Critical Incident Analysis - Assignment Example

?CRITICAL INCIDENT ANALYSIS Background to the incident Differentiation of the weight of twin or other multiple babies is a normal situation with mostall twin and multiple pregnancies (quote). However, there is the need for a clinical check if the disparity of growth and for that matter weight is too large as this could signal a critical endangerment to the smaller foetus. In such cases where there is a severe disparity in the weight or size of the twin babies, a discordant growth in pregnancy is said to have taken place (quote). A reason why discordant growth in twin pregnancy has always been a source of concern to health practitioners is that the situation predicts two major things. The first is that discordant growth may signify that there is something medically wrong with the womb housing the babies or that there is something medically wrong with the foetus with the disparity in growth. It is for this reason that it is always important for health workers in the field of obstetrics and gynaecology to receive specialised training and practical care on ways of handling and dealing with such cases of discordant growth. What is more serious is when there are complications associated with these discordant growths and the cases are reported to the hospital or maternity ward as emergencies, requiring urgent professional attention to avoid further harm to either the affected baby or the mother (quote). There continues to be debate in the medical field as to what may constitute disparity of growth between two twin foetuses. But there seem to be a generalised consensus when a difference of 15 to 25 percent or more is recorded in the weights of the two babies (quote). A similar case of discordant growth in twin pregnancy was recorded in the Messiah Hospital where the writer practices as a midwifery student. The event occurred as one of the reported 15 to 29% of twin pregnancies resulting in discordant foetal growth (quote) but what was peculiar in this case was that the percentage different in weight between the two foetuses was as large as 35%. The twins involved were an identical twin, sharing the same gene and having the same amniotic sac (quote). This means that this was unlike a fraternal twin pregnancy where the babies have genetics of siblings. Through an obstetric imaging, it was found that the discrepancy in weight was set for over 1,000 grams at birth and this situation is known in only 3 percent of all discordant twin foetuses (quote). It is for this peculiarity that the writer finds this experience worth sharing, especially to make known the steps that were taken both at a personalised level and those taken at the organisational level, including successes that were achieved and challenges that were faced. Personal action taken At a personal level, there were two major forms of actions that were taken. The first of these was taken at the pregnancy stage when the writer was put in charge of a team of other midwifery students to diagnose the situation. It must be stated therefore that the entire event under discussion was actually dealt with not as a one-time event but as a process, which needed some time to get everything through to its logical conclusion. So having been put in charge of the team, the writer called for an ultrasound at the early stage of the pregnancy to authenticate the belief that there was actually a discordant foetal growth. This ultrasound was needed because it has been found to be the most effective way of authenticating discordant foetus in the first trimester (quote). After the ultrasound results were in, they produced some level of surety that the pregnant mother was caring a discordant foetus (quote). Even though members in the team deemed this proof as evidential enough to start treatment, it was insisted that some more test be carried out. The next test was therefore carried out on the third visitation of the pregnant woman to the hospital after the first. At this time, the pregnancy was heading for its later days. Due to the age of the pregnancy at this time, the gestational age of the babies were measured. At the second test also, it was identified that these were highly uneven. Meanwhile, uneven gestational age of one babies at latter stages of pregnancy have been identified to be one of the commonest diagnosis to discordant pregnancy (quote). The next action that was taken was to identify the cause of the situation, which was done not as an individual but as a member of a team, though taking the headway role. No additional high-level ultrasounds were used for this purpose as two tests had already proofed authenticity (quote). What was done was to use blood tests of the pregnant mother to determine possibility of a hidden health cause. Later, chorionic villous sampling was also undertaken as a means of testing for chromosomal dysfunctions. The results of these tests to know the cause of the problem came up that there was a twin-to-twin transfusion, causing the normal or larger foetus to receive majority of the nutrients that are being passed to the two foetuses (quote). Further study showed that this had arisen as there was a defect with the placenta of the woman, creating periodic mixing up of the blood vessels of the pregnant mother (quote). Having known all of these, the next and perhaps most challenging task was to ensure a safe delivery for the woman with defect to her placenta, which was of course also to be carried out with the writer as the leader of the team. Action taken by others It must be emphasised that maximum support was received from all other members of the team, each of whom played an instrumental role and took different action to ensure that the diagnosis and identification of cause of the discordant foetal development were identified. Some of the most significant personnel that were identified in the course of the action include the chief surgeon of the hospital, laboratory technician, the senior nursing supervisor, the chief gynaecologist, and other midwifery students. The laboratory technician was very instrumental in aiding in all the laboratory works that were carried out on the pregnant woman including the blood test that was undertaken as well as the ultrasound that were taken at various points of the pregnant woman’s visit to the hospital (quote). The senior nursing supervisor was always around the team to ensure that the team