BORDERS GENERAL HOSPITAL

OBSTETRICS & GYNAECOLOGY UNIT

 

HANDBOOK FOR FY2/GPSTs

 

Updated July 2025

 

 

INTRODUCTION

 

Welcome to the Borders, we hope you settle in easily and enjoy your time here! We hope this information is useful for you: please consider amending it if anything changes during your time here.

 

CLINICAL AREAS

 

Second Floor Pink Zone

• Labour ward

Ward 16 Antenatal and postnatal – Triages and Day Attenders are typically seen here

• Ward 7/9 – Shared surgical specialties ward
• Ward 17 - elective surgical ward
• Pregnancy Assessment Unit – Early pregnancy and antenatal scanning

 

First Floor Orange Zone

Out-patients department – antenatal clinics, gynaecology clinics, hysteroscopy, colposcopy and TOP clinics

 

Ground Floor

• Borders Emergency Care Service (BECS)
• Accident and Emergency

 

 

Non-pregnant patients that need to be seen acutely or as an emergency can be reviewed in the following places:

 

• BECS (Borders Emergency Care Service) - this area serves as medical ambulatory care in-hours and an out-of-hours GP services out of hours and at the weekend. We have one allocated room but can sometimes use others if the other services are not using them. Well gynaecology triage patients can be seen here: there is not out of hours nursing cover so you will have to perform any nursing tasks out of hours.
• Emergency Department - unwell patients are always seen here, consider seeing all out of hours patients here.

 

 

CONSULTANTS

 

There are currently 8 consultants in this unit.

• Dr Shonag Macenzie (Clinical Director)
• Dr Kate Darlow (College Tutor)
• Faye Rodger
• Queenie Menezes
• Nayani Berugoda
• Dr Shireen Irfan
• Dr Ahmed Eissa
• Dr Cameron Martin – attends every other Tuesday for elective gynaecology cancer operating

 

While your first port of call will usually be the registrar on-call, all consultants are very accessible for advice and support or to attend at all hours of the day and night.

 

At the moment, the registrars’ shifts are 0830-1630 or 1630-0830 on the weekdays and 24 hours at the weekends.

 

A fully staffed FY/GPST rota has 5 people on it (usually 3 GPSTs and 2 FY2s).

 

The midwives are all lovely and incredible at what they do. We all work very closely with them. They will be very helpful for any questions / queries / advice.

 

BLEEPS

• On call Registrar (6017) – covers all inpatients and emergency attenders
• Obstetric FY/GPST (6016) – covers Gynae and LW, takes referrals
• Ward 16 FY/GPST (6733) – covers Ward 16 and triages
• On call Consultant (6018)

 

To page somebody:

 

 

 

BREAKS

Breaks are important and can seem hard to take when labour ward is busy – please let the registrar know if you have been unable to take a break so they can try to facilitate it for you. The team usually assemble on labour ward at about 1245 for lunch – a great opportunity to catch up with the team about clinical tasks, too. Try not to put off your evening break – it can get busy as the evening handover approaches.

DOCTORS’ MESS

There is a newly renovated Doctors’ Mess on the first floor, just along from the outpatient department. It is a nice place to relax during breaks and there is a TV with Sky, tea, coffee, snacks and some freezer meals for in the event of forgotten midnight snacks. The £8 pounds you pay monthly is absolutely worth every penny.  And because it is used by many doctors of every level in the hospital, it is a nice place to make new friends

 

GUIDELINES

All guidelines are moving to a website / app called Right Decisions – this includes the local protocol and guidance for methotrexate in the management of ectopic pregnancy / pregnancy of unknown location. https://rightdecisions.scot.nhs.uk/ - follow links for the NHS Borders microsite.

 

MEETINGS

 

Handover - Everybody meets in the labour ward meeting room at 0830 every morning for handover, teaching and announcements.

 

Oncology MDT - This is on Thursday mornings at 0830 and is held in a meeting room on the ground floor, yellow zone, in Cauldshiels (follow the consultants to it the first week!).

 

Perinatal Meeting – This is usually held on the last Wednesday afternoon of the month on MS Teams, as part of our Wednesday afternoon teaching. It is co-ordinated by one of the ANNPs, Emma. You may be asked to present a case, you will be given details of this in advance. All that is required is ~3 slides on the background of the mother and what happened during pregnancy and birth. There is a template presentation on the shared drive. The paediatric team will then take over with what happened to the baby, followed by discussion between both the obstetrics team and the paediatric team.

