Management of Prelabour Rupture of Membranes at Term, at Northland District Health Board.

10.26686/wgtn.17151827 ◽

2021 ◽

Author(s):

◽

Rebecca Hay

Keyword(s):

New Zealand ◽

Maternity Care ◽

Postpartum Haemorrhage ◽

Special Care ◽

Labour Induction ◽

Health Board ◽

District Health ◽

Clinical Notes ◽

Increased Risk ◽

One Year

Background Prelabour rupture of membranes at term (PROM) is a subject of interest to women and maternity care providers alike. Management of PROM varies internationally, and regionally within New Zealand, despite the presence of interprofessional consensus statements. Northland District Health Board (NDHB) policy differs from most maternity care facilities by enabling expectant management of labour for women at low risk of transmission of Group β Streptococcus to their baby to extend to 96 hours from time of rupture of membranes. This study aimed to explore whether the NDHB policy was applied in practice and safely served the needs of women and babies in this DHB. Methods A retrospective quantitative clinical notes review was conducted of files in a one-year sample. The clinical notes of 123 women who had duration from ROM to birth at term of 18 hours or more were reviewed. Statistical comparisons using percentages, means and odds-ratios were made to a one-year sample of all other births at term at NDHB facilities, and with birth data from the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD). Findings Variables including demographic data, antenatal and intrapartum care given, time factors and outcomes themselves were reviewed. Few variables impacted outcomes within the PROM sample, though use of intravenous oxytocin was associated with increased epidural use and increased incidence of instrumental birth. Wāhine Māori had an increased incidence of vaginal births but some variables and outcomes highlighted inequities, including reduced antenatal screening, a higher incidence of maternal smoking, severe postpartum haemorrhage, and admission to Special Care Baby Units. Duration splits at 48 and 96 hours were applied to identify whether time increased risks for women or babies, but duration did not appear to be a factor which increased risk. The phenomenon of PROM itself increased risk for women and babies, increasing rates of labour induction, augmentation, epidural use, operative births, postpartum haemorrhage, admission to Special Care Baby Units and decreased exclusive breastfeeding at discharge. Conclusions The NDHB PROM policy appeared to be applied consistently and did not appear to increase risk for women and babies. Risks were increased for all women with PROM, with some inequitable outcomes for wahine Māori and pēpi. This research provides a comparison which is informative for clinical practice, education, and future research, and supports women’s involvement in decision-making.

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Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

New Zealand College of Midwives ◽

10.12784/nzcomjnl57.2021.6.41-48 ◽

2021 ◽

Vol 57 ◽

pp. 41-48

Author(s):

Rachel Cassie ◽

Christine Griffiths ◽

George Parker

Keyword(s):

New Zealand ◽

Thematic Analysis ◽

Maternity Care ◽

Interprofessional Collaboration ◽

Theoretical Perspective ◽

Positive Interactions ◽

Health Board ◽

District Health ◽

Interprofessional Communication ◽

Aotearoa New Zealand

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

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Knowledge Translation in Action: An Evaluation of the Implementation of Customised Birthweight Centiles at One New Zealand District Health Board

10.26686/wgtn.16997155 ◽

2021 ◽

Author(s):

◽

Malia Noelani Lardelli

Keyword(s):

