R.I.O.s in Maternity Care

Electronic Encyclopaedia of Perinatal Data (www.fawdry.info)Volume VI. MatRIOs (Realistic Input-Output Opportunties)

R.I.O.s in Maternity Care(Realistic Input/Output Opportunities)

using an Electronic Patient Record in Maternity & Neonatal Care

Version 48: 27th August 2007 (Original Version 1999)

as personally compiled, analysed and edited by

Rupert Fawdry , FRCS (Ed), FRCOG.Specialist in Maternity Care, Gynaecology and Medical Information Technology.

General Editor: Electronic Encyclopaedia of Perinatal Data (EEPD) Web site: www.fawdry.info31, St.Mary’s Way, Leighton Buzzard, LU7 2RX, United Kingdom

Home: 01525 37 01 37 Mobile: 077 68 97 44 13 e-mail: [email protected]

orc/o The Perinatal Institute, Crystal Court,

Aston Cross (off Rocky Lane), Birmingham B6 5RQTel: 0121 687 3400. www.perinatal.nhs.uk

Any Comments, Criticisms, Corrections or Suggestions for Improvement very welcome

© Rupert FAWDRY 2001-7 RISCOS: EEPD.06_RIOS.MDetail-48 (27th August 2007) i

IntroductionComputers in a hospital setting will only reduce the workload, stress and fear of litigation of health care workers (and thus becost effective) when they provide "Individual Patient Care” (especially “Patient Encounter Assistance" ) of a high standard.For the acute specialties (medicine, surgery, gynaecology, maternity care, paediatrics, orthopaedics etc.) this will depend on:

A) Identifying and Exploiting R. I. O.s (Realistic Input/Output Opportunities)Forget about replacing the hospital paper record with an electronic record. It is so impractical that it will almost certainly never happen, even if it eventuallydoes it will take decades before adequate technology is universally available (Sadly, millions will continue to be wasted on such fantasies by the combinationof gullible clinicians and plausible computer salespersons!) Instead it is essential to identify when it might be truly practical for data from paper records to beefficiently input into a computer terminal, without too much extra work for staff.

The computer can then be used to create an automatic output of sufficient useful paper printouts (expert suggestions, patient information leaflets, staffguidelines, letters and memos, and eventually laboratory requests etc.) as to make the work of data entry worthwhile in assisting the healthworker with thecare of that individual patient.

Because of the complexity of the computer programming involved this cannot be achieved by any local IT initiatives. Instead it will depend on thecreation of commercial computer programs for national use which will also in turn depend on:

B) High Quality Standardised National PaperworkA significant number of well motivated and experienced clinicians will need to be inspired (and funded?) to work creatively over many years using Desk TopPublishing and Information Sources (e.g. Cochrane etc) to create high quality (nationally?) standardised paperwork - Casenotes, Protocols, PatientInformation Leaflets, Guidelines, Operation Proformas etc

All hospital doctors will then gradually have to be persuaded to use a much more structured style of recording medical information e.g. a National PregnancyRecord, Operation Proformas, National Care Plans etc.

This document starts the process of documenting in detail what would seem likely to be required for the RIOs so faridentified for a fully functional maternity computer system .

© Rupert FAWDRY 2001-7 RISCOS: EEPD.06_RIOS.MDetail-48 (27th August 2007) ii

POTENTIAL OUTPUTS from each RIO

A. Relevant Risks IdentifiedThe computer will need first to set out on screen and / or on paper a list of all the "Risks Identified", on the basis of "Trigger Items" which are already in the patient's individualcomputer record. e.g. Trigger item: country of origin of the mother - India" therefore Risk Identified: "TB in baby" (Rule Based "Expert" systems)

B. Management Signposts (Guidelines)Next, when relevant, a list will be given of appropriate staff guidelines e.g. on the management of expectant mothers with heart problems, or post splenectomy. At the initialassessment appointment, where-ever possible such guidelines need to be printed out and added to the expectant mother's own personally held record so that all those providingcare will always know what the local and/or national policy is for the effective management of such a condition.

C. Relevant Tests SuggestedAt the end of the above set of questions, whenever relevant, a list of lab tests or other investigations, as suggested by data which are already in the patient's individual computerrecord, will be set out on screen e.g. Full Blood Count,Thalassaemia Test etc.

D. Communication - Letters, Memos etc SuggestedNext, whenever relevant, a list of suggested letters or memos etc will be set out on screen e.g. Memo to consultant's secretary re post-partum sterilisation, to paediatric departmentre need for BCG, to scan department to cancel further scans after a miscarriage etc.

Many of the printed outputs will include "Action Suggestions"

E. PrescriptionsIn time it should be possible at this point to have a list of suggested medications, and a system such that a prescription for any proposed drug or any other drug can be easilycreated. This section will probably be the most difficult to implement.

F. Suggested Patient Information LeafletsNext a list will be given, on screen, of patient information leaflets, which, again on the basis of data in the individual's computer record might be helpful e.g. "BCG for your baby","Your Emergency Caesarean", "Your Miscarriage"

G. Clinical TrialsA list will then be given of any clinical trials which this patient would be eligible to enter. An opportunity will then be given to provide further information on the trial for staff and forpatients or to initiate entry into any relevant trial.

© Rupert FAWDRY 2001-7 RISCOS: EEPD.06_RIOS.MDetail-48 (27th August 2007) iii

Template- RIOOn

NEEDEDSINBADS Demographics from PAS.PEOPLE Expectant Mother: Present. Presence not required. Data Entry by: Midwife (or Labour Ward Secretary?)PAPER Antenatal Paper Record (Pregnancy Notes, National Pregnancy Health Record, Green Notes or Local Antenatal Record)

FOUNDATION RESOURCESElectronic Encyclopaedia of Perinatal Data (Relevant Sections)See EEPDPCFILES.03_RESOURCE and 04_LOGICAL (BASIC DATA AT TIME OF GIVING BIRTH)

D1. Mother’s Demographic DataD2. Professional Support Staff Data (at time of Birth)

See IT.STANDARD.ANALYSIS.bPreg (PREGNANCY)P3. Retrospective Data about the whole of the Present Pregnancy

DISPLAY

INPUT(S)RF File Most Recent Local EPR

Title Name RF Version File Name

Ref BKL MP_BKL

OUTPUTS (-RIO)Depending on Local Policy Decisions and the Trigger, the following outputs will be either:1. Be printed out by computer automatically whenever a relevant trigger is present = A (“Automatic” ), or 2. Be offered to the user whenever the trigger is present but will only be printed out after confirmation by the person using the computer = O (“Optional” )

Formats: M = Short Memo, A = A4 Paper Printout, D = Draft Letter, S = Sticky Label, L = Information Leaflet, (Often Personalised) G = Guidelines, F = Laboratory Request Form,R = Reports.Any of these may in time be output electonically instead of on paper; with Memos being the first priority for this inovation.

Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR?

