Organizing An Obstetrical Critical care Unit

Prof. M.C.Bansal. MBBS.MS. MICOG. FICOG.Founder Principal & controller; Jhalawar Medical College And Hospital, Jhalawar.Ex. Principal & Controller ; Mahatma Gandhi Medical College And Hospital, Sitapura, Jaipur.

Why An obstetrical ICU –Needed ?• Pregnancy alters maternal physiology with respect of all body organs and

systems.• In addition providing specific care to mother, we have to consider the

needs of unborn child , most likely to be influenced and affected by mother’s current health status.

• Pregnancy as well delivery poses risk of an extra and newer health problems and unwanted complications having adverse and life threatening effect on both mother and child.

• Addressing this complication prone population requires specific expertise care , not only obstetrician but also nursing and additional ancillary staff who can provide cardio -respiratory support or pharmaceutical intervention.

• Hence it is clear the need to develop multidisciplinary approach to provide optimal care ,under single roof, to critically ill obstetrical patients.

• Current reports , from obstetrical tertiary care centers, accepting referred cases , that 0.5-1% of their admissions do require an intensive care ---there by decreasing their mortality by 10 folds.

Criteria for admission in ICU

with decompensated function of

Staff pattern to help the skilled and experienced obstetrician IN ICU

Staff In ICU• Skilled and experience obstetrician as consultant.• Senior resident (ob & gy Discipline ) on floor duty .• Intensivists .• Respiratory Therapist.• Trained and skilled Nursing staff.• Clinical Pharmacist .• Ancillary Staff. Multidisciplinary team shall coordinately work and

provide, protocol driven care , assist in critical care decision taking ---going ahead with the processes along with having common goal to provide optimal , quality and evidence based care to the critically ill patient .

Charecterstics and job chart of Team Members---

• A. Obstetrician---Head of the team , should be skilled obstetrical care provider along with the skilled knowledge of maternal – fetal Medicine.

His skilled training in this field will help in assessing physiological changes in pregnancy in body systems and their effect in utero--- compromise / compensation and complication to fetus that can jeopardize the well being of fetus and mother.

Characterstics Sand job chart of Team Members---

• B. Intensivists-- physician--- Whose day to day work is in the management of

critically ill patient’s vital sign care– His skills help in early identification of forth coming complications and timely management on war footling , in reducing fetal and maternal mortality and late sequelies , reduce cost factor and hospital stay too.

Time to time he may need immediate help of specialists and super specialists of other medical disciplines as and when a new problem develops.

Characterstics Sand job chart of Team Members---

C . Nursing Staff— High risk obstetric nursing care requires a confident,

companssionate , skilled and well trained nurse willing to under take complexities and challenges of higher acuity care.

Staffing pattern should be should be 1:1 nurse to patient ratio.

At times it may be 2: 1 in cases of unstable patients. Her education and level of skill development --- as per

chart in next slide

Obstetric ICU nurse --- Qualification

Job Chart Of ICU-- Nurse• Patient’s bed side sitting --- general nursing care of

critically ill patient along with cardiopulmonary monitoring .blood draws .medicine administration .fetal monitoring with ETCG . Optimizing patient’s position , surveillance for symptoms and signs of Pre Term labour .

• She also helps to foster communication between obstetrician , Intensivists and family members who are waiting for time to time information about patient’s condition as the are naturally anxious and concerned.

Other Staffing• In order for appropriate clinical services to be provided

to the critically ill patient in ICU unit , ICU must have personnel whose main focus is on administrative details.

• It should be based on the guide lines developed by task force of American college of critical care medicine and its society.

• ICU unit must have designated medical and nursing directors who shall be responsible for assuring standard, appropriate triage through enforcement of patient admission , care and discharge criteria.

• These personnel will also promote continuing education, update the skills of clinical staff, improve and ensure maintenance of quality care being provided to patient.

Other staffing---• Implementing technical advancements , Maintenance of care protocols and all other facilities to

improve the patient care . Maintain safety against hospital born cross infection.

Other than these . Nutritional services, cleanliness disinfection, psychological support to patient and her relatives,

Out patient / home services through spiritual / social agencies also offer additional support to patient and relatives --- help and assist with emotion stress of ICU environment, quick recovery from disease process and even potential end to life.

Flow charts and proto calls for some critical conditions

GUIDELINES FOR OBSTETRICAL ICU CARE

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