The development and implementation of a risk assessment tool (labour) for attending deliveries on labour ward

Abstract

Introduction A recent survey of junior Doctors identified anxieties attending deliveries and uncertainty when to request middle-grade assistance. This audit aimed to identify limitations in the information provided by midwives regarding the progression of labour and the potential for neonatal compromise at delivery. Methods A prospective audit was conducted recording the information volunteered by midwifery staff when requesting the attendance of a Paediatric SHO at deliveries. The audit criteria included: Location Age (gestational) Birth type Ongoing concerns (e.g. CTG abnormalities) Urgency Risk factors (e.g. Group B Streptococcus, meconium, maternal pyrexia/tachycardia). These were deemed important in conducting a risk assessment prior to attending a delivery to determine whether senior assistance would be required. Results The information from a total of 50 calls was documented. Of these, 98% provided the location, 82% the birth type and 48% the urgency. Detailed information regarding gestation, CTG traces and risk factors for neonatal compromise were 16%, 18% and 24% respectively. Following the initial audit, the L.A.B.O.U.R risk-assessment tool was implemented on delivery suite. The acronym was placed above phones and attached to patient notes. One month after implementation a re-audit of calls to the Paediatric SHO was conducted. The information provided from 50 calls included: location 94%, gestation 60%, birth type 86%, ongoing concerns 57%, urgency 71%, risk factors 60%. Conclusion The L.A.B.O.U.R tool has improved communication of essential information from midwives to junior paediatricians enabling them to determine the potential risk for neonatal compromise at delivery and to ask in advance for senior assistance.