Overworked midwives leads to poor documentation: Is there a correlation between fatigue,

workload and quality of documentation?

S. 1
Bailey , G. 1
Wilson , W. Yoong 2
1University
College London Medical School, London, UK
2Department of Obstetrics and Gynaecology, North Middlesex Hospital, London UK

Introduction
Introduction Score (%) for basic documentation and partogram at beginning, middle and end of shift Results
Results
100
Record keeping is an essential part of midwifery practice with clinical and legal Data from 305 note entries and 32 partograms of 42 women were collected manually over
90

Mean Documentation Score

implications. It is well accepted that good quality documentation is linked with an 84 hour period in labour ward. There was a statistically significant difference in mean
80 basic documentation scores between the middle and end of shifts (89% vs 81%;
improvements in patient care. Long shifts, intense workload and current
economic rationalisation (leading to suboptimal staffing levels) can lead to a 70 p<0.001). Mean documentation score was highest at the beginning of shift (91%), but not
Basic documentation
culture where poor documentation becomes common. 60 statistically different from the middle block. The variation in mean partogram score (74%
Partogram vs 55% vs 53%) was not statistically significant. See figure 1. No significant correlation
50
The aim of this study was to assess whether there is a variation in the quality of was found between mean documentation and partogram scores and any of the workload
40
midwifery documentation in a labour ward over the 12-hour shift and if workload variables.
30
intensity influenced the quality.
20

10

Method
Methods
0
Conclusions
beginning middle end
Conclusion
The study took on labour ward at the North Middlesex University Hospital, Time in 12-hour shift Our data indicates that the quality of documentation deteriorates in the final four hours of a
London. The labour ward consists of 13 delivery suites, two high dependency
Table 1 12-hour shift. Whether this is due to fatigue, tedium or anticipation of end of shift is unclear.
units, two obstetric theatres, a minimum of eight midwives per shift and has
However, this may be a surrogate marker for quality of delivered care and warrants further
approximately 3800 deliveries per year. qualitative assessment. The lack of correlation with the workload variables suggests that
Scoring Criteria the solution does not lie in increasing the number of midwives per shift but in modulating
Two aspects of record keeping were assessed: basic documentation and
Basic Documentation1 Partogram2 factors which affect the final third of the 12-hour shift, or decreasing shift length to eight
partogram completion. The quality of basic note keeping was scored according to
Date Patient identification hours.
standards outlined in Nursing and Midwifery Council Guidelines1 and the
“completeness” of partogram entries was scored according criteria laid down in Time Time
Further to this study more data has been collected (from 69 sets of intrapartum care notes
NICE Guidelines2. See table 1. Mean basic documentation and partogram scores Signature Temperature over 120 hours) with similar trends being found, consolidating the need for intervention.
were calculated for the beginning (first four hours), middle (middle four hours) Name and position Maternal pulse
and end (last four hours) of the shift. Black ink Maternal blood pressure
Legible Fetal heart rate
We looked to see whether there was a statistically significant difference between References
mean scores at different points in the shift, i.e. between the beginning , middle Appropriate correction of errors Dilation
and end. The mean documentation and partogram scores for each four hour Intact notes Station 1. Nursing and Midwifery Council (NMC) guidelines 2010. Record keeping. Guidance for nurses and midwives. NMC
(Published July 2009) Available at: <http://www.nmc-
section of the shift were also statistically compared to the following workload Contractions (frequency) uk.org/Documents/Guidance/nmcGuidanceRecordKeepingGuidanceforNursesandMidwives.pdf> [Accessed 26 May
variables: 2013].
Contractions (strength)
• Midwife:patient ratio Contractions (regularity) 2. National Institute for Health and Care Excellence (2007) [Intraprtum Care]. [CG55]. London: National Institute for Health and
• Number of high risk patients on labour ward Care Excellence. Available at: http://www.nice.org.uk/CG55 [Accessed 26 May 2013].
Signature
• Number of obstetric theatres in use
• Number of high dependency rooms in use Figure 1