Nursing Students Major Essays and Projects

St. Paul’s Hospital maternity guideline revisions Jammu, Rachanpreet 2012

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Background   Gestational Hypertension Interdisciplinary Practice Standard Review  Hypertensive disorders of pregnancy are a leading cause of maternal and neonatal mortality and morbidity in Canada.  Practice standards for the care of women with gestational hypertension are critical to ensure the health of both the mother and the baby.  New literature exists related to best practice associated with management of gestational hypertension.  There are also numerous existing practices and policies at different facilities in hospitals in British Columbia.   Epidural Interdisciplinary Practice Standard Review  Epidural analgesia is a common mean for pain relief  in labour. To ensure safe and effective practice, a review and revision of the existing epidural guidelines was necessary to incorporate evidence informed from the most current research literature. Additionally, the multiple existing epidural related guidelines required amalgamation into one user friendly interdisciplinary document. Purpose  Our clinical practice partner from St.Paul’s Hospital requested assistance in revision of selected maternity related practice standards. All clinical practice guidelines must be updated with new information every 4-5 years. Each of the following existing standards required review: • care of women with epidural analgesia in labour, • pregnancy induced hypertension, and • magnesium sulphate administration.  The purpose of this project was to create interdisciplinary guidelines that are clear, evidence based and user friendly.    Tools/Resources Overview of Project  This project was a collaboration between the clinical nurse specialist (maternity services) at St. Paul’s hospital and UBC SoN students.  The standards dealing with epidurals, hypertension in pregnancy and magnesium sulphate required a review. Students first performed an environmental scan by looking into the current guidelines at St. Paul’s hospital and other institutions such as Women’s and hospitals under Vancouver Coastal Health authority.  They proceeded to search for current practice guidelines and recommendations under Perinatal Services of BC, the Society of Obstetricians and Gynecologists of Canada and the World Health Organization.  A literature review was completed by looking at various databases such as Cochrane database of systematic reviews, PubMed and CINAHL to ensure that the revised guidelines included the most current evidence.  Students then revised the guidelines based on the new information and met with the clinical nurse specialist on various occasions to be sure that the changes would be feasible in practice.  Next Steps  The team of UBC SoN students have written, edited and submitted revised practice standards to the maternity clinical nurse specialist. There will be several more steps before the practice standards are approved. The standards will be circulated to several interdisciplinary committees within the hospital, who will also review them and make suggestions or revisions as needed. This process helps ensure that all disciplines have a chance to have input in the standards, and that they conform with the current evidence on best practice. Eventually, after the final revisions are completed, the standards will be ready to implement in the St. Paul’s Maternity Centre. St. Paul’s Hospital Maternity Epidural Standards Carrie Allen Corina Bob Shannon Rees Hypertension Standards Alison Koepke Rachanpreet Jammu


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