Last summer saw the successful launch of a new Scottish course to support maternity professionals in the care of critically ill obstetric women requiring high-dependency care. It’s called ‘Maternity REACTS’, with the acronym standing for ‘recognition, evaluation, assessment, critical treatment and stabilisation’.
It was created by the Scottish Multi-Professional Maternity Development Programme (SMMDP), which aims through a network of local trainers, to provide improved maternity care for women and their babies across Scotland. The programme provides local, affordable, post-registration courses to all professionals in the maternity service team.
The aim of ‘Maternity REACTS’ is to provide candidates with the necessary clinical skills and knowledge to help them recognise – and deal appropriately with – critically ill women who require increased monitoring and support, but who do not meet the criteria for intensive-care admission.
There is a clear need for such a course. The Scottish Confidential Audit of Severe Maternal Morbidity (SCASMM, 2003-2005) reports that one of the factors behind the rise in major obstetric haemorrhage is likely to be the result of changes in the obstetric population, such as increasing numbers with complex medical conditions and increasing age at childbirth. It also reports that high-dependency facilities within labour wards increasingly have to absorb this rise, as there has been no concurrent rise in the number of women admitted to intensive treatment units.
Furthermore,
Saving mothers lives (CEMACH, 2007) reports that one of the core skills of being a clinician is the recognition of a woman who is unwell. This recognition of life-threatening illness is challenging and the earlier detection of severe pathology must lead to a better chance of survival. Recognition of a critically ill woman relies on taking a complete history, the measurement and understanding of vital signs such as heart rate, respiratory rate and pulse oximetry. Identifying increasingly severe illness needs to be taught to clinicians of all grades on a regular basis.
In response to this need, a multiprofessional steering group of clinicians from across Scotland was formed in June 2009. There was representation from both large urban maternity units and smaller units, as well as representation from remote and rural areas.
The steering group included midwives, obstetricians, anaesthetists, a critical care nurse, a pharmacist, adult retrieval and ambulance personnel. The group waas aware that the needs of maternity units would differ, however it believed that the knowledge base of clinicians needed to be the same. It was agreed that competencies would not be appropriate or achievable in some settings, so would be optional. With this in mind, the course was developed and supporting learning materials produced.
Due to the specialised nature of the course, the faculty for the course must include four anaesthetists, an obstetrician, a midwife, a pharmacist and a critical care nurse. Candidates must have current registration in recognised national courses in managing obstetric emergencies (such as SCOTTIE/ALSO) and have current registration in resuscitation skills (such as ILS/ALS).
The course involves pre-course preparation and an extensive manual is provided to give candidates the necessary background knowledge. A number of activities are included, which must be completed prior to attending the two-day practical course. Examples of topics covered include invasive intensive monitoring, assessment skills, recognition and management of a critically ill woman, and drug and fluid management.
The pre-course reading was rated by the candidates as ‘good’ or ‘very good’ and two typical comments provided in feedback were: ‘It provided a very robust theoretical basis for attending the course,’ and ‘The course materials are a great resource, useful for sharing with colleagues and I liked the activities which helped to keep learning focused.’
The first two courses have been run at the Princess Royal Maternity Hospital in Glasgow. So far, 28 midwives and six middle-grade doctors from Scotland have attended the two-day course. The steering group initially felt that this course was suitable for experienced midwives and middle-grade doctors. A local supervising midwifery officer and senior doctors observed the course to verify and confirm that the course met the service and the learners’ needs.
Their feedback suggested that the course is best suited for those who are at ST3 level and above. It was also felt that consultant gynecologists/obstetricians might find the course useful, particularly now as in some units, there is a split with some consultants only providing labour ward on-call cover with no other obstetric input.
The steering group has reflected on comments and suggestions from the candidates, the observers and from their own experience running the two courses. As a result, changes have been made to the course manual and programme.
The new and improved ‘Maternity REACTS’ course is now available to support the multi-professional maternity team.
Maternity REACTS – a two-day course:
Day oneThe course is ‘hands on’ with workshops on the first morning that cover ECG interpretation; oxygen/pulse oximeter; care of arterial and central lines; and arterial blood gases. The candidates, through simulated sessions, have the opportunity to practise skills in a safe environment.
The first day also includes a short lecture and demonstration of the assessment of the woman using the ABCDE (airway, breathing, circulation, disability and exposure) approach.
Then it is the turn of the candidates to use the knowledge and skills gained from pre-course study when they attend the trauma and fluid-management workshops. An over-sized snakes and ladders game provides a bit of fun when learning about fluid management.
Day twoThe candidates participate in scenario sessions, covering the following areas: cardiac, sepsis, respiratory and haemorrhage. All the candidates participate in all sessions and have an opportunity to lead in more than one session allowing plenty of practice. In the afternoon, half the candidates attend a communication workshop using the SBAR tool (situation, background, assessment and recommendation) followed by the preparation for transfer workshop, while the other candidates complete their assessment. The groups then swap over. There is a great sense of achievement with successful completion of the course.
Other courses run by the SMMDPNeonatal resuscitation course
Neonatal pre-transport care course
SCOTTIE obstetric teaching and training in emergencies
Emergency maternity care course for non–maternity care professionals
Routine examination of the newborn course
Generic instructors’ course
Parent education facilitators’ course
For further information, please visit:
www.scottishmaternity.org or email:
helene.marshall@nes.scot.nhs.uk