 

Information you should include in the perinatal presentations:

 

• Risk Factors (age, parity, blood group, BMI, smoking status, drug history)
• Antenatal course, including any routine or extra scans
• Delivery summary (presenting complaint, induction of labour, delivery, baby)

Please include anonymised images such as of growth charts and CTGs, for example, where possible. Any of the registrars would be happy to look over your presentation in advance.

 

TEACHING

Every Wednesday afternoon we have departmental teaching. The schedule for the teaching is on the master rota and changes each week. It is usually a combination of a CTG meeting, the perinatal meeting, journal club and targeted teaching for FY2s or GPSTs.

 

You are also required to participate in the medical students teaching, which Dr Irfan organises. She may ask you to deliver some teaching to medical students on a particular topic.

 

In terms of teaching for the FYs/GPSTs, there is plenty of bedside informal teaching available as your work very closely with the registrars and consultants. If you would like formal teaching on a particular topic, please liaise with the registrars, who would be happy to provide it.

 

ID SWIPE CARD

You should receive this on your induction day. Otherwise, go to the admin department on 1^st floor, blue zone. You need this card to enter all the wards and theatres.

 

 

TRAK CARE

TRAK is slightly different from the version used elsewhere. Gynaecology inpatients’ notes are all on paper, with requests and results of investigations, discharge letters and clinic notes on TRAK. Operation notes are on paper.

Please aim to complete all discharge paperwork prior to the weekend.

Please also sign off any unsigned results on TRAK  (check for the last month under OCS – unsigned results).

As an important note: ‘normal’ bloods values are different in pregnancy. If you unsure, ask for help – please take ownership over any abnormal bloods you see and ask for help.

 

BADGERNET

All obstetric notes are on Badgernet.

The use of this will be included in your induction. You’ll need to know: how to search for information / growth scans etc., how to document a review, how to do a discharge (do it on TRAK and then paste into Badger) etc.

All medical reviews are documented under “specialist review” and any antenatal clinic / significant change to the plan of a patient’s care should prompt an update of the “antenatal management plan” (click “update” next to “Management Plan” on the “Pregnancy Summary” tab) but please check with the registrar or consultant what to write here.

Please note some patients will have important alerts in the “Alerts and Incidents” bar at the bottom of the Badgernet screen – you can click on these for more information.

You can filter patients by “currently admitted” and “recently viewed” - both of which are very helpful.

If you telephone an obstetric patient, you should document this on Badgernet.

 

 

PATIENT RECORDS AND CONFIDENTIALITY

It is absolutely forbidden to share patient information or details – even if anonymised – over any messaging service, including Whatsapp.

The Borders is a small place – be especially mindful of conversations in non-clinical areas.

 

REGISTRARS’ OFFICE

The registrars’ / doctors’ office is situated beside the gynaecology secretaries' office, which is beside ward 15. There are 2 computers and some desk space here to use as you may need. It can be a useful place to do some documenting / dictation etc. You will need to get a key from the secretaries for a £10 deposit.

 

Your pigeonhole can also be found here. Any paper correspondence will usually be posted here.

 

DICTATION AND SECRETARIAL ETIQUETTE

There are no routine ANC (ante-natal clinic) dictations. GOPD (gynae out-patient clinics) dictation is best done at the end of the clinic. You need to get the dictaphone from the secretaries in their office (near ward 15). The dictation software is on the desktop of the computer in the registrars/doctors room and in BGH clinic rooms. The log on is =obgregistrar, (no password).

 

Please ask a registrar to help you if you need to dictate a letter. Once it has been dictated, the secretaries will type it up and then you will need to check it on the “G2” software – again ask a registrar to help with this.

 

BLEEPS

The FY2/GPST on-call / long day shift carries the bleep #6016 (08:30 – 21:00).

 

You will collect the bleep from a fellow FY2/GPST in the morning at the Labour Ward handover. At the end of the day you will hand the bleep over to the H@N (Hospital at Night Team) during handover.

 

You will be bleeped by GPs, community midwives and A&E for patient referrals or advice. At first you are likely to be unsure about what to do, you are expected to discuss these calls with the registrar or consultant on-call: this is a learning opportunity for you so please ask questions. The intention is not to make you feel out of your depth as you can always phone the GP/midwife back once the case has been discussed with a senior.

 

If the query is about a patient in early pregnancy, the team in the Pregnancy Assessment Unit (PAU) can often manage the patient and call the patient directly if you let them know the details. They are great at managing many early pregnancy related problems. They will also sometimes bleep you for advice (e.g. to review patients or discuss bHCG results etc.).

 

The on-call registrar carries the on-call bleep #6017.

The on-call consultant carries the on-call bleep #6018.

 

The FY2/GPST covering the ‘ward’ (W shift on the rota) until 4pm carries the #6733 bleep. This bleep is used to communicate Ward 16 jobs/reviews/issues.

 

The bleeps can be found attached to the Labour Ward white board.

 

58 - ([desired page number]) (then the number where you calling from) then #

To page/bleep somebody at the BGH:

 

 

 

 

 

 

 

 

 

We are a small unit: consider whether you need to bleep / email or whether you can find the recipient and have a better conversation in person.

 

OBSTETRICS

LABOUR WARD

 

Labour Ward has 5 labour rooms plus 1 extra room called the Eildon Room. This room is usually used for infection control purposes or loss e.g. TOPs/miscarriages. The whiteboard at the midwives' station is up to date with patient initials. The midwives oversee labour ward admissions and take triages over the telephone. They will bleep the on-call doctor to request reviews of patients or advise of any jobs to be done by the doctors.

Emergencies and Theatre 5:

There is no theatre in labour ward. Obstetrics emergencies usually go to theatre 5 in the main theatres.

·         Obstetric emergencies are called via a 2222 call for either emergency caesarean sections (category 1 or 2), major obstetric haemorrhage, obstetric emergency etc. See Appendix C below.

·         The registrar or consultnat will determine what category a procedure going to theatre is to be (e.g. category 1 caesarean section).

·         You may be asked to put out a 2222 call for an emergency – please ensure you clearly state the location (eg. “labour ward” or “ward 16” or “theatre 5”) and type of emergency (e.g. “major obstetric haemorrhage” or “category 2 caesarean section”)  so that the correct staff can be contacted and correct equipment prepared.

 

WARD 16

 

This is the antenatal and postnatal ward. See ‘shift type’ section below for more information about Ward 16 jobs and the ward jobs book.

 

ELECTIVE C-SECTIONS

Elective C-sections (ELUSCS) are done on Tuesday and Thursday mornings currently. There is usually space for 2 x elective C-sections on each of these days. If any additional elective sections are required, the Registrars will organise a space for these (usually via CEPOD theatre list).

 

The elective C-sections are usually carried out by the on-call Registrar and the on-call FY2/GPST as their assistant, unless felt to be complex.

*The patients for elective c-section need to be called for a pre-op ‘clerking’ before their planned ELCS date.*

 

This protocol came into place during the Covid pandemic but has remained as it works efficiently.

 

All the patients for the elective CS lists are phoned on the Friday before their c-section date (i.e. either 5 days before their c-section or 7 days before their c-section) by the ward doctor, to go through some pre-op information. The details of who to call each week can be found in the elective c-section folder which lives at Julie’s desk (Ward Clerk) on Ward 16.

The following are the main important points to cover with the patient (proforma available on shared drive to copy and paste into Badger):

 

• Inform the patient of pre-op fasting instructions – no food past midnight, clear fluids until 6am
• Present to Ward 16 at 7am on the morning of their c-section date – they will get their bloods taken then, see the anaesthetist and registrar and sign the consent form.
• Offer the option of coil (IUS/IUD) insertion at time of the c-section for post-partum contraception. They will usually have discussed this/decided this at an antenatal appointment with their consultant but good to check. Please take the time to discuss LARC or post partum contraception plan, if they wish a Mirena coil or copper coil this needs to be added to the consent form that they sign on the day.
• Inform them to take Omeprazole 20mg – one at 10pm the night before and one at 6am the morning of the c-section. They will usually require a prescription for this if not already taking it. You can write a prescription and scan + email to their local pharmacy for patient convenience (Julie – Ward Clerk on Ward 16 can help with this in the morning – she works a half day on a Friday; there is a useful folder with all local community pharmacy emails and addresses in the bottom drawer of Julie’s desk), or you can ask the patient to collect a box of Omeprazole from Ward 16 if easier for them.
• An opportunity to answer any questions the patient may have. They will also have an anaesthetic pre-op assessment carried out by anaesthetics (usually via phone too).
• An opportunity to inform the patient of what to expect when on the day of their c-section

 

 

 

GYNAECOLOGY

GYNAE REFERRALS FROM GP/COMMUNITY

If you receive a call from a GP/ANP requesting review of a patient, first establish if they are well or unwell and if they are pregnant or not pregnant. Any patient who sounds unwell, is in severe pain or is bleeding heavily should be seen in the emergency department to allow safe resuscitation/management if required. Any patient of child-bearing age should have a pregnancy test done, ideally by the person referring them.

Well patients can be seen in BECS (Border Emergency Care Service). BECS is situated on the ground floor – you will be shown this during induction. It is useful to be able to explain where to come to, to patients over the phone.

 

BECS is run by Medical ANPs and nurses. It is important we inform them of any patients we are expecting for review, and we can request any initial observations/investigations we may need. If they are coming in the same day, this can be by telephone or in person.

 

All patients who are seen in BECS should appear on the floorplan on Trak. Once they have been seen, they require a discharge letter to be written to the GP (no proforma available, please include the date, who saw them, what the diagnosis is, whether there is any action for the GP, including “no action for GP” if relevant, and any follow up arranged by us). They then need to be discharged from the floorplan.

If you are booking in a patient for a review in the future (i.e. not same day), they should be added to the handover sheet on the shared drive so that the on-call team on that day are expecting them and they should be added to schedule on TRAK: Ward Attendance -> “General Medicine: Medical Ambulatory Care”. We tend to just book them in one of the last slots and write in the text box the time they are coming and request any nursing tasks eg “gynae pt attending 1000, please do urine HCG, FBC, U+Es, and obs”.

Below is the general gynae referral pathway. Please discuss any referrals with the registrar you are on call with.

PAU (PREGNANCY ASSESSMENT UNIT)

PAU is located next to Ward 16. Sometimes you will be referred patients from here if the midwives think that they need a medical review, or if they are struggling to get blood etc. If patients come in overnight/at the weekend, and you would like PAU to follow them up (e.g. do a full scan etc) then you can email details to the PAU inbox (‘pregnancy assessment unit (external)’). 

 

GYNAECOLOGY THEATRE

You will have the opportunity to go to Gynaecology theatres. Often a third person is required to assist at the ‘bottom end’ and this is either a medical student or an FY2/GPST. These duties can be done on your ‘normal’ days (N day on the rota) if you have a particular interest in surgery/gynae.

Main gynae theatre + CEPOD (emergency list) are usually in theatres 2,4, or 5.

Elective gynae theatre usually starts at 08:30. Surgical brief is at 08:15 and the Consultants will see the patients first thing an 08:00 so you should ideally attend this.

You may be asked to book a case for the CEPOD list (e.g. a surgical evacuation following miscarriage), this is done with the theatre coordinator on page #6595.

 

If you need to arrange any gynae clinic appointments, phone Sally (26527) or email (sally.irvine2@nhs.scot)

 

Post-operative VTE guidelines are available on Right Decisions app / website.

 

 

GOPD

 

Gynaecology clinics are held in the out-patients department – take the stairs opposite labour ward down one floor, then turn left and follow the signs to antenatal clinic. The notes will be stacked up in order outside the consultant’s room. You should discuss with the Consultant how they would like the clinic to run, and if they are happy for you to see patients/would like to observe etc.

 

Chaperones: It is a rule within our department that you must have a chaperone present for any vaginal examination. This chaperone cannot be another Doctor or Medical Student. Your chaperone should sign the notes in Gynae OPD. This is to protect both staff and patients.

 

 

Peripheral clinics: Peripheral clinics are gynaecology themed and they are some distance from the hospital. It is best to arrange with the consultant in advance if you would like to attend.

RAT forms: If asked to, you may need to fill in the first half of the first page of this if booking somebody for theatre and the “traffic light” questionnaire on page 3. It is mainly the registrars who do this.

