Structured Oral Assessment Examination – 13.01.2006
Instructions to the candidate
You had been appointed as a new Consultant to a teaching hospital and have been asked to set up Risk Management in Obstetrics.
You will be asked a number of questions by the examiners.
- What is the purpose of risk management?
1 . To learn from adverse events and prevent them in future (10)……
2 . To minimise the risk of morbidity and mortality (10)……
3 . To minimise the risk of adverse events ending in litigation(10)……
- How would you set about risk management in your maternity unit?
- Set up a multidisciplinary group (10)……
2. List trigger events (10)……
3 . System for identifying events (devise a form) (10)……
- Who would you have on the group and who should take the lead?
Representatives from Obstetrics (Labour ward lead and another), midwifery and nursing staff, anesthesiologist, neonatologist, trainee, administrator , a patient representative. (20)……
- What sort of criteria or trigger events for inclusion in risk management programme?
- Mention at least five. (30)……
Illustrative list
PPH more than 1500 ml
Eclampsia
Third or fourth degree tears
Hysterectomy
Inta partum still birth
Babies over 2500 g with severe hypoxia
Caesarean sections not done within specified time limits
Scar dehiscence
Patients’ complaints
*Not abnormal CTG tracings, pre-eclampsia, breech or twins
- How would you act on any one of these adverse events?
Discuss case in group, coming out with an analysis of where things went wrong in management. Identify root causes.
Design or amend protocols to minimise the likelihood of system failures (If need be designate senior individual to speak to individual clinicians).
Provide written report of case analysis and action points for distribution to all staff. Highlight changes and amendments to protocols and procedures. (30)……
- A primigravida at 38 weeks with a small baby is induced at a base hospital with no neonatal facilities. She develops fetal distress and is transferred to your hospital.
- After admission she is seen first by the house officer and then the registrar who decides that a caesarean section is indicated (The cervix is three cm dilated.
- The fetal heart is 90 beats/ min and there is meconium staining). One and a half hours after admission she is sent to the theatre.
- The baby who weighs 2.3 kg has an Apgar of 1 and 5 is transferred to the neonatal unit in poor condition.
What are the issues? How would you prevent them in future?
- Protocol for peripheral hospitals to prevent induction with small babies. (10)……
- Protocol for mothers admitted with fetal distress (10)……
- Examine reasons for delay in theatre and amend time limits if necessary (10)……
Global mark (10)…….
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