Obstetric High-Dependency unit (hdu) CME

CME slides on Obstetric HDU following CME at maternity in a general hospital by the medical officer in charge maternity

1. High Dependency unit (hdu) April 17 2022 Andrew Jokene MBChB, MPH SMO Maternity CME Moyo General Hospital

2. Outline Intro Definitions Aims of HDU types of HDU HDU set up/ team Admission criteria to HDU Discharge criteria Resources Comments

3. intro HDU provides the kind of care between the ICU and the general ward Reduces the need for ICU admissions

4. definitions HDU is an area in a hospital where patients can be cared more extensively than in a normal ward, but not to the extent of ICU Single organ dysfunction (HDU) vs multiple organ dysfunction (ICU) A patient in HDU may require ICU admission (step up) or A patient in ICU may improve and be transferred to HDU (step down)

5. Aims of hdu Critical monitoring of patients Provide complex interventions Nursing care Prevent complications e.g. DVT Efficient use of resources in one place

6. Types of hdu Obstetric HDU Surgical HDU Medical HDU

7. Pic 1

8. Obstetric hdu set up Should be part of maternity unit Should be located near labor suite and operation theatre for easy shifting of patients Well lit and clean Reliable power supply Well ventilated Adequate Space allow free movement of staff Proper waste disposal

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10. HDU SET up Continued… Stock checking and replacing regularly HDU equipment (list them?) Safe water supply Pt Hygiene in HDU – daily washing What different cadres of staff present? Roles of each staff? Nurse rounds and doctors rounds daily

11. “The most important monitor is a good nurse” - Kate Stephens

12. HDU Admission criteria No. CRITERIA EXAMPLES 1 HEMORRHAGES APH, PPH, Abortion Severe Complications Hypovolemic shock 2 HYPERTENSIVE DISORDERS IN PREGNANCY Severe pre-eclampsia Eclampsia Chronic HTN 3 MEDICAL HIGH RISK OBSTETRIC CONDITIONS Sickle cell disease CCF in pregnancy Asthmatic attack Thyroid disorders in pregnancy 4 SEVERE ANEMIA WITH IMPENDING CARDIAC FAILURE IN PREGNANCY   5 POST SURGICAL DIFFICULT SURGERIES/ COMPLICATIONS Hysterectomy Laparotomy Ectopic pregnancy lap Near miss Pulmonary embolism 6 INFECTIOUS DISEASES IN PREGNANCY Cerebral malaria Severe malaria with complxn Meningitis

13. Discharge criteria When patient no longer needs critical monitoring Hemodynamically stable When patient no longer needs oxygen therapy Referral to a higher facility Stabilized medical condition When no need for continuous IV meds and blood tests

14. Resources Ministry of Health. (2022). Essential Maternal and Newborn Clinical Care Guidelines for Uganda. Wandegeya: Reproductive and child health department, MOH Zheng, N.G. & Dai, Y. (2022). Severe maternal morbidity: admission shift from intensive care unit to obstetric high-dependency unit. BMC Pregnancy Childbirth , 22(140). Retrieved from https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-022-04480-x.pdf Setting up a High Dependency Unit. https://e-safe-anaesthesia.org/sessions/12_03/d/ELFH_Session/1409/session.html?lms=n#summary.html

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