1. 1000 lives + Mini Collaborative: Community Bundle
Marie Lewis
Donna Owen
Powys Local Health Board

2. 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.

3. 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.

5. 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

6. 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
/min
41-60 or /min
<40 or >130/min
Systolic BP
mmhg
mmhg
91-99mmhg
<90 or >161mmhg
Diastolic BP
Up to 90mmhg
mmhg
>110 or <40mmhg
Temperature
38-39
<35 or >40

7. 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.