Ultrasound Examination for Fetal Presentation – Competency Workbook

NHS Borders clinical guidelines
NHS Borders

Guidelines for Ultrasound examination to determine fetal position

Situations when ultrasound examination may be performed by a midwife who has achieved competency for this examination;

  • When fetal presentation cannot be ascertained on abdominal palpation
  • On admission for Induction of Labour and after removal of a Cooks Balloon

Limitations of Ultrasound examination to determine fetal position

The purpose of this examination is solely to identify fetal presentation i.e. to confirm cephalic presentation. Evidence of the fetal heart will be by CTG or sonicaid. The operator must make the limitations of the scan clear to the parents.

Pre‐Entry Criteria to undertake competency training - Dimension 1: Supporting Knowledge

Registered Midwife

Evidence of competency

 

Dimension 1: Supporting Knowledge

Indicator

Required Knowledge/skills

Evidence

Date & Sign

Identify the importance of appropriate use & care of the ultrasound machine

•Evidence knowledge of use of portable USS for presentation scan.

•Display knowledge of how to report malfunctions

•Discussion

• Supervised Practice

  

Identify importance

of accurate diagnosis

•Under supervision evidence skill in identify fetal head to confirm cephalic presentation

•Supervised

Practice

•Self‐study to ensure best practice

  

Evidence of competency – Dimension 2 Assessment

Indicator

Required Knowledge/skills

Evidence

Date & Sign

Performs

ultrasound scan accurately according to guidelines

•Communicates well with patient

•Uses equipment appropriately

•Maintains patients dignity throughout the procedure

•Performs successful scan

•Discussion

 

•Supervised Practice

  

Interpret and report the clinical findings

•Be able to identify the fetal head

•Be able to report accurately to supervisor

•Appropriately document findings

•Discussion

•Supervised Practice

•Written Report

  

Evidence of competency – Dimension 3 Ultrasound Examination

Prior to ultrasound examination

Following abdominal ultrasound

examination
  • Specify to parents the limitations of a presentation scan
  • Prepare the working area and the scan machine. Turn on the scan machine following the appropriate procedure.
  • Ensure transducers and cables are fixed safely in position.
  • Select appropriate transducer for examination.
  • Explain procedure, position woman appropriately
  • Protect clothes with paper towels and apply ultrasound gel
  • Scan across lower abdomen to establish presentation
  • Wipe gel off abdomen
  • Assist women from examination couch/bed
  • Clean transducers and cables with wipes as recommended by manufacturers
  • Document finding and relay to appropriate midwife/medical staff

Evidence, Assessment and Maintenance of Training

Each candidate must:

 

  • Receive education session from sonography mentor or Consultant Obstetrician
  • Complete the competency workbook
  • Attend scan sessions with mentor/senior sonographer/Obstetrician for observation and supervised practice

 

Evidence of competency:

 

  • Can be provided by completion of educational sessions, supervised practice and discussion
  • Assessment of competency to be completed by designated mentor

 

Assessment of competency:

 

  • Competently perform ultrasound examination on a least 5 patients as assessed by mentor
  • At least one case should be a malpresentation
  • Mentor should verify competencies by signing and dating competency record

 

Maintenance of competency:

 

  • Practitioners are responsible for maintaining their own competence
  • Demonstrate an up to date knowledge of current evidence base
  • The Code (NMC 2018) requires that a midwife must maintain the knowledge and skills needed for safe and effective practice

 

Limitations of learning

 

When competencies are achieved, the midwife will only be able to perform an ultrasound examination to diagnose fetal presentation. The midwife will NOT be competent to perform any other type of ultrasound examination. This policy will apply to singleton pregnancies only.

 

Scope of Practice

Any midwife undertaking additional clinical tasks must ensure they adhere to The Code (NMC 2018) and work within their sphere of practice. Particular attention should be paid to the following elements of The Code;

 

13.0 Recognise and work within the limits of your competence

 

13.2 Ask for help from a suitably qualified and experienced healthcare professional to carry out any action or procedure that is beyond the limits of your competence

 

13.5 Complete the necessary training before carrying out a new role

 

(NMC 2018) The Code: Standards of Competence for Registered Midwives www.nmc‐uk.org

Record of Supervised Cases

 

Competently perform ultrasound scan for presentation yes/no

Date

Signature of sonography mentor/Obstetrician

Signature of midwife

CHI Number
1          
2          
3          
4          
5          
6          
7          
9          
9          

This workbook should be kept as a record of competence in personal development folder.

Editorial Information

Next review date: 29/04/2029

Version: 1.0

Approved By: Women's and Children's Services CMT

Reviewer name(s): K. Darlow, K. Guthrie.

References

This document has been adapted from a competency workbook developed by NHS Forth

Valley.