1000 lives + Mini Collaborative: Community Bundle Marie Lewis Donna Owen Powys Local Health Board

Transforming Maternity Services Mini collaborative: Community Model The community bundle is made up of three aspects similar to the four care bundles within Transforming Maternity Services. Pre-Admissions: All women have adequate history taken and recorded in their hand held records including BMI, Medical conditions, Obstetric History and VTE risk assessment. Plan for frequency of observations. Recognition: Routine maternal observations carried out as per local guidelines. Risk assessments repeated as appropriate and any changes recorded within the hand held records. Early warning score used as trigger for full set of observations and referral if necessary. Response: Communication with all members of the team using the SBAR format. Referral to appropriate place for further care and investigation. Immediate care if necessary prior to and during transfer. Mechanism for recording findings, actions and follow up.

When implementing the community bundle organisations need to consider local processes for referral from community to acute settings, the acceptable timeframe and communication process feeding back to community from the acute setting.

Community Risk assessment tool for venous thrombosis [VTE] Pre-existing risk factors Tick Score Previous recurrent VTE 3 Previous VTE – unprovoked or oestrogen related Previous VTE - provoked 2 Family history of VTE 1 Known thrombophilia Medical co-morbidities Age [dependant on that set by mini collaborative] Obesity [dependant on that set by mini collaborative] Parity [dependant on that set by mini collaborative] Smoker Gross varicose veins Pre-eclampsia Dehydration/ hyperemisis/OHSS Multiple pregnancy or ART Caesarean section in labour Elective CS Mid cavity or rotational forceps Prolonged labour >24 hours PPH >1 litre or required transfusion Current systemic infection Immobility Surgical procedure in pregnancy or >_ 6 weeks postpartum Total score at booking Total score re-assessed: Gestation: Date: Score >/= 3 Antenatal requires referral. Score >/= 2 Postnatal requires referral

Community Early Warning Score Aide memoir: 1 2 3 Looks/feels well Yes No Respirations 9-20 /min 21-24/ min 25-29/ min <8 or >30/ min Pulse 61-100/min 101-110/min 41-60 or 111-129/min <40 or >130/min Systolic BP 100-140mmhg 141-160mmhg 91-99mmhg <90 or >161mmhg Diastolic BP Up to 90mmhg 100-109mmhg >110 or <40mmhg Temperature 36-37.9 35.1-35.9 38-39 <35 or >40

Full set of observations: At each contact, the healthcare professional should ask the woman about her health and wellbeing. Any symptoms reported by the woman or identified through clinical observations should be assessed. [NICE CG 37] If a women reports feeling unwell or has a EWS of 1 a full set of observations should be carried out. Full set of observations should include: Heart rate Respiratory rate Systolic blood pressure Maternal wellbeing Temperature Observations should be scored using the Early Warning score as a trigger for referral. Health Professionals always remain responsible for the decisions they make and regardless of the early warning score should refer to the obstetric unit any concerns that they have.