Counselling

Explain procedure without medical jargon

Use pictures if possible
Interpreter if necessary
Explain benefit and alternatives
Explain serious (death and serious trauma) and frequent risks (infection
+ pain)
Give information leaflet and time to ask questions
E.g.s
Missed miscarriage counsel
Laparoscopy - counsel
Nuchal translucency - councel
ABDOMINAL HYSTERECTOMY FOR HEAVY PERIODS
Audit
A dynamic process that compares clinical practices with a gold standard practice and
possibly suggests change to practice that should be implemented and re-audited to
complete the loop.
1.Standard (RCOG grade A):
2 MARKs
2.EXPLAIN will involve consultant in charge for audit / audit dept / midwives etc to
formulate any other questions / standards to look at with e.g. s
4 marks
3.Then draw up an audit form to fill in (? Use FORMIC software to analyse data sheets)
ask medical records for notes via audit dept if possible. Store notes carefully and extract
information onto the forms pre-prepared.
2 MARKs
Then enter data onto computer / keep data confidential i.e. initials and hosp no only
4.Use Access/excel and powerpoint to present the data and see how measure up to the
standard.
1 MARK
5.Disseminate the recommendations from the audit presentation to all in DEPT and set a
date for the re-audit process / audit cycle.
1 MARK

Standards

Agreed practice



Disseminate





User

Audit
Effect Change

Critical appraisal

Usually a leaflet / patient information

Is it easy to read / non jargon

? simple diagrams

? available in other languages

? does it explain diagnosis / alternative treatments and address pros and cons

does it give a contact number if questions required ?

? who constructed the info leaflet and when will it be updated

Prioritization
Labour ward board
Gynae emergencies and Obs emergencies
Gynae OPD letters and op lists


Make use of all staff and facilities you have available
Midwife can suture episiotomies, put in venflons
SHO may be career SHO ERPCs / assess obstetric patients
Spr ask off going Spr to stay around to help if really busy
Cons ask advice but the examiner wants to know you can prioritise

OPD WHEN TO SEE if suspect cancer 2 WEEK WAIT RULE
URGENT Vs routine

Op lists consultant should really be present

Risk management
How to reduce clinical risk (CNST)
LEVEL 1 10%
LEVEL 2 20%
LEVEL 3 30%

Fill in clinical risk forms

How to make a protocol / guideline
Set format see e.g.
Evidence based (NICE or RCOG)
Review date

Essex Rivers Healthcare NHS Trust

Directorate of Women, Children and Families

Maternity Services

Title of Guideline

Introduction Aims and objectives etc
Body
Structured and progressive framework
Clinical guidelines may be in Table format- including a column for the ACTION and a
column for the RATIONALE but alternatively may be in bullet points
All headings as section breaks

Action
Rationale
Put up IV fluid To maintain circulating volume
References
Harvard referencing (instructions to follow on Harvard System)

As agreed by Obstetric Division (if it is a medical issue)
Head of Midwifery (if it is a midwifery issue only)


------------------------------------------- ---------------------------------------
Anne Ferris Consultant Obstetrician
Head of Midwifery Lead Consultant Delivery Suite
If non medical signed by Head of Midwifery
Date of guideline: (Month and Year)
Review date: (usually 3years later, Month and Year)
Compiled by: