Society Of Anesthesiology And Intensive Care: Factors And Best Practices

Factors that contributed to the death of Sarah James

Discuss about the Society of Anesthesiology and Intensive Care.

The research will involve the causes of maternal deaths amongst women and on the strategies that can be considered to be able to reduce the number of maternal deaths.  The paper will focus on a film that shade light on the causes of deaths of women at the end of their pregnancy.  In the film, Sarah James delivered her second daughter Grace the normal way through the vagina, but later on, she experienced vaginal bleeding.  She experienced vaginal trickling and boggy fundas that made it necessary for the midwives with the help of the doctor to transfuse her with blood and oxytocin from time to time.  Her condition only became worse, and later on, she had difficulties in breathing. Sarah was later taken to the theater after about an hour and 40 minutes of unmanaged vaginal bleeding.

The local private health center is unable to control the situation fully and thus refers her to a public healthcare by the name of St Helen’s, and at this time the doctors were not feeling her pulses. The emergency unit took some time to take her to the hospital because of the redirection that the doctor makes. The transfer is because of the need for Helen to acquire a quick hysterectomy. She later passed on at St Helen’s hospital because they were unable to manage her hemorrhage. The paper will give light on the prospects that are to be implemented to help mitigate the maternal deaths of innocent women in need of healthcare.

Data was attained stating that the number of deaths has declined from an approximated number of 35800 maternal deaths to 530000 deaths annually.  Africa and Asia report the most maternal deaths in women. The maternal deaths can be caused by factors that can be controlled. There are some causes of maternal deaths that are beyond the control of the health team. Such cases include indirect obstetric causes. The maternal deaths often occur within 42 weeks in instances that are related to the monitoring of the pregnancy.  The survival of a woman depends on the ability to acquire health care in time (Grönvall et al. 2014)

To begin with, Sarah James death was caused by the prolonged vaginal trickling a condition that was persistent. The condition led to her being hemorrhage, Sarah James had to be added blood frequently and even gauzes inserted in her vagina to stop the bleeding.  But more milligrams of blood kept on being lost. The intensive bleeding made her weak, and she started feeling tired. At the time of her transfer, she had lost 2litres of blood. The uncontrolled vaginal bleeding was the major cause of death ( Egenberg et al. 2015).

Communication and documentation

The other cause was the fact that there was poor coordination of the midwives and the doctor. The doctor was not around most of the time. The doctor was called most of the period and gave directions without a clear description of the condition of Sarah James. Oxytocin was administered to Sarah James most of the time yet the condition of the patient continued to deteriorate.  The decision to take Sarah James to the theater in the local health care was late, and the patient was in a severe condition.  After her theater session, things became even worse with the patient being unable to manage her airways.  The nurses watched the patient suffer yet they could not agree on whether to call the doctor or not.

Moreover, the doctor was not conversant with the condition that Sarah James was in, and so he had to take a lot of time researching on coagulation in patients. It is after some time that he discovered that Sarah was depicting signs of moderate anemia. Delays in diagnosis are a major cause of maternal deaths because of the delayed treatment process. The wrong prescriptions were being administered throughout the session. Lack of proper technical knowledge in the field of health has made it difficult for patients to acquire quality healthcare (Bolin et al. 2014). Sarah had to wait for so long for Doctor Krite to admit that he and his team could not help her.

There was the delay in reaching care.  The emergency team that was first called by the midwife to take the patient to St. Margaret health center that was a private hospital. Dr. Krite redirected the doctor that was on shift that the patient should be transferred to St Helen public hospital.  Sarah was referred to a modernized hospital, where Sarah James could acquire a prompt hysterectomy. The delayed decision to the right medical care was a major cause of her death.  Therefore, the cause of the death was controllable.

Lastly, the death of Sarah James was caused by lack of proper medical care. The local health care that Sarah James chose to visit lacked the facilities to administer the best care to Sarah James. The medical center lacked its emergency services transport. The local medical center was unable to administer hysterectomy to Sarah James. Delays could not otherwise be sustained if the facilities were present at the institution. Under development of medical centers is a major cause of maternal deaths.

Best Clinical Practice Recommendations in the management of a PPH

Communication between the Sarah James and the caregivers was apt.  Sarah was spoken to politely throughout the session. In addition, the caregiver talked to her every time asking her on how she was feeling. Sarah was informed on what she was being injected with every time an injection was being administered to her. It is also significant that before Sarah was taken to the theater, she was explained to what she was to undergo. She was then made to sign a document agreeing to be taken to the theater.

In addition, every time she had blood pressure and the temperature was assessed, the data was recorded in her medical report immediately (Jorgenson, 2013). It was identified that documentation of the records was inaccurate because the caregivers were talking and thus the caregiver that was assessing Sarah James was unable to take down data regarding her pulse rate. It is evident that the caregivers were so tensed to keep the records more so at the time that Sarah James was in the recovery room. The other shortcoming in the manner of communication was the inability to listen to what the other caregiver was saying and thus there was no coordination of ideas (Dahlke et al. 2015).

The quantity of blood that was lost was not measured at any juncture. The midwives just looked at it and threw away the blood soaked clothes. The practice is questionable, but there is no evidence that indicates that the caregivers are supposed to measure the amount of blood (Chi,2015).The blood quantity was just approximated. It was appropriate for the caregivers to study the blood loss from Sarah James from time to time. The use of oxytocin was appropriate for the control of PPH (Lavigne?Lissalde, 2015). In addition, the health center also applied the best practice recommendations by incorporating prostaglandin gels in the case of Sarah James.

 The use of oxytocin is important for patients with PPH because it is very effective than other drugs. In addition, oxytocin can easily be combined with other drugs such as prostaglandin, ergometrine and carbetocin thus it is very apt. Conversely, the drug has limited side effects to the patients. Such a drug is the most relevant in the case of a woman having the PPH for it will not further her infections (Le Gouez & Mercier, 2016).  Oxytocin performs the role of reducing the blood loss of a woman with PPH

First and second-line drug and fluid management

The first and the second line drugs were not well managed. The best practice recommends that for PPT to be well managed; then oxytocin should be combined with ergometrine, carbetocin and the prostaglandins (Liu et al. 2014). Only prostaglandins were combined with oxytocin. In addition, there was poor management where the caregivers did not administer ergometrine after the dose of oxytocin failing to stop the bleeding that Sarah James was experiencing.   The patient was transfused with blood from time to time to make sure she had enough blood (Hofmeyr & Qureshi, 2016).

According to the best clinical practice recommendations, the caregivers are required to give a dosage of 20 units in managing complications that occur in pregnancies. In the case of Sarah James, the local health care was giving Sarah 5 units of oxytocin in the third stage. After some time, after the direction of the doctor, the midwife was to administer 40units   in one Litre of normal saline that was to be given the frequency of 125ml per hour. In the case of the best practice requirement, a patient that is using the drug should be given 20units in a Litre of fluid and then 40 drops given to the patient in intervals of one minute (Sentilhes et al. 2016).  The best practice requirements were not critically followed by the caregivers. The overdose of the drugs could have resulted to the seriousness of the case of Sarah James.

It is also important to note that the caregivers were efficient in identifying that oxytocin was the most effective drug for the management of complications of pregnancies. At the juncture that a patient is identified to have symptoms of PPH, she is supposed to be massaged (Mishra & Doke, 2015). In the case of Sarah, the massage was not administered immediately. It was only done once, and though it helped reduce the bleeding, the midwives did not persist on it alongside other medications. The massage of the fundas is recommended because it is easy and it reduces the medical costs that could be sustained if another practice was administered.

 The uterus packaging is appropriate in reducing a blood loss. It is important that Sarah James had her uterus packed with four gauzes at the theater to control her bleeding. It is contrary to the case that uterus packaging helps in reducing the chances of getting a hysterectomy (Salati  & Tolosa, 2016).  In the case of Sarah James, she had to be transferred to another medical center for the invasive procedure. The uterus packaging was either delayed, or it was not done in the proper way.