© Rupert FAWDRY 2001-7 RISCOS: EEPD.06_RIOS.MDetail-48 (27th August 2007) iv

M0. Generic RIOs

© Rupert FAWDRY 2001-7 EEPD.06_RIOS.RIOsM-47 (28th January 2007) M0-1

M0.1: REGISTRATION-RIORegistration of Expectant Mother or Patient

COMPLEXITY/EXPERT DOCUMENTATIONLocal EPR Registration Screen compared with NMRP (File: M0_GENERIC.REGISTRATION.RegNMRP)

INPUT(S)RF File Most Recent Local EPR


Registration Screen Reg

M0.2a: STATUS_GENERAL-RIOSpecial Features / Status of this Patient

SCREEN or PAPER OUTPUT / MODIFICATION OPPORTUNITYPermanent Problems Posting Routine

M0.2b: STATUS_PREG-RIOSpecial Features / Status of this Expectant Mother

SCREEN or PAPER OUTPUT / MODIFICATION OPPORTUNITYAnte-Natal Status Screen Status Oct 1994

M0.2c: STATUS_ANAES-RIOSpecial Features / Status relevant to the giving of an Anaesthetic to this patient


M0.3: LEAFLET-RIOAll by Request at any time (Optional)For appropriate selections of patient Information leaflets for different situations, see also on PC harddisk pathway: ELECT_TXT.LEAFLETS.GENERAL.Refill

OUTPUTS Latest

Title Filename Version

A. NON SURGICAL GYNAECOLOGYIrritable Bladder BladIrr Jan 2007True Stress Incontinence BladTrue Jan 2007Countries not Cars – Introduction CorCGen Jan 2007Countries not Cars – Hormones CorCHorm Jan 2007Countries not Cars – Law CorCLaw Jan 2007Fibroids Fibroids Jan 2007Small Benign Ovarian Cysts OvCysts Jan 2007Vaginal Ring Pessaries RingPess Jan 2007Gynaecology “Step” Options Steps Jan 2007Steps Explained StepMore Jan 2007Vulval Dystrophy VulvDyst Jan 2007Irritable Bowel BowelIrr Jan 2007Countries not Cars - Medical Education CorCMed Jan 2007Cystitis Cystitis Jan 2007Strengthening the Pelvic Floor PelvFloor Jan 2007Thrush Thrush Jan 2007


B_OPLEAF (Gynaecology Operations)Bartholin‘s Cyst or Abscess Bartolin Jan 2007Colposuspension Coplsusp Jan 2007Cone Biopsy Cone Jan 2007Standard Consent Form Consent Jan 2007Consent Form using Leaflet ConsLeaf Jan 2007D&C / Hysteroscopy DandC Jan 2007Day Unit Instructions (NHS) DayInst Jan 2007Day Unit Instructions (PP) DayPP Jan 2007Welcome to Day Bed Unit DayWelc Jan 2007Cervical “Erosion” Erosion Jan 2007Fentons Operation Fentons Jan 2007Hysterectomy Hyst Jan 2007Hysterectomy Choices HystOpts Jan 2007Diagnostic Laparoscopy LapDiag Jan 2007"Your Laparotomy" Leaflet Laprtomy Jan 2007"Sterilization of the Female by Laparoscopy" Leaflet LapSteri Jan 2007Stamey Stamey Jan 2007Reversal of Sterilisation SteriRev Jan 2007Early TOP TOPEarly Jan 2007Vaginal Repair VRepair Jan 2007Waiting Lists WaitList Jan 2007Endometrial Ablation EndoAbl Jan 2007Thermal Endometrial Ablation EndoTher Jan 2007


C_PREGA (Screening, Early Pregnancy)Welcome to Ante Natal Care ANCWelc Jan 2007Choices for Maternity Care Choices Jan 2007

EARLY PREGNANCY ASSESSMENT UNITEmpty Uterus - Possible Ectopic E_Empty Jan 2007Healthy normal pregnancy E_Health Jan 2007“Your Miscarriage" Leaflet E_Miscar Jan 2007Scanty Curettings - Possible Ectopic E_Scanty Jan 2007Threatened Miscarriage E_Threat Jan 2007Missed Abortion or Hidden Miscarriage E_Hidden Jan 2007

SCREENINGAnte Natal Serum Screening S_SerumSc Jan 2007Spina Bifida Test: Increased Risk S_AFPup Jan 2007Downs Test: Increased Risk S_Downs Jan 2007Planned Amniocentesis S_Amnio Jan 2007Chorion Villus Biopsy (CVB) S_CVB Jan 2007Termination of Pregnancy S_EndPreg Jan 2007

ULTRASOUNDUltrasound in Pregnancy U_Scans Jan 2007Choroid Plexus Cysts U_Cysts Jan 2007Dilated Ureters U_DilUret Jan 2007"Hydatidiform Mole" Leaflet U_Mole Jan 2007Cardiac Golf Balls U_Golf Jan 2007Echogenic Gut U_Gut Jan 2007Nuchal Thickening U_Nuchal Jan 2007

C_PREGB (Obstetric and Medical)Checking Baby‘s Heart in Pregnancy CTG_Preg Jan 2007Placenta Praevia Praevia Jan 2007”Shirodkar Suture" Leaflet Stitch Jan 2007Symphysis Pubis Pain SymPain Jan 2007Toxoplasmosis in Pregnancy Toxo Jan 2007

APEC"Pre-Eclampsia" Leaflet (APEC) A_PET Jan 2007Pre-Eclampsia - Full Version for Staff (APEC) A_PETAll Jan 2007Low dose Aspirin (APEC) A_Aspir Jan 2007Eclampsia (APEC) A_Eclamp Jan 2007HELPP Syndrome (APEC) A_HELPP Jan 2007


D_BIRTH (Birth, Labour)"Home or Hospital Birth" Leaflet Home Jan 2007"Your Induction of Labour" Induct Jan 2007"Your Breech Baby" Breech Jan 2007"An Epidural for your Labour" Leaflet EpiLab Jan 2007Premature Rupture of Membranes Waters Jan 2007Checking Baby in Labour CTG_Lab Jan 2007Stillbirth due to Abruption of the Placenta AbruptSB Jan 2007“An Epidural for your Caesarean Section" Leaflet CSAwake Jan 2007Emergency C/S CSEmerg Jan 2007"Your Planned (Elective) Caesarean Section" Leaflet CSPlan Jan 2007After Caesarean: Vaginal or C/S CSScar Jan 2007"Sterilisation at the time of your Caesarean Section" Leaflet CSSteri Jan 2007Mini-Lap Sterilisation MiniLapS Jan 2007Laparoscopic Sterilisation LapSteri Jan 2007

E_POSTN (Postnatal)Perineal Care Perineum Jan 2007Grade Three or Four Tear Third Jan 2007Fentons Fentons Jan 2007

F_BABY (Neonate)Cremation S_Cremat Jan 2007Vitamin K. VitK Jan 2007Vitamin K by Mouth VitKOral Jan 2007Jaundice Jaundice Jan 2007Breathing Problems Resp Jan 2007BCG BCG Jan 2007Hip Problem Risk CDH Jan 2007Hepatitis B Vaccination HepB Jan 2007Hearing Risk Hearing Jan 2007Keeping Baby cool Cool Jan 2007


M0.A: WHEN_WHO-RIOLET

INPUTRF File Most Recent Protos


(Date), (Time) activity done by (Profession), (Name), (Grade), (Personal Code)

M0.X: OTHER PROTOS FILESProtocol Procedures (Checking Program) - File 1 MP_PROCProtocol Procedures (Checking Program) - File 2 MP_PROC2Protocol Procedures (Checking Program) - File 3 MP_PROC3

Referral MP_REFCommunity Discharge MP_CMDSC Community Referral MP_CMREF


M1. Initial Assessment RIOs

(Referral and Assessment)


M1.1: START-RIOOn receipt of "Booking" Letter from GP, or on receipt "Notification of Pregnancy" Proforma

NEEDEDSINBADS Demographics from PAS PEOPLE Expectant Mother: Not usually present. Data Entry by: Records Department Personel (or Labour Ward Secretary?)PAPER Free Text GP Referal Letter

or "Notification of Need for Pregnancy Care" Proforma (A Re-draft of the "A Birth in Milton Keynes" proforma)

FAWDRY DATA DICTIONARY (Relevant Sections)See IT.STANDARD.ANALYSIS.ABasic. (BASIC DATA AT TIME OF GIVING BIRTH)

A1. Mother’s Demographic DataA2. Professional Support Staff Data (at time of Birth)

COMPLEXITY DOCUMENTATIONNone?

INPUTRF File Most Recent Local Mat EPR


Referral for Maternity Care BKL MP_BKL

OUTPUTS (-RIO)Depending on Local Policy Decisions and the Trigger, the following outputs will be either:1. Be printed out by computer automatically whenever a relevant trigger is present = A (“Automatic” ), or 2. Be offered to the user whenever the trigger is present but will only be printed out after confirmation by the person using the computer = O (“Optional”) Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,


Acknowledgement of Receipt of Booking Letter All M (or e)? GP & Midwife A

M1.1b: BK_MIDWIFE- RIO Community Booking by a midwife. Probably needs to be made redundant


M1.2a: INIT_MIN- RIOLETFor inputing the minimal amount of Initial Assessment Data, where there are only terminals on theLabour Ward and Initial Assessment Data is entered until the mother arrives in Labour. The only dataitems which should be included in this minimal version are those essential for the paperwork after thebirth. For a fuller analysis see under COMPLEXITY heading

NEEDEDSINBADS Demographics from PAS.PEOPLE Expectant Mother: Not needed Data Entry by: Midwife (or Labour Ward Secretary?)PAPER Antenatal Record (Antenatal Paper Record (National Pregnancy Health Record, Green Notes or Local Antenatal Record)

FAWDRY DATA DICTIONARY (Relevant Sections)See below under INIT_FULL-RIO

COMPLEXITY DOCUMENTATIONSee below under INIT_SELECT-RIO

INPUT(S)RF File Most Recent Local Mat EPR


Essential Initial Assessment Protocol Essl Oct 1984 MP_BHCUT or MP_ESSI

OUTPUTSOnly as Part of BIRTH_AFTER-RIO


M1.2b: INIT_SELECT- RIOFor inputing the minimal amount of Initial Assessment Data, where the initial assessment process takesplace in the community without a computer terminal. The only data items which should be included inthis shortened version are (i) those that are essential for the serum screening process and (ii) thoseessential for the paperwork after the birth.

NEEDEDSINBADS Demographics from PAS.PEOPLE Expectant Mother: Presence not necessary. Data Entry by: Midwife (or Labour Ward Secretary?)PAPER Specifically Tailored Proforma (See INIT_FULL.PAPER.InitGN - Green Notes or InitNR - National Pregnancy Record)

or Antenatal Record (Antenatal Paper Record (National Pregnancy Health Record, Green Notes or Local Antenatal Record)

COMPLEXITY/EXPERT DOCUMENTATIONFilename: MidPreg = Proposed Selective Initial Assessment Data Set (See M1_INITIAL.2b_INIT_SELECT.COMPLEX



Selected Parts of Booking History

OUTPUTSDepending on Local Policy Decisions and the Trigger, the following outputs will be either:1. Be printed out by computer automatically whenever a relevant trigger is present = A (“Automatic” ), or 2. Be offered to the user whenever the trigger is present but will only be printed out after confirmation by the person using the computer = O (“Optional”) Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,


Serum Screening Test Request Request for Serum Screening F Pathology Lab A


M1.2c: INIT_FULL- RIOAt any time after the Initial Assessment Data has been recorded on Paper (or in some units before entering data on paper?)

STARTSINBADS Demographics from PAS PEOPLE Expectant Mother: Usually present. Data Entry by: MidwifePAPER Antenatal Paper Record (National Pregnancy Health Record, Green Notes or Local Antenatal Record)

COMPLEXITY DOCUMENTATION



GREEN NOTES VERSIONSocial History MP_HISTSMedical History MP_HISTMObstetric and Miscellaneous History MP_HISTOObstetric and Miscellaneous History MP_PGSUMPrevious Pregnancy Summary MP_PRPG

NATIONAL PREGNANCY RECORD VERSIONSummary of Questions SummInitial Assessment - A. First Section (Pages 1,2 & £) InitA Jan 1998 MP_INITAInitial Assessment - H. Health etc InitH Sept 1997 MP_INITHInitial Assessment - M. Medical History InitM July 2000 MP_INITMInitial Assessment - O. Obstetric Summary InitO Sept 1997 MP_INITOInitial Assessment - P. Past Pregnancies InitP Sept 1997 MP_INITPInitial Assessment - Y. Any Past Pregnancy InitY Sept 1997 MP_INITYInitial Assessment - Z. Last Section InitZ Sept 1997 MP_INITZ[Menstrual History Only MenstH Sept 1997]


M1.2c: INIT_FULL-RIO (Contd)OUTPUTS (-RIO)Depending on Local Policy Decisions and the Trigger, the following outputs will be either:1. Be printed out by computer automatically whenever a relevant trigger is present = A (“Automatic” ), or 2. Be offered to the user whenever the trigger is present but will only be printed out after confirmation by the person using the computer = O (“Optional”) Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,

Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR? ALLSummary of Positive Data / Problems identified All A4 or S Hospital Record A Sept 93 I1a(including Management Suggestions) A4 or S Maternent--Held Record? O ?Risk Scores? All A4 Hospital Record A Sept 93 I1cPositive Data from Initial Assessment All S? Maternent-Held Record A Sept 93 I1d“Confirmation of Booking” Letter All L GP (&/or Midwife) A Sept 93 2a"Congratulations on your Pregnancy" All I Expectant Mother A July 98"Ante-Natal Serum Screening Blood Tests" All I Expectant Mother O 2001 S_SerumSc"Welcome to the Consultant Antenatal Clinic" 1st Attendance at Consultant Clinic I Expectant Mother A July 98

REFERALS & LETTERSRequest for Information about a Past Pregnancy Difficult Pregnancy Elsewhere L Previous HospitaI O May 93 I2bAnaesthetic Problem Potential Anasthetic Problem L Anaesthetisits O May 93 I2cRequest for Medica l Consultation Major Medical Problem L Physicians O May 93 I2d

Request for Haematology Consultation PH of DVT or PE L Haematologist O Aug 93 I2e“Deep Vein Thrombosis” Leaflet PH of DVT or PE I Expectant Mother O

Request for Other Consultation Other L Other O

PLANNED OPTIONSAmniocentesis request If Amniocentesis Requested F Scan Department O"Your Planned Amniocentesis" If Amniocentesis Requested I Expectant Mother O 2001

Chorionic Villous Biopsy Request If CVB Requested F Scan Department O "Your Planned Chorionic Villous Biopsy" If CVB Requested I Expectant Mother O 2001

"Your Planned Caesarean " If for Planned Caesarean I Expectant Mother O 2001

"Your Planned Cervical Stitich " If for Shirodkar Planned I Expectant Mother O 2001



RISKS (See H_PROCESS.EXPERT directory for full details)

Thalassaemia Pathology Test Request Thalassaemia Risk Identified R Haematology Lab A"Checking for Thalassaemia Problems" Thalassaemia Risk Identified L Expectant Mother OThalasaemia Local Management Guidelines Thalassaemia Risk Identified G Staff OThalasaemia National Management Guidelines Thalassaemia Risk Identified G Staff O

Sickle CellPathology Test Request Sickle Cell Risk Identified R Haematology Lab A"Checking for Sickle Cell Problems" Sickle Cell Risk Identified L Expectant mother OSickle Cell Local Management Guidelines Sickle Cell Risk Identified G Staff OSickle Cell National Management Guidelines Sickle Cell Risk Identified G Staff O

HIV Pathology Test Request HIV Risk Identified R Haematology Lab OHIV Information Leaflet HIV Risk Identified L Expectant mother OHIV Local Management Guidelines HIV Risk Identified G Staff OHIV National Management Guidelines HIV Risk Identified G Staff O

LINKED FOR POSSIBLE IMMEDIATE FOLLOW-ON: a) TEST_REQ_INIT-RIOLET, & b) ANY ALERT RIOLETS


M1.2A: INIT_TEST_REQUEST-RIOLETInitial Assessment Test Requests.