New Zealand ◽

Knowledge Translation ◽

Gestational Age ◽

Implementation Process ◽

Large For Gestational Age ◽

Health Board ◽

Care Providers ◽

District Health ◽

Physiological Variables ◽

Increased Risk

Identifying small for gestational age (SGA) and large for gestational age (LGA) babies is important, because these babies may be at increased risk of hypoglycaemia at birth. It is proposed that customised birthweight centiles (CBWC) can more accurately identify these babies by taking into account several physiological variables of the pregnancy affecting birthweight. These variables are: maternal height and booking weight, ethnicity, parity, the baby's gender and gestation. CBWC for a New Zealand (NZ) population were developed by McCowan, Stewart, Francis and Gardosi (2004), and can be downloaded for free from www.gestation.net. Using CBWC is not in common practice in NZ, even though its use was discussed in a 2007 Health and Disability Commissioner report in relation to neonatal hypoglycaemia. The setting for the study was a NZ District Health Board (DHB) that calculates a CBWC for each birth. The research question asked how the evidence behind CBWC was put into practice and what outcomes resulted from translating this knowledge into action. This was a mixed methods evaluation which included interviews, focus groups, an audit and document analysis. The knowledge-to-action (KTA) framework (Straus, Tetroe, & Graham, 2009) was used as a theoretical template to describe the implementation process that occurred. The results revealed that maternity care providers were initially challenged by the evidence. But over time, guideline compliance improved as practitioners experienced the benefit of using CBWC in practice. All agreed that the CBWC calculator was user-friendly. However, the audit demonstrated it was easy to make a mistake or manipulate results when using the calculator. CBWC can help identify babies at risk of hypoglycaemia who otherwise would have been missed. But it is unknown what difference it had made in improving neonatal morbidity and mortality, due to insufficient data. But anecdotally, stakeholders felt it had made a difference. The findings demonstrated that knowledge translation is a complex process which is difficult to capture within a one-dimensional framework. However, using such a framework can identify what stages are needed to complete an implementation process.

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Knowledge Translation in Action: An Evaluation of the Implementation of Customised Birthweight Centiles at One New Zealand District Health Board

10.26686/wgtn.16997155.v1 ◽

2021 ◽

Author(s):

◽

Malia Noelani Lardelli

Keyword(s):

New Zealand ◽

Knowledge Translation ◽

Gestational Age ◽

Implementation Process ◽

Large For Gestational Age ◽

Health Board ◽

Care Providers ◽

District Health ◽

Physiological Variables ◽

Increased Risk

Identifying small for gestational age (SGA) and large for gestational age (LGA) babies is important, because these babies may be at increased risk of hypoglycaemia at birth. It is proposed that customised birthweight centiles (CBWC) can more accurately identify these babies by taking into account several physiological variables of the pregnancy affecting birthweight. These variables are: maternal height and booking weight, ethnicity, parity, the baby's gender and gestation. CBWC for a New Zealand (NZ) population were developed by McCowan, Stewart, Francis and Gardosi (2004), and can be downloaded for free from www.gestation.net. Using CBWC is not in common practice in NZ, even though its use was discussed in a 2007 Health and Disability Commissioner report in relation to neonatal hypoglycaemia. The setting for the study was a NZ District Health Board (DHB) that calculates a CBWC for each birth. The research question asked how the evidence behind CBWC was put into practice and what outcomes resulted from translating this knowledge into action. This was a mixed methods evaluation which included interviews, focus groups, an audit and document analysis. The knowledge-to-action (KTA) framework (Straus, Tetroe, & Graham, 2009) was used as a theoretical template to describe the implementation process that occurred. The results revealed that maternity care providers were initially challenged by the evidence. But over time, guideline compliance improved as practitioners experienced the benefit of using CBWC in practice. All agreed that the CBWC calculator was user-friendly. However, the audit demonstrated it was easy to make a mistake or manipulate results when using the calculator. CBWC can help identify babies at risk of hypoglycaemia who otherwise would have been missed. But it is unknown what difference it had made in improving neonatal morbidity and mortality, due to insufficient data. But anecdotally, stakeholders felt it had made a difference. The findings demonstrated that knowledge translation is a complex process which is difficult to capture within a one-dimensional framework. However, using such a framework can identify what stages are needed to complete an implementation process.

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Registered nurse prescribing: A descriptive survey of prescribing practices in a single district health board in Aotearoa New Zealand

Nursing Praxis Aotearoa New Zealand ◽

10.36951/27034542.2020.014 ◽

2020 ◽

Vol 36 (3) ◽

pp. 61-72

Author(s):

Melinda McGinty ◽

◽

Betty Poot ◽

Jane Clarke ◽

◽

...