 

GYNAECOLOGY DISCHARGE LETTERS

It is vital that you ensure the correct information about an operation is included on the patient’s discharge letter as this can impact the care they receive for the rest of their lives: e.g. “subtotal hysterectomy” means the patient still has a cervix and therefore still requires regular cervical screening. Please include details of how the patient’s skin has been closed: it is really important to know as those with staples or non-absorbable sutures will require removal of them.

FY2/GPST SHIFT TYPES

 

Ward Shift [W on rota](0800 - 1600):

 

There is now a hospital wide handover at 0800 on Mon-Fri. This is in the Tryst on the ground floor near the Chaplaincy. The early person on the rota (usually the person doing ward ‘W’ shift) starts at 0800 and attends this handover, where they pick up the on-call FY2/GPST bleep (#6016) and receive any handover from the night team.

 

After this, head to Labour Ward for the O&G handover, which starts at 0830. Here you will hand over the #6016 bleep to the on-call FY2/GPST for that day when they start their shift at 0830. We use the big TV screen to do handover – this can be very slow in the mornings. As you will be the first person on the ward, it is generally a good idea to get Trakcare and Badgernet up on the big computer screen, ready for everyone arriving in time for handover.

 

There is a handover sheet on the shared drive on the computer which should be updated daily. You will need to print a few copies of this prior to handover so that the patients can be discussed and to plan workload appropriately.

 

During the day, you will be predominantly based on Ward 16 reviewing in-patients, writing discharge letters (see separate section for details on this) and seeing any patients who attend the ward for assessment (eg. hyperemesis etc). There is a good hyperemesis protocol that the midwives will be happy to show you if need be.

 

Ward 16 have a jobs book in the middle section of the midwives station – check this fairly regularly throughout the day to make sure you’re doing all the D/C letters and kardexes etc. We use the job book to communicate results that need chasing with each other, for example swabs/MSU from patients. Please put patient CHI numbers and contact numbers for the patients, reason to chase result and preliminary plan based on normal/abnormal results. It otherwise can take a lot of time to figure out why we’re chasing something and it should be easy and quick to provide that detail when writing down a patient on there.

 

The Ward 16 doctor is also responsible for carrying out the pre-clerking of the elective CS patients for the next week. This is essentially making sure that they know when and where to come on the day of their elective CS. The list of patients to be called for each Friday is in the CS diary (purple folder above Julie’s desk on ward 16) – see ‘ELECTIVE C-SECTION’ info above for more details.

 

On Monday, the ward doctor goes to the anaesthetic assessment area of the outpatient department at 1330 to help pre-assess gynaecology patients for upcoming elective operations.

 

If the ward is quiet and you have completed the jobs for the day, you are encouraged to try to go along to some clinics or theatres for your own learning.

 

Normal Shift [N on rota] (0830 – 1600):

 

This shift is essential for your learning / training. This is a great opportunity to attend clinics and/or theatres. You can look in advance at the rotas to see if there is something in particular you would like to attend and arrange this with the appropriate consultant, for example when attending peripheral Gynae clinics. Otherwise, morning handover is a good time to find out what is on each day and what you might be able to attend.

 

On elective CS list days, it may be helpful for you to assist. Peripheral gynae clinics (Eyemouth, Duns, Hawick) can be excellent learning opportunities as this is a consultant led gynaecology clinic. If you would like to attend one, it is best to discuss with the consultant in advance to arrange this. You can also ask/arrange to attend the sexual health clinics held in Galashiels Health Centre (email Debbie White, Clinic Administrator).

 

There are also always many medical students to arrange teaching sessions for.

 

Long Shift / On-Call [L on rota](0830 – 2100):

 

The on-call doctor should pick up the O&G on-call bleep (#6016) from Labour Ward handover during the week at 0830 (from the ‘ward’FY2/GPST) and from the hospital handover at the weekend at 0900 (from HAN FY2/GPST) after attending the unit handover at 0830.

 

After morning handover the ‘on-call’ team will usually then do a ward round of labour ward and ward 16 and any gynae patients on wards 7 and 9 – the on-call team is usually the consultant, registrar and long day FY2/GPST.

 

The rest of the day is mainly spent taking and seeing referrals/admissions, reviewing patients on the labour ward or ward 16 (for example PIH, reduced fetal movements, abdo pain etc), and reviewing gynaecology patients on the surgical wards/in BECS/in ED.