These will usually follow immediately after the Initial Assessment but, to avoid taking blood twice, it is often the custom to postpone taking the Initial Blood Tests until the SerumScreening Blood tests are taken a few weeks later.

COMPLEXITY DOCUMENTATION“Antenatal Screening for Syphylis” Working Party Report

INPUT(S)All or which Tests required



Initial Assessment Local Blood Tests Requests All F Pathology Laboratory OInitial Assessment Regional Blood Transfusion Requests All F Regional Blood T Lab? ODating Scan Request All F Scand Department O


M2. Pregnancy RIOs


M2.1: EPAU-RIOEarly Pregnancy Assessment Unit (May need to include SURG_PREG-RIO, ANAE_PREG-RIO)

NEEDEDSINBADS Demographics from PAS, Pregnancy test Result from Laboratory.PEOPLE Expectant Mother: Present. Data Entry by: EPAU NursePAPER Early Pregnancy Assessment Record


A1. Mother’s Demographic DataA2. Professional Support Staff Data

COMPLEXITY DOCUMENTATIONAlgorythm on Data Entry and Selection of Relevant Outputs


Title Name RF Version File NameEarly Pregnancy Assessment Unit Epau-8 Sept 97 MP_EPAU

The above will often also include the following: SCAN-RIO, SURG_PREG-RIO, ANAE_PREG-RIO


OUTPUTS (EPAU-RIO)Depending on Local Policy Decisions and the Trigger, the following outputs will be either:1. Be printed out by computer automatically whenever a relevant trigger is present = A (“Automatic” ), or 2. Be offered to the user whenever the trigger is present but will only be printed out after confirmation by the person using the computer = O (“Optional”) Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,

Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR? (See Complexity Documentation)NO SURGERYA. HEALTHY Normal Pregnancy.Information for the Expectant Mother Normal Pregnancy Scan I Expectant Mother A 2001 E_HEALTHMemo to Community Midwife Normal Pregnancy Scan M Community Midwife AMemo to GP Normal Pregnancy Scan M General Practitioner A

B. THREATENED MISCARRIAGEInformation for the Expectant Mother Bleeding + Normal Preg Scan I Expectant Motehr A 2001 E_THREATMemo to Community Midwife Bleeding + Normal Preg Scan M Community Midwife AMemo to GP

C. INTACT SAC - NO FETAL HEARTBEAT - TOO EARLY? - FOLLOW-UP ARRANGEDMemo to Community Midwife Sac but No Heart M Community Midwife O Jun 93Memo to GP Sac but No Heart M General Practitioner O Jun 93

D. EMPTY UTERUS. PAST +VE PREGNANCY TEST- NO FOLLOW-UP CONSIDERED NECESSARYInformation for the Expectant Mother Empty Uterus, Possible Ectopic L Expectant Mother A 2001 E_EMPTYScan Department Memo. Cancel any Pregnancy Scans Empty Uterus, Possible Ectopic M Scan Department AMiscarriage Memo to Community Midwife Empty Uterus, Possible Ectopic M Community Midwife O Jun 93Miscarriage Memo to GP Empty Uterus, Possible Ectopic M General Practitioner O Jun 93

E. EMPTY UTERUS. NEVER HAD +VE PREGNANCY TEST- NO FOLLOW-UP CONSIDERED NECESSARYInformation for the Expectant Mother Empty Uterus, L Expectant Mother A 2001 E_NEVERLetter / Memo to GP Empty Uterus, Possible Ectopic M General Practitioner O Jun 93

F. MISCARRIAGE. POSSIBLE EVACUATION OF RETAINED PRODUCTS OF CONCEPTIONInformation for the Expectant Mother ERPC / Miscarriage I Expectant Mother A 2001 E_MISCScan Department Memo. Cancel any Pregnancy Scans ERPC / Miscarriage M Scan Department OMiscarriage Memo to Community Midwife ERPC / Miscarriage M Community Midwife O Jun 93Miscarriage Memo to GP ERPC / Miscarriage M General Practitioner O Jun 93

G. OTHERFree Text Memo to Community Midwife ERPC / Miscarriage M Community Midwife O Jun 93Free Text Memo to GP ERPC / Miscarriage M General Practitioner O Jun 93

IF SURGERY

I. INCOMLETE MISCARRIAGE - EVACUATION OF UTERUS


Scan Department Memo. Cancel any Pregnancy Scans ERPoC / Adequate Curretings M (or e) Scan Department OMemo/Letter to Community Midwife ERPoC / Adequate Curretings M (or e) Community Midwife A Jun 93Memo/Letter to GP ERPoC / Adequate Curretings M (or e) General Practitioner A Jun 93Information for the Expectant Mother ERPoC / Adequate Curretings I Expectant Mother A 2001 E_MISC

II. SCANTY CURRETINGS - POSSIBLE ECTOPICScan Department Memo. Cancel any Pregnancy Scans ERPoC / Scanty Curretings M (or e) Scan Department ALetter/Memo to Community Midwife ERPoC / Scanty Curretings M (or e) Community Midwife A Jun 93Letter/Memo to GP ERPoC / Scanty Curretings M (or e) General Practitioner A Jun 93Information for the Expectant Mother ERPoC / Scanty Curretings I Expectant Mother A 2001 E_SCANTY

& E_MISC

III. OTHER PREGNANCY RELATED SURGERYMemo/Letter to Community Midwife Other Pregnancy-Related Surgery M (or e) Community Midwife A Jun 93Memo/Letter to GP Other Pregnancy-Related Surgery M (or e) General Practitioner A Jun 93Memo/Letter to Scan Department. Cancel any Pregnancy Scans Other Pregnancy-Related Surgery M (or e) Scan Department OAppropriate Information for the Expectant Mother Laparotomy I Expectant Mother O 2001 LAPTOMY


M2.2: ANCARE RIOs & RIOLETSNEEDEDSINBADS Demographics from PAS PEOPLE Expectant Mother: Present Data Entry by: Midwife or GP or ObstetricianPAPER Antenatal Paper Record (National Pregnancy Health Record, Green Notes or Local Antenatal Record)

M2.2A: AN_CHECK_RIOLETBP & Urine Testing during Pregnancy

M2.2B: ABD_EXAM_RIOLETAbdominal Clinical Examination during Pregnancy

M2.2C: VAG_EXAM-RIOLETVaginal Examination when not pregnant or before 24 weeks Pregnancy


M2.2D: SCREENING_REQUEST-RIOLETData entry relevant to request for Serum Screening

COMPLEXITY/EXPERT DOCUMENTATIONData Set for Screening Program (Community Midwife to Hosp Computer) with Reasons

NEEDEDSINBADS Demographics from PAS.PEOPLE Expectant Mother: Presence not required. Data Entry by: Any Community Midwife. Screening Co-ordination MidwifePAPER Antenatal Record (Antenatal Paper Record (National Pregnancy Health Record, Green Notes or Local Antenatal Record)

or Paper Screening Request Form?