There should be a chain of command in the monitoring of PPH. Before the midwives administer any treatment, they should be advised by the physician in control. Therefore, it is evident that the midwives that were taking care of Sarah James were keen to follow protocol before engagement in any practice. The process to a great extent delayed the medication process because the doctor had to be reached every time through a call. Before a patient is referred to another medical center, a protocol must be followed (Seacrist & Noell, 2016). In this case, delays can be experienced because of the lags that are experienced before decisions are reached more so when the doctor or the one in authority is far away. The principles create formality on operations, but they have implications.

A woman experiencing PPH as a result of continuous bleeding after a vaginal birth should be monitored sensitively by medical practitioners. The situation poses a great risk to the woman. It is evident that there are symptoms that may depict that a patient is not responding to the treatment that is being administered (Macrae  & Draycott, 2016).  If the patient becomes weak, cannot communicate and also has difficulty in breathing then the patient‘s condition is deteriorating.  In the case of Sarah James, she had all these symptoms, and yet they were not taken seriously at the beginning. It was until the caregivers studied her pulse rate that the doctor had to refer her to another hospital.  It is with certitude that the life of Sarah could have been saved. If at the point that she became weak and her temperature and blood pressure were at critical point she could have been referred to a modernized hospital, then she could have survived. It is not moving for a doctor to carry out a research on the condition of a patient at a time that the patient is at a critical point. The doctor must be conversant already with the cases of coagulation (Behling & Renaud, 2015).

Teamwork was properly carried out by the team at the hospital. The midwives worked in twos at the beginning and after Sarah delivered her daughter Grace. The midwives communicated from time to time. Throughout the time that Sarah was in the hospital, there was teamwork (Jackson & Tuckey, 2017).  The midwives accompanied Sarah to St Helen medical center where she is referred. The problem arises when the doctor makes his decisions before the consultation, and the other team members are confused.

The doctor later redirected the midwives to transfer Sarah to a public hospital yet initially they had agreed that the patient should be taken to a private hospital.  The caregivers were concerned about the condition of Sarah, but the problem was that they did not respond in time. Teamwork should be more effective in the time of turbulence at a medical care which was not the case. Delays were caused by calling and the arrival of the emergency team (Varghese et al. 2015).

Training should be administered to most of the medical practitioners. Training enables the caregivers to be more conversant with the medical procedure. For instance in the case of measuring the amount of blood loss of a patient that is suffering from  PPH. Training will help in the efficiency of most of the procedures that are undertaken in the health centers (Rousseau et al. 2016).   In addition, patients should be informed of the way to go about when they notice some symptoms. Like in the case of Sarah, if she was informed that her condition could not be treated in the local hospital, she could have advocated being taken to another medical institution. The emergency services more so those of the transport sector should be quick to respond to emergencies. Like in the case of Sarah, the emergency services team delayed a bit when they were summoned.

Communication should always be effective amongst the team members at health facilities. For instance, most of the time the doctor was not around, and he only checked on Sarah on very few occasions (Wikkelsø et al. 2015). The collaboration of all the team workers would create more sensitive care to patients that suffer from pregnancy complications. It is also important for a health care to have its emergency services vehicle that can help in timely transportation of patients to referral hospitals.

Conclusion

There is an indication that a lot of women and not just Sarah James have lost their lives in cases related to complications of pregnancy. The cases are serious because they have led to massive deaths in women. The fact that some of the causes of the deaths could be controlled is so sad. It is evident that more developments and training should be done in health care facilities so that they can better give quality health care to patients with obstetric complications. Ethical standards should always be incorporated in medical care for the best results. The ability to save lives makes the health care sectors to earn the respect that they deserve. It is important for all stakeholders in the healthcare sector to diversify research and engage in the best practices so that the best care is given to women with PPH

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