• Dinoprostone (Propess 10mg) for 24hours, followed by Dinoprostone (Prostin 1-2mg) 2 doses 6 hours apart if needed

Common prescriptions:

Syntocinon: 10units in 500mls 0.9% saline, start at 6ml/hr unless VBAC

Steroids: IM Betamethasone 12mg every 12 or 24hrs for 2 doses

Benzylpenicillin for GBS or PROM, 3g stat and 1.5g every 4 hours

PROM Protocol

• Prostin 1-2mg for 6hours

For EM C/S or Trial, Request on CRS as NOC (RNJ-RL Obs)

• Pre-meds: 40mg omeprazole PO, 10mg metoclopromide IM (STAT)

• Blood track-Log in to check if G&S sample valid if not present on CRS. If G&S not present on CRS but was done, call transfusion and ask for the CMV flag to be removed, then will be reflected as a valid sample on CRS

Elective C/S

• What to do on nights for it? (Print list from SNReportBuilder, Obs theatre 6 and Crosscheck with C/S Calendar, Indication for C/S, Placental location, relevant comorbidities, Bloods (including valid G&S)+MRSA. Photocopy 5 copies and pin to LW board

Completing C/S Op note:

-Check with operating surgeon before finalising

-Make note of timings (into theatre, anaesthesia, KTU etc) and cord gases

-Via Adhoc, Maternity, Maternity Cesarean section

• Where is the 6E Handover list? (Q Drive, Gynae Handover)

• OP Prescriptions-Click Adhoc and under maternity, do OP prescription

• Common prescriptions on 6E/6F

  • PPROM (Erythromycin 250mg QDS)

  • PROM (Benzylpen 3g Stat then 1.5g 4hrly, If allergic Clindamycin 900mg TDS IV)

  • Bethamethasone 12mg 12 or 24hrs apart depending on situation

  • Magnesium (Maternity care pathway)

  • Sliding scale (Maternity care pathway-VRII)

  • Antenatal sepsis: Cefuroxime+Metronidazole

• 
  

• Common prescriptions on 8F

  • Ferrous sulphate 200mg OD

  • Iron Infusion: Ferric Derisomaltose Care plan

  • Dihydrocodeine/Paracetamol/Ibuprofen/Oramorph

  • Postnatal sepsis: Co-Amox

• 
  

• Who to refer to post OASI? (Email gynae secretaries at bartshealth.rlh.gynaeadmin@nhs.net and cc in Miss Chaliha perineal clinic for 3 months, Also email Aliz for physio at bartshealth.physiotherapy.gynae.rlh@nhs.net if within the catchment area, otherwise for GP to refer to physio)  

• What’s in a complete liver screen for deranged LFTs? (Bile acids, Hep A, EBC, CMV, Liver autoantibody screen-IgG/M/A, ANA, AMA, Anti-smooth muscle antibody, liver kidney microsomal antibody, Liver US including doppler, Clotting screen)

• How to refer to Gateway team (BHNT.GatewayTeam@nhs.net)

• How to refer to birth reflections clinic? (Fill in form on Q drive and email to BHNT.antenataloutpatients@nhs.net) 

• How to refer for FMU scan? (Email bhnt.rlhfmu@nhs.net) 

• How to book obstetric scan? (Email bartshealth.antenatalultrasound@nhs.net) 

• How to refer to Obstetric Medicine clinic? (Email r.rashidchoudhury@nhs.net or bartshealth.rlhmaternalmedicine@nhs.net)

• How to refer to vulval derm clinic? (Email arucha.ekeowa-anderson@nhs.net)

• How to request a nuclear medicine scan for suspected PE?- Get CXR first,do a crs request then call nuclear med on 41055

• How to book IOL? (Request on CRS as IOL (OP) regardless of IP/OP and select exact date and then book via calendar, Or ask ward clerk to book)

• How to refer to high risk anaesthetic clinic? (Email bartshealth.rlhobshra@nhs.net) 

• How to refer to maternal medicine? (Email Maternal medicine BartsHealth.rlhmaternalmedicine@nhs.net)

• How to book cat 3 C/S?

  email Miss Egbase, Anaesthetic cons Parvesh, Husna Kamali (07842302927). Request C/S on CRS. Put name on LW board.