INPUT(S)See above INIT_SELECT-RIO or INI_FULL-RIO



Data required for Pathology Department Request All F (or e) Pathology Lab A

M2.2E: TEST_REQ_PREG-RIOLETRequests for Laboratory or other tests

Later Blood Test Request


M2.2F: IMAGE_REQ_PREG-RIOLETRequests for Imaging (inc Scans)

Pregnancy Scan Request -Anomaly Scan Request See Expert directory F (or e)? Imaging Dept O T4bSerial Scan Request See Expert directory F (or e)? Imaging Dept O T4cRequest for CT Scan Pelvimetry Jun 93Guy's Special Cardiac Ultrasound Test Request Jun 93

M2.2G: AN_CTG-RIOLETAnte-Natal CTG

M2.2H: LIST_BOOKING-RIOLETBooking the Date for a Caesarean, Insertion of Cervical Suture or other obstetric surgery

M3.2A:CERVIX-RIOLETClinical Vaginal Examination in Labour or late Pregnancy


M2.2a: AN_CLINIC-RIORoutine Ante-Natal Clinic

DATA INPUTAnte-Natal Clinic Visits MP_ANC

OUTPUTS Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,


Information Leaflets relevant to Pregnancy. See M0_GENERIC-RIOs.LEAF_PREG-RIO

M2.2b: AN_DIABETIC-RIODiabetic Ante-Natal Check

M2.2c: AN_HOME-RIODomiciliary Ante-Natal Care (includes data needed for Ante-natal Community Contact Return)

COMMUNITY EVENTSRecord Community Contact MP_CMCT

M2.2d: AN_LATE-RIOAntenatal Ward Attender or Late Pregnancy Assessment Unit Ward Attendance MP_ADTWAnte-Natal Day Unit Attendance MP_ADUAnte-Natal Day Unit Visit MP_ADUIN

M2.2e: AN_INPAT-RIOAnte-Natal Check while an In-Patient


M2.3: SCAN_REPORT-RIOIndividual Ultrasound Scans Report (inc Anomaly Scan)

NEEDEDSINBADS Demographics from PAS.PEOPLE Expectant Mother: Usually present. Data Entry by: Midwife (or Labour Ward Secretary?)PAPER Antenatal Record (Antenatal Paper Record (National Pregnancy Health Record, Green Notes or Local Antenatal Record)




COMPLEXITY DOCUMENTATIONScanAlgo, ScansSum (Oct 98), KINGS.Data-5



Scans Input Scans Oct 1998 MP_SCAN


M2.3: SCAN_REPORT-RIO (Contd)OUTPUTS (SCAN_REP-RIO)Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,

Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR?REPORTScan Report All A6-A4 Maternent-Held Record A

All A6-A4 Hospital Casenotes O

LABOTARTORY REQUESTSRequest for Cytogenic/Biochemical Study of Amniotic Fluid If Amniocentesis F (or e) Cytogenetics laboratory O Feb 93Request for Cytogenic/Biochemical Study of Chorionic Villous Sample If CVB F (or e) Cytogenetics laboratory O Feb 93

Multiple PregnancyManagement Guidelines Multiple Pregnancy on Scan Report G Scanning Staff OBABY_ALERT-RIOLET 3 or more fetuses on Scan ReportA4 (or e) Paediatruc Department A“TAMBA” Information Leaflet Multiple Pregnancy on Scan Report I Expectant Mother O

Echogenic GutManagement Guidelines Echogenic Gut on Scan Report G Scanning Staff O“Echogenic Gut” Information Leaflet Echogenic Gut on Scan Report I Expectant Mother O 2001 U_Gut

Cardiac Golf BallsManagement Guidelines Golf Balls on Scan Report G Scanning Staff O“Cardiac Golf Balls” Information Leaflet Golf Balls on Scan Report I Expectant Mother O 2001 U_Golf

Cardiac ProblemsManagement Guidelines Cardiac Problem on Scan Report G Scanning Staff OBABY_ALERT-RIOLET Cardiac Problem on Scan Report A4 (or e) Paediatric Department OReferral to Tertiary Centre Cardiac Problem on Scan Report A4 Specialised Cardiac Scans O

Choroid Plexus CystsManagement Guidelines Cysts on Scan Report G Scanning Staff OBaby_Alert Proforma and Sticky Alert Label Cysts on Scan Report A4 (or e) Paediatruc Department O“Choroid Plexus Cysts” Information Leaflet Cysts on Scan Report I Expectant Mother O 2001 U_Cysts

Dilated UretersManagement Guidelines Dilated Ureters on Scan Report G Scanning Staff OBABY_ALERT-RIOLET Dilated Ureters on Scan Report A4 (or e) Paediatruc Department A“Dilated Ureters” Information Leaflet Dilated Ureters on Scan Report I Expectant Mother O 2001 U_DilUret


M2.3: SCAN_REPORT-RIO (Contd)Hydatidiform MoleManagement Guidelines Hydatidiform Mole on Scan Report G Scanning Staff ORegistration of Mole with Recognised Centre Hydatidiform Mole on Scan Report A4 Charing Cross A May 93“Hydatidiform Mole” Information Leaflet Hydatidiform Mole on Scan Report A4 Guy’s Cardiac Scanning A 2001 U_Mole

Non-Viable or Sever Fetal AbnormalityGo to END-RIO Non-Viable Fetus

M2.4a: END-RIOEND- RIOEnd of Pregnancy without a Registered Birth in this District (Inc End of Pregnancy by Termination of Pregnancy)

NEEDEDSINBADS Demographics from PAS.PEOPLE Expectant Mother: Presence not required Data Entry by: Midwife (or Labour Ward Secretary?)PAPER Antenatal Record (Antenatal Paper Record (National Pregnancy Health Record, Green Notes or Local Antenatal Record)





INPUT(S) RF File Most Recent Local Mat EPR


Close Pregnancy Record MP_CLOSE


OUTPUTSFormats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,


"Ending a Pregnancy because of Fetal Abnormality" Non-Viable Fetus I Patient O 2001 S_ENDPREGNotification of Intention to Terminate a Pregnancy Medical Abortion Intention A4Notification of Medical Termination of a Pregnancy Medical Abortion Performed A4

Memo to Community Midwife End of Viable Pregnancy M (or e)? Community Midwife OMemo to GP End of Viable Pregnancy M (or e)? GP O

M2.4b: END_FUP-RIOEnd of Pregnancy without a Birth in this District (Inc End of Pregnancy by T of Pregnancy) Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,



M2.5a: ADMIT_PREG-RIOPregnancy / Maternity Admissions or Transfers (Inc Pregnancy in Gynae Ward)

Admission MP_ADTA

M2.5b: DISCH_PREG-RIODischarge MP_ADTD

Pregnancy / Maternity Discharges or Transfers (Inc Pregnancy in Gynae Ward)The above will/may need to include the following RIOLETS (See above): LATE_PREG_CLIN and LATE_PREG_VAG

Antenatal/Gynaecology In-Patient Care Discharge Letter

M2.6a: SURG_PREG-RIOSurgery during pregnancy without a Birth

M2.6b: ANAE_PREG-RIOAnaesthetic Input during Pregnancy - Not a Caesarean


M2.7A: ALERT_BABY-RIOLETWhen a Baby Alert needs to be sent to the Paediatricians

NEEDEDSINBADS None at present. Possible Data from any separate Fetal Anomaly Scanning Computer ProgramPEOPLE Data Entry by: User of RIO. Expectant Mother: Presence not required. PAPER None probably. or Hospital Record?

COMPLEXITY/EXPERT DOCUMENTATIONCurrent Paper Version of Baby Alert

INPUT RF File Most Recent Local Mat EPR


Baby Alert Protocol

OUTPUTS Automatic Latest RF RF In Local

Title Trigger Format Destination or Optional Version Code Mat EPR?

