THIS Institute ran a rapid-response consultation exercise, conducted through Thiscovery, to understand what good looks like when managing obstetric emergencies in women with suspected or confirmed COVID-19. We gathered insights from more than 100 specialists in maternity care, infection prevention and control, and human factors using innovative consensus-building methods.
Background
Using large-scale collaborative approaches for generating evidence for process improvements enables inclusion of many perspectives and sourcing of expertise that may not always be available locally across the NHS.
These approaches can also reduce duplication of effort and support shared understanding.
THIS Institute conducted a proof-of-concept online collaborative project to understand how to improve processes for responding to obstetric emergencies in women with suspected or confirmed COVID-19.
Approach
A video was created to illustrate a possible way of managing obstetric emergencies in women suspected or confirmed with COVID-19.
THIS Institute gathered recommendations on how to improve the practices illustrated in the video through a rapid-response consultation exercise involving over 100 specialists working in maternity care, infection prevention and control, and human factors.
The project used Thiscovery, a platform developed by THIS Institute to support research and development in healthcare improvement. It enabled a pace and scale of work that would otherwise not have been possible.
Results
After watching the video on Thiscovery, participants provided over 900 recommendations on how to improve the practice illustrated. Analysis identified the 22 most frequent recommendations. Next, participants were asked to score the recommendations. There was firm agreement that 12 should be implemented. In a final round, they were asked to review any recommendations where agreement was not yet clear, and to consider their scores again in the light of scores from others. In the end, agreement was reached on 16 recommendations, which are listed below.
The original video has been updated in light of these insights, and an infographic and a short summary of the key points have also been produced.
Recommendations from the consultation
Preparation and team roles
(1) To prevent excessive donning and doffing associated with leaving and re-entering the room, assign someone outside the room to act as a runner. For example, to receive blood samples to send to the lab or to obtain extra equipment if needed.
(2) Use role identifiers for staff wearing PPE. For example, staff should wear stickers or laminated photos.
Donning of PPE
(3) Have a person to assist with donning of PPE if possible. For example, the third team member should receive assistance from the second team member with donning.
(4) Perform hand hygiene prior to donning PPE.
(5) Secure and fix hair away from face to protect hair and face from contamination. For example, use disposable hats, caps or tie hair back.
(6) To avoid contamination, ensure appropriate glove use: wear double gloves, do not open doors with gloved hands, and wear the gloves over the long-sleeved gowns.
(7) Clarify correct sequence for donning gloves and entering room.
Layout and design
(8) Provide a clear demarcation of dirty/clean zones to indicate moving in and out of a potential ‘contamination’ zone. For example, mark a red area outside of room for doffing, to ensure potentially contaminated equipment is doffed in a controlled area.
(9) Apply human factors principles to the design of the PPE donning station. For example, items in sequence of use, standardised layout.
(10) Improve grab bag design. For example, indicate contents, use a box and standardised layout.
(11) Improve bin design to allow easy PPE disposal. For example, wider aperture and a fully opening lid.
Communication
(12) The importance of communicating with the woman and/or partner should be emphasised. For example, when wearing masks, staff should have awareness of eye contact, tone of voice and body language between the team and towards the woman and partner.
(13) Review the design of the algorithm (step-by-step guide). For example, optimise text size and contrast for legibility and provide a hard surface for writing on.
(14) Provide instructions to explain correct processes of donning and doffing. For example, a poster on the wall.
(15) Provide opportunity for debrief and feedback for the team involved.
Doffing
(16) Include more time and instruction on the correct doffing order. For example, doff the majority of PPE (gloves and gown) inside the room and doff masks outside of the room.
This project is supported by the PROMPT Maternity Foundation, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Obstetric Anaesthetists’ Association, Each Baby Counts, and the Infection Prevention Society.
Funding and ethics
This project is funded by the Health Foundation’s grant to THIS Institute. It is led independently by THIS Institute.
This project is supported by the PROMPT Maternity Foundation, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Obstetric Anaesthetists’ Association, Each Baby Counts, and the Infection Prevention Society.