 

Referrals:

Any Obstetrics referrals should be referred directly to Labour Ward for review.

Any early pregnancy problems/emergencies should be seen in BECS or ED, except for hyperemesis which is managed in Ward 16.

Gynae patients are seen in BECS/ED.

 

 

Admissions:

Generally pregnant women under 12 weeks gestation will go to Ward 7 or 9; management of miscarriage usually admit to Eildon Room (on LW).

Over 12 weeks gestation will be admitted to Ward 16 or Labour Ward. Hyperemesis patients will go Ward 16 even if they are below 12 weeks.

 

At 2100 you take the bleep and anything to hand over down to the Tryst to hand over to the Hospital at Night team – the bleep goes to the HAN FY2/GPST overnight.

 

It is your job to update the shared drive handover sheet prior to 2100 / end of shift.

 

DISCHARGE LETTERS

 

Anybody who has had a caesarean section, instrumental delivery, PPH or any other complication, or those needing medications which the midwives cannot prescribe will need a discharge letter completed via Trak. Just print one copy. It is good practice to complete an IDL for patients who have had a midwifery-led pregnancy with an unassisted vaginal delivery, although this is strictly not required.

 

These are written on Trak (there is a shortcut “\obs ” (don’t forget the space at the end), but a copy also needs to be added to Badger. This is done by adding a “Clinical Note” and pasting the text of the letter into it. Click on “Add a new note” à “Clinical Note” à Select “Other” and type Discharge Letter into the free field box.

 

1. There are no shortcuts for Gynae discharge letters.

 

Some important points for obstetric IDLs:

 

Iron Tablets - Required if postnatal haemoglobin <105 ng/L

You should prescribe a 6 week course, usually BD. The ward stocks ferrous fumarate - 322mg.

 

Dalteparin - All Caesarean section patients will need to be prescribed at least 10 days Dalteparin post-operatively. The dose and duration of this can be found on the post-natal VTE risk assessment on Badger.

Some patients will require a 6 week course if they have been on dalteparin antenatally.

Some postnatal patients who have not had a caesarean section will also need Dalteparin, again refer to the VTE assessment.

 

The RCOG guideline has a helpful flowchart if there are any queries about this: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf

(See Appendix B below).

 

Analgesia and Laxatives – All c-section patients (and some non- c-section patients) will require some analgesia for discharge. Standard practice for c-section discharges is to provide a 14 day supply of paracetamol and ibuprofen (reduced to 400mg TDS dose), and a 7 day course of dihydrocodeine (30mg PRN use). They should also be prescribed laxatives following a c-section – usually 10mls BD lactulose.

Contraception – All patients should be offered and encouraged postpartum contraception. Postnatal contraception discussions are an essential part of ante/postnatal care.

The progestogen only oral contraceptive pill will need to be prescribed on the IDL if requested. Implants (Nexplanon) insertion is easy to learn and useful to do on the Ward. Try to do these supervised early so you can insert them yourself when things get busy.

 

Mirena/copper coils can be inserted up to 48 hours post-partum or during C-section. If not done within this period, then women have to wait at least 4 weeks for IUD/IUS insertion because of the increased risks of perforation PP.

 

For coils inserted during sections or immediately post-partum, standard protocol is for the inserter (but usually the GPST/FY2 writing the IDL) to arrange the appropriate follow-up. See Appendix A below for the details regarding this. Pleasee discharge with 3 months of desogestrel to cover the patient until the coil is confirmed to be in the correct place post-natally (either by a thread check with GUM or on scan if GUM are unable to locate the coil threads).

Extra Tips

 

Pessary issues:

• Helen Kilic (gynae nurse) – has pessary clinic on a Tuesday for pessary changes in the OPD – good clinic to go along to practice changing pessaries (kilic@nhs.scot)

TOP clinic

• This is led by the GUM team in the hospital on Tuesdays and they would be very happy for you to join them to learn more.

 

For booking OP scans

• Go to Appt. List tab on TRAK ->select one of their OP appointments -> can add OCS request from here

Gynaecology clinic appointments are made by Sally Irvine: phone 26527 or email (sally.irvine2@nhs.scot)

 

Antenatal clinic appointments are made by PAU – you can visit them in person, email them or call them.