had its ways right with what was going on by supervising out actions and giving constant and rapid assessment, as well as feedback on whatever was going on. It was with the chief surgeon’s input that it became realised that the situation would head for surgery. There were further instructions and assistance offered the team as to what should and would be done when the surgery began at the delivery point. The chief gynaecologist was more or less a teacher to the group, from whom the group would go for counsel in difficult times of its experiences. The chief gynaecologist was also always present during key actions that were taken by the team, just to ensure that all was going well with the team’s actions. Finally, the other midwifery students served as what may best be described as team members as midwifery is a team job (quote). Most demanding moment of the event Even though all of the actions that were taken on the woman experiencing discordant twin pregnancy at the antenatal stage would be considered as demanding and eventful, none of those were as demanding as the experience that was had at the delivery stage of the problem. As there was a twin-to-twin transfusion as the cause of the disparity of growth among the two foetuses that were present in the pregnancy, further studies and checks on the woman actually proved that a feto-foetal transfusion occurred as a pathogenetic mechanism in the growth of discordant baby (quote). The situation became so severe, due to the over 25% in weight difference that the smaller baby, just ahead of the time of delivery was noticed to have died in utero. This means that the smaller baby was noticed to have died while still in its mother’s womb (quote). This called for urgent action to be taken to save the mother and the other baby alive as any further delays could result in complications (quote). As part of the duty of the team of which the writer was a leader, it was necessary to take an immediate decision on ways of saving the two remaining lives in this situation. This was indeed the most demanding moment of the event as not just one life but two depended on the writer as a leader of the team to ensure that these lives were saved. Most immediate reaction about the demanding moment In fact, when it was first noted that the twin with discordant growth had died, the writer shivered with fear and emotional disappointment. This is because much had been done to ensure the baby was not one of the 25% of babies with discrepancy who die in uteo or are born still or with massive complications (quote). But it must be said that this reaction and feeling was not made to affect the professional roles that were needed to be performed further in saving the two remaining lives. There was therefore the need to gather courage, which indeed happen. The general consensus that came up with the pregnancy was to undertake a caesarean section to remove the babies from the womb of their mother before actual labour started. There were two major factors that accounted for this decision with the first being that the mother had a defect on her placenta and so delaying till delivery could mean that the mother’s own live could be at danger (quote). Secondly, it was realised that even with the baby with normal development, and for that matter the larger twin, Advances in Neonatal Care have showed that such babies would have acute respiratory difficulty after birth (quote), which was certainly not favourable for natural labour. The patient was therefore given clinical examination and was prepared for the theatre where the chief surgeon and his group would take over with the caesarean section, with the presence of the team and the writer. 186 Outcome of the situation Most satisfactory Certainly the most satisfactory outcome would be related to the most demanding task of all the events that took place, which was the need to save the mother and the larger twin from death after one case of death in utero had been recorded. Without an act to platter to one’s personal actions and performance, it will be said that the writer was higher pragmatic in the steps taken in ensuring that the right decision was taken in the form of opting for caesarean section ahead of delivery in other to avoid any further complications. The action was taken in the midst of courage and boldness and with optimism that that was going to be the best way out for the desperate mother who was hoping to have all two babies born alive. Indeed, the diagnosis that were taken on the woman were very accurate and gave out the right instructions and preparatory grounds to the surgical team as to what needed to be done in the course of the caesarean section in order to ensure that the two remaining lives were unharmed (quote). Gladly also, way ahead of the natural labour for the woman, she had a successful caesarean section, which saw her have a save birth of the larger twin and she herself not recording any noticeable complications or challenges with her health. Areas for improvement Despite the latter success, which brought so much joy to the writer, it will be put on record that there were some major earlier decisions and actions that were taken, which needs much improvement in future occurrences and events of discordant twin pregnancies. Key among these will be the rate of detection and authenticity of disparity of growth among the twin. In the current case, it would be noted that not much was done on the part of the writer as the leader of the team to ensure that the authenticity was done early enough. It was only towards the end of the pregnancy that the authenticity was completed through a blood test. Once this happens, the level of care that can be given to the pregnant woman becomes minimal (quote) and so risk of losing the baby with disparity becomes higher (quote). As early as the first trimester, all necessary detections and authentication must be completed to make care begin right away. The second area that needs improvement is the area of antenatal care given to mothers pregnant with discordant twins. Indeed, it is only these forms of antenatal care that can ensure that the development of the affected foetus does not get to such a stage where it will be associated with complications that will need to be taken care of at an emergency level (quote). Lessons learnt about the situation 2 Institutional recommendations arising out of the situation 2 Conclusion Read More