1. WORKFLOW FOR PREGNANT WOMEN WITH SUSPECT, CONFIRMED H1N1 KKH 16.6.09 DR CAROL TAN SENIOR CONSULTANT GERIATRICIAN MBBS, MRCP FAMS

2. WORKFLOW FOR SUSPECT AND CONFIRMED H1N1 Pregnant woman Suspect H1N1 (History of travel to affected country + Flu symptomsConfirmed H1N1 Admit to single bed isolation room Admit to single bed isolation room if available If no more rooms available, to cohort Non H1N1H1N1 confirmed Basic management and investigation during admission for suspect and confirmed H1N1 Frequency ( minimum and more frequently as required ) In chargeRemarks Swabs on admissionOnceDoctor to order +Nursing Swabs from day 4 till negative 2 swabsDaily or at least six hours apart Oxygen saturationDailyNursing<95% to alert doctors Temperature, Pulse, Respiratory rateTDSNursing DoptoneTDSNursing CTGDailyNursing Blood pressureDailyNursing Medical Ward roundDaily and more frequently as and when required including whether ICU is needed O & G teamCriteria for ICU admission 1.Septicaemia + hypotension 2.Respiratory failure with hypoxaemia Secondary referral, blue letterAs and when requiredO & G to refer as blue letter to Geriatric, GM team, Anesthetists in consultation with TTSH, CDC Other investigations e.g. ABG, FBC, CXRAs and when requiredPrincipal teamBased on clinical judgement Discharge home

3. ANY OTHER ISSUES VISITOR POLICY If husband or any other adult family member suspect, admit to TTSH If child suspect, admit to KKH Paeds No visitors for isolation wards If husband insists on accompanying wife, he must agree to stay with pregnant patient in the single room throughout the period of stay of patient ESTIMATED LENGTH OF STAY Suspect but not confirmed H1N1 while awaiting swab confirmation - 12-24 hours Confirmed H1N1- 10-14 days VALIDITY OF WORKFLOW The workflow is for the containment phase only and will be modified if we move into mitigation phase INTEGRATION WITH RESPIRATORY, ID AND OTHER MEDICAL SERVICES IN HOSPITALS OUTSIDE KKH KKH medical resident team will be working out similar workflows with medical specialties outside KKH for the management of medical co morbidities for adult women patients in KKH REFERENCES http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0512a1.htm http://www.cdc.gov/h1n1flu/clinician_pregnant.htm