– EBM Plan
1. What single problem are trying to resolve for this patient?
I am trying to manage my chosen patient’s pain. A pseudo name will be used to protect the woman’s, identity. Hence, confidentiality will be maintained throughout the plan (Clemens, 2016; Confidentiality within the NMC (Midwifery), n.d.).
Mrs T, a 26-year-old woman with her first pregnancy presented to maternity triage with a history of contractions, moderate, lasting 30 to 40 seconds and not coping with pain. She is not allergic to any drugs, nil medical history.
I carried out an internal examination to confirm if she is in established labour/ a baseline for future assessment. Post assessment, Mrs T was found not to be in established labour. Her cervix was closed, os long and posterior. I discussed the examination findings with Mrs Tox and informed her that she will need to go home and await the event. I offered her pain relief with a safety net when to return to the hospital. She declined paracetamol and dihydrocodeine as our first line of pain relief and requested pethidine.
This is not our first line of drugs, and the patient must be admitted before pethidine can be administered due to its side effects and reaction on the foetus. Also, it is impossible as contractions are irregular and will limit her options later. The patient was informed and advised to go home and try non-medical pain therapy, I.e., warm shower/bath, breathing technique, lower back massage during contractions and listening to music.
Her refusal of first-line pain relief, and not coping with the mild to moderate contraction pains, makes her complex and required lots of encouragement.
Assessors Comments: ok so you are aiming to reduce pain as ths single aim?
2. What would routinely be the options and why can’t you follow these options for treating this patient for this problem?
In accordance with the trust policy, my first line of option is to offer and give the patient paracetamol and dihydrocodeine for pain relief depending on cervical dilatation and medical history.
However, with Mrs Tox, I can’t as she declined and requested pethidine at os close. This will means admitting her to the hospital and this is not possible as not indicated. Her stay in the hospital will increase intervention.
Hence, I gave her other non-pharmacological pain relief options.
Assessors Comments: for te purposes of this essay you need 3 drug options at level 7 and 2 at level 6 and one non drug option for both options
So you can’t use the guideline option- what is second line- can you use this? How about other pain relief options that you could consider?
3. What is the single aim you are trying to achieve for this patient i.e. what outcome are you looking for in the evidence?
I am trying to ensure she is comfortable, and aware of other available pain relief till she can have pethidine and trying to support her make an appropriate informed (Decision-Making and Mental Capacity NICE Guideline, 2018; Wear, 1998). It also supports her birthing plan of using a maternity-led unit when in established labour.
I will incorporate evidence from the (NICE, 2007), RCOG
(Rosmiarti et al., 2020) and other evidence
Assessors Comments:
Too many aims- you need one so you focus so I suspect in this case you are trying to reduce pain. How will you measure this- on a VAS?
4. Which options have you ruled out and why?
I have ruled out pethidine administration as too early, the patient can only have up to 3 doses of pethidine, having it now will limit her options later as she declined other pain reliefs including an epidural.
Assessors Comments: ok thsis is clear and you have ruled out paracetamol and dihydr as your patient will not have this- is there a reason why?
5. Which options are you going to consider for analysis and why?
I will consider her having water, music, breathing technique and pethidine for pain management as she declines paracetamol and dihydrocodeine.
I will also offer her Entonox for pain relief
I will research into the reaction and effect of the medication interaction for both the mum and foetus.
Regarding the pethidine, I will Inform her that these will provide limited pain relief during labour and may have significant side effects for both herself (drowsiness, nausea, and vomiting) and her baby (short‑term respiratory depression and drowsiness which may last several days).
I will also, consider the administration of an antiemetic.
Assessors Comments:You seem to be offering everything at once which will not wrk for this essay. You need 3 or 4 options based on your level of study so as an example you could have:
– Music therapy (non pharma)
– Entonox
– Pethidine (although not sure this is feasible as you ruled it out above
These are all options you can use at this moment in time
You then consider the primary evidence for each option in order to implement the best option
Tis could work with some tweakd but not as it stands
NICE: Intrapartum care for healthy women and babies
Clinical guideline [CG190] Published: 03 December 2014 Last updated: 21 February 2017