ANSC March Update: The Royal Hospital for Women

Information for GPs regarding the allocation of a 24 hour designated triage service within RHW Birthing Services

0439 869 035

Background / Rationale

We recognised a need for a triage system within our birthing service as we have a large number of women who present for clinical review or telephone for advice. Some of these women will have already been seen in the community and are being referred on for more specialist review; others are self-referrals with clinical concerns. In addition to these women we have labouring women to accommodate.

To safely meet the needs of all these women we require a triage process that allows prioritisation of the most urgent cases. Some women can be seen and assessed and referred to a less acute service, other may require admission. We receive a large number of phone calls for advice and at present there is no designated triage person to take these calls. This can lead to the same women speaking to different staff members if she calls 2-3 times within a few hours and potentially receiving inconsistent advice.

We also wish to prioritise our labouring women and ensure we have adequate delivery rooms available to manage our delivery suite efficiently. We are aiming for 1:1 midwifery care for women in labour. This will be more achievable if other clinical reviews are under taken by a separate team.

Clinical Care arrangements

  • A designated midwife will be allocated 24/7 to answer calls from pregnant women or other health care providers regarding acute obstetric concerns.
  • This midwife will also assess and triage women on their arrival to Delivery Suite.
  • One extra full-time midwife per shift will be allocated for this position. This midwife will carry a mobile phone which will be dedicated to this purpose.
  • Medical staff will see women as required, after initial assessment by the midwife and according to established guidelines.
  • Women who have non-urgent reasons for medical or midwifery review may be redirected to an outpatient clinic for review or to their nominated GPSC provider.

Expected benefits

  • Safer care for women through effective triage processes
  • More efficient flow of women through Birthing Services
  • Increased opportunity for core staff to provide 1:1 care in labour- including access to Birth Centre for more women
  • Consistency of advice to women who call DS for clinical advice

If you have any questions about this process please contact the triage no: 0439 869 035

 

Prenatal genetics update – preconception genetic carrier screening

 

Due to a number of recent newspaper articles and television programs on the topic you may have had an increased number of enquiries about preconception genetic carrier screening. Our service has definitely seen an increase in referrals and phone calls from couples planning, and early in pregnancy.

 

There are a number of carrier screening options available. One of the more established tests is the prepair™ test by the Victorian Clinical Genetics Service (VCGS). Prepair is a genetic carrier screen for cystic fibrosis (CF), spinal muscular atrophy (SMA) and Fragile X syndrome. These three genetic conditions have serious health consequences and are some of the most common inherited conditions in the general population. A similar test is also now available through Sonic genetics (DHM Pathology).

There are also larger carrier screening gene panels including the Counsyl Foresight Carrier Screen which looks for over 175 conditions including CF, SMA and Fragile X syndrome. The Virtus preconception screen looks at over 500 recessive conditions and can be arranged at a number of private ultrasound and IVF practices in Sydney.

All of these tests can be offered to individuals and couples who are considering or are in early pregnancy. If the couple is pregnant it is recommended to screen both parents at the same time to avoid delay in reporting. If preconception, it is advised to test the mother first.

There are out of pocket costs for all of these tests. None are currently publicly funded.

If there is a family history of a condition we encourage a phone call or referral to a genetic service (RHW Genetic counsellor: 9382 6099) as there might be more specific tests that need to be considered or that are more appropriate. Individuals who are identified as being carriers of any conditions on these screening panels can be referred to the Genetics service at RHW for further counselling.

Details and request forms can be found on these websites:

 

Fluvax & Boostrix

 

There are still women who have had their Boostrix and/or Influenza vaccinations at the GP practice which has either not been recorded correctly or not recorded at all on the yellow cards.

Can you please ensure the women have a record of Boostrix and Influenza vaccinations, this needs to include date given and batch number. The women need to give this information at her next antenatal visit @ RHW with either the Doctor or Midwife.

This information greatly assists in exposure follow-up, for example a 2 year old child with Pertussis for two weeks came with his mother to antenatal outpatients, ultrasound and Pregnancy Day Stay. This is a particular risk for women in their last month of pregnancy who may deliver while being infectious. We need to make sure all women exposed >36/40 had been vaccinated, if not they require prophylactic antibiotics. Documentation could be improved in a number of areas which will help to protect our patients.

 

 

Pathology results

 

Due to the overwhelming amount of pathology and ultrasound results that RHW OPD receive everyday via fax and mail can you please ensure that you do not copy RHW OPD or send via fax and that instead you give the original copies of all test results and scans to the woman to bring to her next antenatal visit @ RHW. Do not copy or fax results to RHW.

Any investigations requested by the GP for the woman under his / her care must be followed up by the GP. It is the responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up and communication. This eliminates multiple handling of results.

 

26-28 week blood test

 

Over the past few weeks, there have been a number of incidents whereby NO Antibody screen has been ordered for Rh Neg women. It is important to remember to add this screening when ordering the routine 28 week blood screening as when the women comes to RHW for her 30 week visit she also has her Anti-D 625IU injection.

If the Antibody Screen has not been ordered, the woman has to go and have this screening done before returning to OPD so the Anti-D 625IU can be administered.

 

Please remember to order an antibody screening on RH neg women at the routine 28 week blood test.

 

 

Cross Cultural Workers in Maternity & Child & Family Health Services South Eastern Sydney Local Health District

 

Referrals are welcome to the RHW Cross Cultural Worker, Galuh Sapthari, who is focused on working with women and families who are newly arrived migrants (less than 5 years), refugees or Medicare ineligible.

Galuh’s role is to:

  • Support and encourage women and families to access and maintain ongoing engagement through the continuum of maternity, child and family, and allied health services (until a child is 5 years of age)
  • Link women and families to pregnancy, child and family health services and community supports
  • Provide culturally appropriate information and education to women and their families, including language specific information, pregnancy and parenting programs.

Please find attached pdf interactive referral form (192 KB) and details of the FREE pdf antenatal group for Medicare ineligible women (210 KB) birthing at RHW.

Please contact Galuh if you have any questions:

Galuh Sapthari

Monday – Wednesday

Royal Hospital for Women Randwick

Tel: 02 9382 6107 Mobile: 0439 510 697 Galuh.Sapthari@health.nsw.gov.au