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Developing the State Record of Labour Document

Office of Kids and Families
Project Added:
6 April 2016
Last updated:
20 April 2016

Developing the State Record of Labour Document

Summary

This project is developing a statewide Record of Labour Document (ROLD) that standardises labour and delivery care for women and babies in NSW.

Aim

To ensure 100% of NSW public health maternity birthing services implement the ROLD by 2017.

Benefits

  • Improves labour and delivery outcomes for women and babies.
  • Provides a complete ROLD that upholds the principles of the Clinical Excellence Commission (CEC) Between the Flags program and complies with relevant state guidelines and procedures.
  • Standardises the ROLD across NSW, to avoid duplication and misinterpretation of data.
  • Eliminates duplication of maternity care and labour documentation.

Background

In 2013, NSW Kids and Families and the Nursing and Midwifery Office facilitated a workshop to explore the use of partograms in labour care. The partogram was developed by Dr Friedman in 1954 and is a paper or electronic form that is used to record labour observations. It provides a visual representation of labour, to alert midwives and obstetricians to deviations in maternal or fetal wellbeing and measure labour progress.

Prior the workshop, partogram forms had not been updated to incorporate best practice or current NSW Health documentation requirements. The workshop initiated discussions about creating a statewide partogram form, which would incorporate all observations including the principles of the CEC Between the Flags program.

In February 2014, the NSW State Record of Labour Working Party was formed and began developing a standardised partogram form that could be implemented in all maternity birthing services across the state. It found that clinician misuse and misinterpretation of the partogram was a common occurrence, which increased clinical risk for women and their babies, particularly if they are transferred from one service to another.

Written and verbal complaints from patients showed that they felt pressured to conform to time constraints imposed on them by the partogram. They also felt that their labour was not assessed individually and that there was too much emphasis on cervical dilation rather than additional signs of labour progress. Some women also felt they were not given enough time for their body to function as it’s designed to, while others felt their labour was prolonged and would have preferred intervention sooner.

Since the partogram was designed in 1954, clinical variables have changed in ways that affect the progress of labour. More women are now induced and in some populations, a significant proportion of women are obese. New research also suggests the active stage of labour is likely to begin at 6cm dilation rather than the traditional view that it begins at 4cm dilation.

The working party determined that a statewide ROLD which incorporated Between the Flags strategies may be more valuable than a partogram form and would lead to improved clinical practice across NSW.

Implementation

  • A needs analysis was undertaken in February 2015 to determine the requirements of a standardised ROLD.
  • Key stakeholders were engaged to develop a multidisciplinary, evidence-based, clinician-focused and patient-centred ROLD.
  • Terms of reference were developed by the working party committee.
  • Regular (fortnightly then monthly) face-to-face and teleconference meetings are held with the working party to maintain progress and enthusiasm throughout the project.
  • A ROLD will be developed by the working party that takes into consideration the needs analysis, feedback from stakeholder consultation and clinical governance requirements.
  • The ROLD will be implemented in a pilot phase between April 2016 and July 2016, to measure results and determine if the model is appropriate to be rolled out across the state.

Project status

  • Pre-implementation - Planning for the initiative is well underway. Clinician and consumer consultation has occurred.

Key dates

  • Project start: February 2015
  • Initial consultations: February 2016
  • Pilot start: April 2016
  • Implementation start: July 2016

Implementation sites

  • All maternity birthing services in NSW.

Partnerships

  • Northern NSW Local Health District
  • NSW Ministry of Health
  • CEC Between the Flags Program
  • NSW Maternal and Newborn Reference Group
  • NSW State Forms Committee
  • NSW ObstetriX Consortium
  • NSW eMR Committee
  • NSW Clinical Midwifery Consultants Network
  • Nursing and Midwifery Office

Evaluation and Results

  • The project team completed initial consultations in February 2016. Stakeholder feedback will determine the final evaluation criteria for this project. Possible measures may include:
    • number of root cause analysis and clinical incidents due to the incorrect use of the ROLD by clinicians in maternity units
    • number of unnecessary or non-indicated interventions in the active or latent labour phase
    • number of necessary interventions during labour
    • improved clinical outcomes in labour and delivery
    • barriers to completing the ROLD
    • patient and staff stories that illustrate the impact of the ROLD.
  • Audits will take place pre-implementation, post-pilot and post-implementation to determine results.

Lessons learnt

  • The working party are committed to the project and have placed their individual agendas aside, so the group can focus on developing a ROLD that is based on evidence and places the safety of women and their babies as a priority.
  • As committee members are positioned throughout the state and have demanding work schedules, it has been difficult to incorporate competing priorities. Scheduling meeting times and staying focused on the project has required significant organisation.
  • There have been delays to the project, due to the progress of various clinical governance approvals. Incorporating stakeholder consultation feedback has also caused some delays.

Further reading

  • Lavender T, Hart A, Smyth RM. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database of Systematic Review 2012; 8: CD005461. doi: 10.1002/14651858.CD005461.pub4.
  • Clinical Excellence Commission. Between the Flags.

Contact

Suzanne Weir
Child Health Services Development Officer
Northern NSW Local Health District
Phone: 0422 676 002
suzanne.weir@ncahs.health.nsw.gov.au

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