Keyword(s):

Primary Care ◽

New Zealand ◽

Registered Nurse ◽

Health Conditions ◽

Health Board ◽

Prescribing Practices ◽

District Health ◽

Survey Tool ◽

Aotearoa New Zealand ◽

Descriptive Survey

The expansion of prescribing rights in Aotearoa New Zealand has enabled registered nurse prescribers (RN prescribers) working in primary care and specialty teams, to enhance nursing care, by prescribing medicines to their patient population. This widening of prescribing rights was to improve the population’s access to medicines and health care; however, little is known about the medications prescribed by RN prescribers. This paper reports on a descriptive survey of self-reported RN prescribers prescribing in a single district health board. The survey tool used was a Microsoft Excel spreadsheet to record nurse’s area of practice, patient demographic details, health conditions seen, and medicines prescribed and deprescribed. Simple data descriptions and tabulations were used to report the data. Eleven RN prescribers consented to take part in the survey and these nurses worked in speciality areas of cardiology, respiratory, diabetes, and primary care. Findings from the survey demonstrated that RN prescribers prescribe medicines within their area of practice and within the limits of the list of medicines for RN prescribers. Those working in primary care saw a wider range of health conditions and therefore prescribed a broader range of medications. This survey revealed that the list of medications available for RN prescribers needs to be updated regularly to align with the release of evidence-based medications on the New Zealand Pharmaceutical Schedule. It is also a useful record for both educational and clinical settings of the types of medications prescribed by RN prescribers.

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Modeling the Costs of Hospital-Acquired Infections in New Zealand

Infection Control and Hospital Epidemiology ◽

10.1086/502192 ◽

2003 ◽

Vol 24 (3) ◽

pp. 214-223 ◽

Cited By ~ 19

Author(s):

Nicholas Graves ◽

Tanya M. Nicholls ◽

Arthur J. Morris

Keyword(s):

New Zealand ◽

Economic Cost ◽

Cost Effective ◽

Sensitivity Analyses ◽

Primary Data ◽

Health Board ◽

District Health ◽

Hospital Acquired Infections ◽

Input Variables ◽

Hospital Acquired

AbstractObjective:To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.Design:Monte Carlo simulation model.Setting:Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.Patients:All adults admitted to general medical and general surgical services.Method:Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.Results:The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.Conclusions:The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.

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Community Governance and Civil Society: An Examination of the Purpose, Intent and Structure of Residents' Groups in New Zealand

10.26686/wgtn.17000653 ◽

2021 ◽

Author(s):

◽

Jarrod Coburn

Keyword(s):

New Zealand ◽

News Media ◽

Local Community ◽

Political Activity ◽

Health Board ◽

District Health ◽

Community Governance ◽

Set Up ◽

Civil Defence ◽

Charitable Activities

Residents’ groups have been in existence in New Zealand for almost 150 years yet very little is known about them. The collection of residents’, ratepayers’ and progressive associations, community councils, neighbourhood committees and the like make up a part of the community governance sector that numbers over a thousand-strong. These groups are featured prominently in our news media, are active in local government affairs and expend many thousands of volunteer hours every year in their work in communities… but what exactly is that work? From the literature we see these groups can be a source of local community knowledge (Kass et al., 2009), a platform for political activity (Deegan, 2002), critical of government (Fullerton, 2005) or help maintain government transparency and accountability (Mcclymont and O'Hare, 2008). They are sometimes part of the establishment too (Wai, 2008) and are often heard promoting the interests of local people (Slater, 2004). Residents’ groups can be set up to represent the interests of a specific demographic group (Seng, 2007) or focus on protecting or promoting a sense of place (Kushner and Siegel, 2003) or physical environment (Savova, 2009). Some groups undertake charitable activities (Turkstra, 2008) or even act in a negative manner that can impact on the community (Horton, 1996). This research examines 582 New Zealand organisations to derive a set of purposes that residents’ groups perform and ascertains how their purposes differ between geo-social and political locality and over three distinct eras of community development. The thesis also examines the relationship between residents’ groups and councillors, council officers, district health board members and civil defence and seeks to uncover if the level of engagement (if any) has an affect on their overall raison d’etre. The research concludes with a typology of New Zealand residents’ groups along with the key purposes of each type.