Memo to Paediatric Department As part of any Pre-Birth RIO A4 or M Paediatricians O

M2.7a: AWARE_BABY-RIOAction Suggestions by the Paediatricians in response to a Baby Alert

INPUT RF File Most Recent Local Mat EPR


Opportunity for Paediatricians to Document their Response PaedAware

OUTPUTS Automatic Latest RF RF In Local


Response by Paediatricians (Immediate) PaedAware M (or e) Informant & Consultant AResponse by Paediatricians (At time of BIRTH_BEFORE-RIO) PaedAware M (or e) Labour Ward A

M2.7B: ALERT_ANAES-RIOLETWhen an Anaesthetic Alert needs to be sent to the Anaesthetic Department


M2.7b: AWARE_ANAES-RIOAction suggestions by the Anaesthetic Department in response to a Anaesthetic Alert

M2.7C: ALERT_PHARM-RIOLETWhen a Pharmacy Alert needs to be sent to the Pharmacy

M2.7c: AWARE_PHARM-RIOAction suggestions by the Pharmacy in response to a Pharmacy Alert

M2.7D: ALERT_CARE-RIOWhen a Confidential Report needs to be sent (first) to the Midwifery Group Leader

M2.7d: AWARE_CARE-RIOAction Suggestions by the Midwifery Group Leader in response to a Confidential Alert

M2.7e: CHILD_PROTECT-RIOEntering a Baby onto the Child Protection Registert

M2.8: BK_CHANGE-RIOChange of “Booking” Arrangements at any time during pregnancy (before admission for Birth)


M3. Birth RIOs


M3.1: BIRTH_BEFORE- RIOAt the End of any pregnancy of more than 20 weeks gestation. Just before (or shortly after) childbirthComment: The RCOG Suggested STANDARD data set or any similar data sets will always include such questions as "Systolic Blood Pressure above 140 at any time during pregnancy" or"Suspected Intra-Uterine Growth Restriction at any time during pregnancy" or "Ante-Partum Haemorrhage at any time during pregnancy" etc. etc. Such information may sometimes alreadybe on the computer but most often data entry will be incomplete. This RIO is intended to provide an opportunity to make sure any such information is complete

NEEDEDSINBADS Demographics from PAS.PEOPLE Expectant Mother: Present. Data Entry by: Midwife (or Labour Ward Secretary?)PAPER Antenatal Paper Record (National Pregnancy Health Record - Antenatal Section, Green Notes or Local Antenatal Record)




INPUT PROTOCOL(S)MP_PSUMM Present Pregnancy Summary

OUTPUTS (-RIO)Depending on Local Policy Decisions and on the Trigger, the following outputs will be either:1. Be printed out by computer automatically whenever a relevant trigger is present = A (“Automatic” ), or 2. Be offered to the user whenever the trigger is present but will only be printed out after confirmation by the person using the computer = O (“Optional”) Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,

Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR?LABOUR MANGEMENT SUGGESTIONSDiabetic Mangement Guidelines See 05_SIGNPOSTS. G Labour Ward Staff OCardiac Patient Mangement Guidelines See 05_SIGNPOSTS G Labour Ward Staff O


M3.2: BIRTH_DURING- RIOData Entry during a Birth Event


M3.3a: BIRTH_AFTER- RIOData Entry after a Birth Event

NEEDEDSINBADS Demographics from PAS should already have been transferred with BIRTH_BEFORE-RIOPEOPLE Expectant Mother: Present. Data Entry by: Midwife (or Labour Ward Secretary?)PAPER Antenatal Record, Labour Record, Labour CTGs

ELECTRONIC ENCYCLOPAEDIA (Relevant Sections)

See IT.STANDARD.ANALYSIS.cMother (M. MOTHER) Only ONCE even if multiple birthsM1. LabourM2. Pain Relief for LabourM3. Route of Birth. Method of Birth - See under “Baby”M4. Caesarean DataM5. Retrospective of the whole of this Birth EventM6. Analgesia/Anaesthesia for BirthM7. Post Delivery Analgesia/Anaesthesia

See IT.STANDARD.ANALYSIS.dBaby (B. BIRTH & BABY) May differ for each baby if multiple birthsB1. BirthB2. LabourB3. Method of BirthB4. Birth InterventionB5. Membranes and LiquorB6. Birth Anaesthesia / AnalgesiaB7. Professional Staff Present at BirthB8. Baby (including Resuscitation)


See M0_GENERIC.EXPERT


M3.3a: BIRTH_AFTER- RIO (Contd)DATA INPUT (BIRTH_AFTER-RIO)

RF File Most Recent Local Mat EPR Title Name RF Version File Name

BIRTH A (Labour) BirthA Oct 94 MP_BIRTA.TXTLabour: Y/N, if Y then Labour Spontaneous or Induced, etc

BIRTH B (Birth) BirthB Oct 94 MP_BIRTB.TXTSeparately for each birth, mainly regardless of Method of Delivery

BIRTH C (Delivery) BirthC Oct 94 MP_BIRTC.TXTSeparately for each birth, flow-pattern depending on Method of DeliveryBABY (Resuscitation, Neonate) Baby Oct 94 MP_BABY.TXT

CONFINEMENT (THIRD STAGE) Conf Oct 94 MP_CONF1.TXT, MP_CONF2.TXT,Matters regarding the mother, after the birth has taken place


M3.3a: BIRTH_AFTER- RIO (Contd)POSSIBLE ACTION SUGGESTIONSPostnatal Rubella Vaccination See EXPERT.MOTHER.Rubella


Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR? MOTHER

MOST BIRTHS. MOTHER-RELATED (BM)Birth Memo for immediate dispatch to GP All Births M (or e) Health Centre/Surgery A May 93 BM1aBirth Memo for immediate dispatch to Community Midwife All Births M (or e) Community Midwife A May 93 BM1bBirth Memo for immediate dispatch to Health Visitor All Births M (or e) Health Visitor A May 93 BM1cBirth Memo available to use free text to any required destination If requested M (or e) Health Centre/Surgery (O) May 93 BM1d

Birth Event Summary All A4 Post Natal Record A Jun 94 BM2Copy of Birth Event Summary If Mother requests A4 Mother O Jun 94 BM2Data relevant to the Midwifery Care Process All A4 Post-Natal Ward A May 93 BM3Appropriately Worded Congratulation Letter If Livebirth L Mother A Sept 93 BM4

PROBLEMS/NEEDS. MOTHER-RELATED (BN)Perineal Care If Episiotomy or Tear P Mother ? Mar 01 PERINEUMGrade Three or Four Perineal Tears If Grade III or IV Tear P Mother A Mar 01 THIRDMemo on the Need for Grade III or IV Perineal Tear Follow-up All Grade III or IV Tears M Medical Secretary A Oct 97 BN1

“Your Laparoscopic Sterilisation” If Post-Partum Steri agreed PMother O Mar 01 LAPSTERI

Memo regarding Postnatal Sterilization If Sterilisation agreed M (or e) Medical Secretary A May 93 BN2

Memo on the Need for Postnatal Rubella Vacination If Rubella Antibodies absent M To be clipped to Notes? A May 93 BN3

Memo on the Need for Anti-D Injection If Rh Neg + No Antibodies M To be clipped to Notes? A BN4

Memo on the Need for Postnatal Colposcopy If Positive Smear in past M Consultant's Sec A May 93 BN5


M3.3a: BIRTH_AFTER- RIO (Contd)OTHER INFORMATION LEAFLETS. MOTHER-RELATED“Breast Feeding” If Breasfeeding Intention I“Your Emergency Caesarean” If Emergency Caesarean I Mother A Mar 01 CSEMERG“Eclampsia” (APEC Leaflet) If Eclamptic Fit I Mother O Mar 01 A_ECLAMP“HELLP Syndrome” (APEC Leaflet) If HELLP Syndrome I Mother O Mar 01 A_HELLP

Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR? QUALITY/AUDITNotification of a Potentially Critical Incident If Potentially Critical Incident A4 Maternity Risk Co-ordinator A Jan 01 BF6Notification to Consultant If Potentially Critical Incident M (or e) Consultant’s Secretary A