 

If you speak to a patient on the phone – please document this on Badgernet for obstetric patients and on TRAK (under clinical notes, note type “Phone communication”) for all other patients. This is especially important if you are delivering information (such as an HCG or STI screen result) that it would be useful for the next doctor looking at their notes to know.

SOME USEFUL NUMBERS

 

	PHONE	BLEEPS
LABOUR WARD	26897 OR 26898
WARD 16	26016 OR 26116
PAU	26735
ON-CALL CONSULTANT		6018
ON-CALL REG		6017
ON CALL FY2/GPST		6016
ANAESTHETIST ON CALL		3933
THEATRE COORDINATOR/CEPOD		6595
DR NAYANI BERUGODA		6727
DR KATE DARLOW		6721
DR SHONAG MACKENZIE		6720
DR QUEENIE MENEZES		6725
DR FAYE RODGER		6792
DR SHERIN IRFAN		TBC
DR AHMED EISSA		TBC
ELAINE	26729
MARION	26732

 

APPENDIX A:

 

Coil Insertion at Elective Caesarean Section or Immediately

 

Postpartum – FOLLOW-UP

Pre-caesarean section clerking – all patients should be offered the option of IUS insertion at time of elective caesarean section. This will have been consented for on the day, pre-procedure.

Check ‘Operation Note’ to find details of IUS insertion (i.e. check it was inserted and insertion was uncomplicated).

 

ALL patients who had an IUS inserted at time of CS, or immediately postpartum, require the following:

 

1. Advice and explanation that their coil cannot be relied upon for contraception until the threads have been checked at approximately 6 weeks postpartum.

 

2. A 12 WEEK SUPPLY OF INTERIM CONTRACEPTION that can be used until thread check – progestogen-only oral contraceptive pill (DESOGESTREL 75 mcg daily).

 

3. A REFERRAL to the Borders Sexual Health Team via email (see below for example referral).

 

APPENDIX B

 Advice on prescribing 

 

1. Good Practice in Handwriting Hospital Based Prescriptions (HBP) for dispensing in the Community.

 Any Independent Prescriber (IP) can prescribe on HBP pads in addition to GPs.  An IP must state their registration body and registration number on signing the HBP.

• The patient’s name and address must be stated on the top of the prescription.
• It is good practice to write the patient’s CHI number on the prescription.
• A maximum of 3 medicines can be prescribed on one HBP prescription form (except for controlled drugs where only one item should be written).
• Do not abbreviate units for micrograms or nanograms.

 

Non-Controlled Drug Prescription

 

APPENDIX C:

OBSTETRIC DELIVERY IN THEATRE

 

Category I	Immediate	Aim for delivery <30mins
Category 2	No immediate threat to the life of women or fetus                 (includes non reassuring CTG and obstructed labour)	Aim for delivery <60mins

 

Labour Ward

Registrar	Midwife
·         Confirm the decision with the consultant (except for obvious Type I emergency when consultant should be informed as soon as safely appropriate)   ·         Phone 2222:          (Anaesthetist, Theatre, Obstetric FY2/GPST, Paediatrician, SCBU, General Services)   o   Category 1 Caesarean Section o   Category 2 Caesarean Section o   Trial of Forceps in Theatre   ·         Consent	·         Ensure bed ready for transfer ·         Ensures that G+S taken (needle only, not venflon) ·         Dad to get changed – transfer to theatre should not be delayed by dad not being changed ·         Jewelleryand Gown ·         Bring checklist to Theatre

 

Transfer to theatre - If ready, and porters not present, and enough staff, push the bed

Transfer onto theatre table sitting up.

 

Midwife	Theatre Nurse	Anaesthetist	Registrar
·         Sodium Citrate (pre-spinal) ·         Checklist jointly with theatre nurse (yellow shaded areas only) ·         Catheter (post-spinal) ·         Check FH	·         Prepare theatre, including spinal pack ·         Checklist jointly with theatre nurse (yellow shaded areas only) ·         Patient Safety Check	·         IV access ·         Epidural top-up (ideally rapid acting agent), Spinal or GA as judged following discussion with obstetrician in theatre.	·         Discuss urgency with anaesthetist and offer help with IV access ·         Discuss clinical details with paeds ·         Scrub