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Induction of labour and its feto-maternal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193037 ◽

2019 ◽

Vol 8 (7) ◽

pp. 2748

Author(s):

Mridu Sinha ◽

Shashi Bala Arya ◽

Shashi Saxena ◽

Nitant Sood

Keyword(s):

Vaginal Delivery ◽

Statistical Tests ◽

Post Partum ◽

Tertiary Care ◽

Relative Effect ◽

Induction Of Labour ◽

Labour Induction ◽

Time Period ◽

Increased Risk ◽

One Year

Background: Induction of labour is an iatrogenic deliberate attempt to terminate the pregnancy in order to achieve vaginal delivery in cases of valid indication. It should be carefully supervised as it is a challenge to the clinician, mother and the fetus. Aim of this study was to find out common indications for IOL in a tertiary care teaching centre and its feto-maternal outcome.Methods: An institutional based retrospective observational study was conducted to describe the prevalence of labour induction and factors associated with its outcome, during the time-period of one year from January 2018 to December 2018, at SRMS IMS, Bareilly. Logistic regression analysis was employed to assess the relative effect of determinants and statistical tests were used to see the associations.Results: Most of the patients were primigravidas of younger age-group. Idiopathic oligohydramnios and postdatism were the commonest indications for induction of labour and Misoprost was the commonest drug used for it. Though majority had vaginal delivery, as the method was changed to combined method it was significantly associated with increased likelihood of LSCS. Similarly there was increased association with maternal cervico-vaginal tear / lacerations as the method was changed to combined type. However there were no association between post-partum hemorrhage, meconium stained liquor or fetal distress.Conclusions: Common indications for induction of labour were oligohydramnios and postdatism. Misoprost can be safely used for induction of labour without any increased risk for LSCS or any fetal / neonatal risks.

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Use of aspirin and statins for cardiovascular risk reduction in New Zealand: The residential care story

Journal of Primary Health Care ◽

10.1071/hc09184 ◽

2009 ◽

Vol 1 (3) ◽

pp. 184 ◽

Cited By ~ 4

Author(s):

Jae Bon Hoem ◽

Ngaire Kerse ◽

Shane Scahill ◽

Simon Moyes ◽

Charlotte Chen ◽

...

Keyword(s):

New Zealand ◽

General Practitioners ◽

Residential Care ◽

Prescribing Patterns ◽

Health Board ◽

District Health ◽

Cardiovascular Risk Reduction ◽

Residential Care Facilities ◽

Care Facilities ◽

Social Debate

INTRODUCTION : Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality for older New Zealanders. Medication prescribing for secondary prevention of cardiovascular events in residential care is unknown and prescribing patterns for aspirin and statins by general practitioners (GPs) in residential care facilities in Auckland, New Zealand are reported here. METHODS: A representative sample of residential care facilities, all residents over age 65 years and their GPs in one district health board region in Auckland were recruited. Prescribing and medical records were audited by a trained nurse and medications coded into classes according to a standardised process. Diagnoses from summary sheets and hospital letters were recorded. Descriptive statistics were used to show variability in proportion of residents prescribed aspirin and statins. RESULTS: Of a total of 24 facilities approached, 14 consented to participate (58%); 537 residents (88% of eligible) agreed to participate and 533 completed the study. Residents took on average 8.3 (standard deviation 2.4) medications. On average 2.64 (range 16) GPs serviced each facility with eight GPs working in more than one facility. On average 54% of residents with documented CVD were prescribed aspirin and 31% of those with CVD and/or dyslipidaemia were prescribed statins. Variability between prescribers and facilities was high. DISCUSSION: Prescribing in residential care does not appear to be guidelines-based. The reasons for this are unknown. Ongoing social debate about the role of prevention for older people and interventions for GPs and residential care facilities may impact prescribing rates. KEYWORDS: Cardiovascular diseases; residential care; aspirin; statins; prescribing patterns; general practitioners

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