BABY

MOST BIRTHS. BABY-RELATED (BB)Baby Record (Part A) If Livebirth A4 With Baby A May 94 BB1Copy of Baby Record (Part A) If Mother requests A4 Mother O May 94 BB1Reporting to the Registrar of Births, Deaths and Marriage If Livebirth A4 Via Mother to Registrar A May 93 BB2Birth Notification Form If Livebirth A4 District Child Health A May 93 BB3Korner Maternity Data Set All A4 Coding Department A May 93 BB4aProposed Revised Korner Maternity / Maternity Tail All A4 Coding Department ? Jan 01 BB4b

PROBLEMS/NEEDS. BABY-RELATED (BP)Down’s SyndromeLeaflet from Down’s Society If Down’s Syndrome I Mother O DOWNS

Cranio-Facial Anomaly Referral Memo If Hare Lip or Cleft Palate M (or e) Orthodental Surgeon O May 93 BP1“Hare Lip” Leaflet If Hare Lip I Mother A HARELIP“Cleft Palate” Leaflet If Cleft Lip I Mother A CLEFT

RISKS. BABY-RELATED (BR) For detailed documentation regarding risk factors, See 0_GENERIC.EXPERTHaemorrhage RiskVitamin K by Mouth only Information Leaflet If Vitamin K by Mouth only I Mother A Mar 01 VITKORAL

Tuberculosis RiskBCG for your Baby. If Tuberculosis Risk I Mother A Mar 01 BCGRisk of TB. Memo on the need for BCG If Tuberculosis Risk M To be clipped to Notes A May 93 BR1

Hepatitis B Risk“Hepatitis B Vaccination for your Baby” If Hepatitis B Risk I Mother A Mar 01 HEPBRisk of Hepatitis B. Memo on the need for Hepatitis B Prevention If Hepatitis B Risk M To be clipped to Notes A BR2


M3.3a: BIRTH_AFTER- RIO (Contd) Automatic Latest RF RF In Local


Congenital Dislocation of the Hips . “A Special Scan for Baby’s Hips.” If CDH Risk I Mother A Mar 01 CDHMemo on the need for Hip Scan If CDH Risk M To be clipped to Notes? A May 93 BR3

Hearing Risk“A Special Hearing Test for Your Baby” If Hearing Risk I Mother A Mar 01 HEARINGMemo on the need for Hearing Test If Hearing Risk M To be clipped to Notes? A May 93 BR4

Risk of Kidney Problem . “A Special Kidney Scan for Your Baby” If Renal Problems on Scans I Mother AMemo on the need for Renal Scan If Renal Problems on Scans M To be clipped to Notes? A May 93 BR5STILLBIRTHS (BS)Stillbirth Action Checklist If Stillbirth A4 Labour Ward Staff A May 93 BS2

Stillbirth Memo If Stillbirth M (or e) Medical Secretary A May 93 BS1Stillbirth Memo If Stillbirth M (or e) G.P. A May 93 BS1Stillbirth Memo If Stillbirth M (or e) Community Midwife A May 93 BS1Stillbirth Memo If Stillbirth M (or e) Health Visitor A May 93 BS1

Memo on Date of Perinatal Meeting (Bottom half of above) GP via Med SecretaryPost-Mortem Information Leaflet If Stillbirth I Mother A 2000 S_POSTMStillbirth/Neonatal Post Mortem Agreement / Declaration If Stillbirth A4 Labour Ward Staff O BS3Proforma for use when requesting a Post Mortem If Stillbirth A4 Pathology Dept O May 93 BS4Cremation Information If Stillbirth I Mother A Mar 01 S_CREMATStillbirth following Abruptio If Stillbirth and Abruptio I Mother A Mar 01 S_ABRUPT

ACTION SUGGESTIONS (MOTHER)For further details see Expert File

Action Suggestion(s) Trigger Output Document

Rubella Vaccination Rubella Antibodies absent Birth Event Summary

Anti-D Immunoglobulin Injection Rhesus D Neg Birth Event SummaryNo Anit-D antibodies in most recent blood test


M3.3b: BIRTH_HOME?Different Protocol after a Home Birth?

M3.4a: BIRTH_ASSISTED-RIOLETAfter an Assisted BirthAssisted Delivery MP_OPDLV

M3.4b: BIRTH_CAESAR-RIOLETAfter an Caesarean Section

Caesarean Operation

M3.4c: ANAES_BIRTH-RIOAnaesthetic Input after a Birth

M3.5: ANAES_POSTBIRTH-RIOAnaesthetic Input after a PostNatal Anaesthetic

M3.6: BIRTHRATE-RIOCompletion of any missing details for Birthrate Studies

M3.7a: LEAVE_LW_MOTHER-RIOFinal Details before leaving Labour Ward (Mother)

M3.7b: LEAVE_LW_BABY-RIOFinal Details before leaving Labour Ward (Babay)


M4. Post Birth RIOs


M4.1a: ADMIT_PN_MOTHER-RIOOn Arrival in Post-Natal Ward (Mother)

M4.1b: ADMIT_PN_BABY-RIOOn Arrival in Post-Natal Ward (Baby)


M4.2a: DISCH_PN_MOTHER-RIOPost-Natal Discharge (Mother)

COMPLEXITY/EXPERT DOCUMENTATION


Title Name RF Version File NamePost Natal (Mother) MP_TPM

OUTPUTSDepending on Local Policy Decisions and the Trigger, the following outputs will be either:1. Be printed out by computer automatically whenever a relevant trigger is present = A (“Automatic” ), or 2. Be offered to the user whenever the trigger is present but will only be printed out after confirmation by the person using the computer = O (“Optional”)

Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,


Transfer Hospital to Community All A4 Community Midwife Oct 94 P2 YesTransfer from Community Midwife to Health Visitor All A4 Community Midwife Oct 94 P3 Yes


M4.2b: DISCH_PN_BABY-RIOPost-Natal Discharge (Baby)

Post Natal (Baby) MP_TPN



P5 Discharge Letter P/N Hospital Discharge (Baby) GP Oct 94 YesP6 Transfer Hospital to Community P/N Hospital Discharge (Baby) Community Midwife Oct 94YesP7 Transfer from Community Midwife to Health Visitor P/N Hospital Discharge (Baby) Community Midwife

Oct 94 Yes -

Pi Proforma on Epidural Outcometo be filled in on the Post Natal Ward and used to enter data at the time of discharge

Post-Natal Admission/Discharge (Antenatal and Postnatal Admissions) MP_ANADM

M4.3a: HOME_PN_MOTHER-RIODomiciliary Post-Natal Care - Mother (includes Post-natal Community Contact Return)

M4.3b: HOME_PN_BABY-RIODomiciliary Post-Natal Care - Baby (includes Post-natal Community Contact Return)

M4.3: PNCARE_HOME-RIODomiciliary Post-Natal Care (includes data needed for Post-natal Community Contact Return)


M4.4: ADMIT_LATEPN-RIOLater Post-Natal (Re-)Admission (Mother & Baby)Post-Natal Referral MP_PFRPCPost Natal Admission/Discharge Outline MP_PMADM

M4.5a: DISCH_LATEPN-RIOLater Post-Natal Discharge (Mother)

Late Post Natal (Mother) MP_LTPM

M4.5b: DISCH_PNLATE_BABY-RIOLater Post-Natal Discharge (Baby)

Late Post Natal (Baby) MP_LTPN

M4.6a: FINAL_PN_MOTHER-RIOFinal Maternity data entry / Transfer to Health Visitor (e.g. 28 days after Birth - Mother)

M4.6b: FINAL_PN_BABY-RIOFinal Maternity data entry / Transfer to Health Visitor (e.g. 28 days after Birth - Baby)


