Amelia Bream

Date and time Clinical Description

Pressure Ulcer Grade (circle)

Signature + Stamp

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

Date


ANTENATAL OBSERVATIONS

Date

Time

40oC

220

39oC

200

38oC

180

37oC

160

36oC

140

35oC

120

Temp º

100

FHR X

80

Pulse

60

BP 40

Resp Rate

Conscious level

Urine - ketones

Urine - glucose

Urine - protein

Blood sugar

Initial box when completed

MOWS Score (Modified Obstetric Warning Score) Resp rate

Pulse

Systolic

Diastolic

Consciousness

Urine Output

Total MOWS

Date



Documents

Hyperemesis Gravidarum - royalberkshire.nhs.uk protocols and...©RBFT Hyperemesis Gravidarum Inpatient ICP (V5.0 June 2019) Page 1 of 14 Hyperemesis Gravidarum In-patient Care Pathway