Friday, May 22, 2009

Am I Responsible?

'Am I Responsible?' was the theme of the professional study day presented by the Australian Nursing Federation in Carlton today.

Case studies were presented as examples of the complexities that nurses and midwives face in situations where their professional actions are investigated. Coroner Audrey Jamieson explained the Coroner's role in seeking answers when a death is investigated. Barrister Ron Gipp described legal respresentation given for a nurse who was required to attend the Coroner's Court. Nurses Board CEO, Nigel Fidgeon, presented the Board's role in investigations into professional conduct.

I am interested in these matters, and value the opportunity to consider the issues from the perspective of health care professionals generally. On occasions when I accompany a woman to hospital I am able to observe the practice culture of the unit, as well as the behaviours of individual staff members.

I have recently had reason to be very concerned about what appears to be a culture of carelessness concerning drug administration in a hospital maternity unit. The young midwife had reached the end of her shift and said to the midwife who was replacing her, "I have drawn up the Syntocinon (oxytocic). It's in the fridge (and pointed to the small fridge in the room)." The second midwife seemed happy with that, and did not make any comment.

There was no emergency situation. Baby had been born 30 minutes previously, and mother and baby were well. There was no bleeding. The mother had requested physiological Third Stage.

Hospitals may not have a 'guideline' or 'protocol' on physiological Third Stage. Most hospitals promote active management of the Third Stage. Many midwives in hospitals have had little experience with any part of physiological birth.

I am not criticising the fact that the drug had been drawn up. I am critical of the casual handover from one midwife to the next. There have been far to many cases when the wrong drug has been administered. In birthing suites there have been tragic cases such as mistaken administration of a dose of Syntometrine (Syntocinon and Ergometrine, a common oxytocic mixture used in Third Stage) to a woman in labour, in stead of an analgesic such as Pethidine. The oxytocic had been drawn up 'early' and kept on hand. When Pethidine was also drawn up but the standard checking and adminsitration by two midwives had not been followed, the mistake had taken place.

I had a quiet word with the midwife, and explained my concerns. There was no adverse event at the time, but I hope that by drawing attention to the matter I will be preventing tragic mistakes at some other time. Midwives who administer any medicine or substance to women in our care have a duty of care to take full professional precautions in every instance. Once we step outside 'Plan A' - spontaneous, unmedicated birth - and use drugs and other medical interventions, the risks to both mother and baby are upped. A midwife's competence in management of these medical substances and procedures is, for that woman, just as important as her competence in promoting normal birth.

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