M4.7: FUP_GYNOPD-RIOOPD Post-Natal Follow-Up in Hospital (Usually Gynaecology Clinic)

M4.8a: MAT_DEATH-RIOIntial data entry regarding a Maternal Death

M4.8b: MAT_DEATH_LATER-RIOFinal data entry regarding Maternal Death

M4.9a: NND_BABY-RIOInitial data entry regarding a Neonatal Death

M4.9b: PND_BABY_LATER-RIOFinal data entry regarding a Perinatal Death (Stillbirths and Neonatal Deaths

M4.9c: FUP_PERIN_DEATH-RIOFollow-up in OPD after a Stillbirth or Neonatal Death (Usually Gynaecology Clinic)


M5. Reports / Lists / Sets RIOs


M5.1: LEGAL-RIOPAPER OUTPUT Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,


Full Printout of Computer Record for Legal Purposes Mother’s or Lawyer’s Request A4 Mother or Lawyer O

3b.TEST_REPORT_PREG-RIOSets of EPRs awaiting manual data entry of Report(s) (other than for Initial Assessment or Screening Tests)


2c. MISSED_SCREEN-RIOA weekly (?) check to see which expectant mothers have still have a viable pregnancy but there is no result of a serum screeing test in the maternity computer systemOut put is a list of mother where the screening result or comment is missing and is overdue



16(?) weeks gestation and have no Serum Screening result 16 (?) wks + No Serum Sc Result List Screening Co-ordinator A

2b.SCREENING_REPORT-RIOSets of Serum Screening Results either manually entered from a paper set or list of pathology reports or (in future) electronically transferred directly from the Pathology system to the Maternity Computer System

NEEDEDPEOPLE Expectant Mother: Not needed. Data Entry by: Screening Co-ordinatorPAPER Serum Screening Test Reportsor SINBAD





Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR?HIGH RISK OF SPINA BIFIDAHigh AFP Memo High Risk of Spina Bifida M Community Midwife A Oct 94 C3aHigh AFP Memo High Risk of Spina Bifida M GP A Oct 94 C3a“Raised Spina Bifida Blood Test" Leaflet High Risk of Spina Bifida I Expectant Mother O 2001 S_AFPUP

HIGH RISK OF DOWNSHigh Down’s Risk Memo High Risk of Downs M Community Midwife A Oct 94High Down’s Risk Memo High Risk of Downs M GP A Oct 94"High Risk of Down's" Leaflet High Risk of Downs I Expectant Mother O 2001 S_DOWNSUP


DEATH_MOTHER-RIO

OUTPUTSFormats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,


Death of Mother Memo Data required by Death CertificateMaternal Death Initial SummaryMaternal Death Final Report

DEATH_BABY-RIOOUTPUTS Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,



CODING_MAT-RIOOUTPUT Formats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,

Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR?Diagnosis/Procedure Coding Sheet for Hospital Coding All A4 Coding/Casemix Clerk O May 93 P9

KORNER-RIO



Complete Korner Data MP_FFINF



CESDI-RIO


Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR?CESDI Initial Memo Stillbirth or Early Neonatal Death M (or e) Regional CESDI A Oct 94 S10dCESDI Data needed for Full Report Stillbirth or Early Neonatal Death A4 Local CESDI Co-ordinator A Oct 94 S10e


ADOPTION-RIO



Adoption Proforma Printout

AUTOMATIC-RIO


Automatic Latest RF RF In Local Title Trigger Format Destination or Optional Version Code Mat EPR?Anonymised Report to the Child Development Centre in Oxford? May 93 -X2Assisted Conception Memo Assisted Conception IVF Unit or Med Sec May 93 S4Clinical Trials Memo Medical Secretary May 93 S5History of Hydatidiform Mole. Need for Postnatal HCG Obstetricians's Sec May 93 S9

and GP

Prenatal Diagnosis Memo (Immediate) Medical Secretary May 93 N3a- (Reminds Secretary to look out for form to be sent to Regional Genetics Department)Prenatal Diagnosis Outcome Report Regional Genetics Dept May 93 -N3b

MONITORING (What is happening Now)M1 List of outstanding Multifactorial Screening Test Results Oct 94M2 List of outstanding Amniocentesis decisions/outcomes Oct 94

LISTS (What has happened)L1 List of Births (Daily, Chronological) June 91L2 List of Births (Monthly, Alphabetical by Surname) June 91L3 List of Births (Monthly, Chronological) for Child Health Register cross-check June 91L4 List of Possible TB Risk Births (Monthly, Chronological) for DHA June 91 Yes

DRAFT LISTS (Monthly)D1 Stillbirths May 91 -D2 Cases of Special Interest (Maternity)D3 "Near Miss" Cases (Mothers)D4 "Near Miss" Cases (Babies)


RIO - PAEDIATRIC SCBU REPORTSDRAFT LISTS (Monthly)D6 Neonatal Deaths May 93D7 Fetal Anomalies List May 93D8 Cases of Special Interest (Paediatric) May 93


M6. Statistics RIOs

All either by Request of the person “conducting” the RIOor Automatically at certain fixed times of the Month or Year.


M6.1: FORECASTS-RIOMonthly Forcasts of Births


Latest RF RF In Local Title Timing Format Destination if not Requester Version Code Mat EPR?

Community Version - By Health Centre/Group Practice Monthly or by Request A4 Maternity Unit Manager June 91 F2Hospital Version by Responsibility (Midwife / Consultant / GP Unit) Monthly or by Request A4 Maternity Unit Manager June 91 F1

M6.2: DEPT_STATS-RIOMonthly or Annual Statistics


Latest RF RF In Local Title Timing Format Destination if not Requester Version Code Mat EPR?

Maternity/Delivery Statistics every Month (usually for Past Month) Monthly or on Request A4 Statistics Midwife? May 91 RMatDelMaternity/Delivery Statistics for Past Year (Calender or Financial) Annually or on Request A4 Statistics Midwife? May 91 RMatDeGP Unit Statistics (Calender or Financial) Annually or on Request A4 Chairman GP Committee May 91 RGPlSCBU Statistics Statistics every Month (usually for Past Month) Monthly or on Request A4 Statistics Midwife? May 91 RSCBUSCBU Statistics for Past Year (Calender or Financial) Annually or on Request A4 Statistics Midwife? May 91 RSCBU

I


M6.3: STAFF-RIO

Statistics of Staff Activity Automatic Latest RF RF In Local Title Timing Format Destination or Optional Version Code Mat EPR?

Obstetric Junior Doctor's Work Statistics and Experience On Request A4 RequesterTrainee Midwives Work Statistics and Experience On Request A4 RequesterAnaesthetic Junior Doctor's Work Statistics and Experience On Request A4 RequesterPaediatric Junior Doctor's Work Statistics and Experience On Request A4 RequesterTrainee SCBU Nurses Work Statistics and Experience On Request A4 Requester

M6.4: RETURNS-RIOFormats: M = Memo, A = A4 Paper, L = Draft Letter, S = Sticky Label, I = Information Leaflet, G = Guidelines, F = Laboratory Request Form, R = Reports,

Latest RF RF In Local Title Timing Format Destination Version Code Mat EPR?

Annual Return for Royal College of Obstetrics and Gynaecology Annually A4 RCOG June 92Annual Return to the English National Board Annually A4 ENBAnnual Return to the Royal College of Anaesthetists Annually A4 RCAAnnual Return to the Royal College of Physicians (Paediatric Faculty) Annually A4 RRCPAnnual Report for Clinical Benchmarking Company Annually A4 Benchmarking Company

Suggested Format for minimised LABOUR WARD BIRTH REGISTER May 1993 Li


R.I.O.s in Maternity Care

Documents