• How to refer antenatal patients to a dietician? frances.austin@nhs.net

• Contact details for diabetic midwives Rong and Sigrun 07768702618

Writing an outpatient prescription: Adhoc, Outpatient, Outpatient prescription (Confirmation present in requests)

Gynaecology Assessment Unit:

• Depending on Cons on call, there might be a scanning list in the afternoon from 13:30 to 16:00 (Mr Wong, Mr Aquilina, Miss Egbase, Mr Onwudiwe, Mr Okaro, Miss Ball, Miss Madhvani, Miss Bourke, Miss Morin)

• David is the administrator who can help with booking GAU scans if needed (Ext 41578) 

• Booking a GAU appointment:

  Millenium, PM Office, scheduling appointment book (top left icon), bookshelf, RNJ Women, RNJ GYNAE GAU, appointment, appointment type - Gynae GAU new, add encounter, Facility name (type T, Royal London), Is this a waiting list encounter - Always click yes, available conversation - always Outpatient referral list. Right click, add episode, ok, click encounter, click ok, referral details. Fill yellow boxes RTT always 98, admission booking - always full booking, main building RLH, 

  Right click yellow box, add new appt, then click move. then confirm.

• How to book CEPOD (Book on CRS, Write patient’s name on yellow paper on level 4, fill up sheet as well, call anaesthetic reg 1220 and theatre coordinator on 45662)

• When is EGU open? (Mon-Fri 08:00 to 16:30, Sat 08:00 to 13:00)

• How to refer to EGU? (Email bhnt.egu@nhs.net) 

• How to book TWOC clinic? (Email bartshealth.rlh.gynaeadmin@nhs.net or ask ward clerk on 8F to book patient under Sanghi/Nurse clinic every Monday AM)

• Seeing patients in A&E-Remember to DEPART

• How to refer to urogynae MDT? (Email Miss Chaliha)

• How to refer to Endometriosis MDT? (Email Sophie Strong and zwelihle.magama@nhs.net)

• How to refer to Gynae Onc MDT? (Fill in gynae onc MDT proforma and email to bartshealth.gynaeoncmdt@nhs.net) 

• How to send sample for cytogenetics? (Fill up cytogenetics form on 8C and ensure dry pot)

• How to book an ERPC? (EGU will directly arrange, however if patient comes the night before, SHO to clerk in and arrange as one would for CEPOD-Consent and pregnancy loss forms)

• How to book a MVA? (Liaise with cons who can do them-Mr Wong)

• What to do if a patient wants medical management of miscarriage? (Offer OP or IP, Consent and pregnancy loss forms, If OP Miso 800mcg, If IP Miso 4hrly protocol)

Contact bartshealth.guardiansofsafeworking@nhs.net and lucy.hamer4@nhs.net to get account set up to do it

I wanted to highlight the following email addresses that would enable you to seek advice regarding antenatal patients - 

1. bartshealth.rlhvirtual.antenatal@nhs.net

This email address is not reviewed daily but is reviewed at least weekly. 

• call the breast team on 0203 465 5644

• and email : bhnt.breastappointments@nhs.net

This includes any patient in pregnancy/ postnatally.

Inpatients (e.g. breast abscess) - call general surgeons/ breast team oncall during working hours

• Complete the enhanced recovery checklist. 

• Provide the epidural and LSCS patient information leaflet. 

• Ensure that justification for the c-section is CRS documented. 

• Review PMH, PSH, DH, SH, and alerts to screen for the need for anaesthetic or neonatal input.

• C-section consent.

• Book the c-section on CRS and the departmental calendar.  Yes

• Request MRSA swabs, which an antenatal clinic colleague takes following the appointment

• Request FBC/G&S, which will be taken at  PAC (Preassessment clinic). Patients do not have to attend phlebotomy for blood tests as blood will be taken in PAC

  Inform the patient of the PAC appointment on weekdays the day before the procedure.

  
  

Elective section Pre-assessment Clinics 

ALL Monday LSCS patients need to attend PAC on Thursday afternoon as there is no PAC on Sunday. 

For now, some patients are asked to arrive at the same time for their PAC clinic on Tuesdays and Thursdays. But the calendar will change soon. The best thing to do is tell the patient to attend PAC at the time the slot states and explain they may need to wait.

• Monday LSCS patients - PAC appointment Thursday PM & Bloods in maternity triage Sunday AM.

• Wednesday LSCS patients -  PAC appointment Tuesday AM - bloods will be taken at PAC.

• Friday LSCS patients -  PAC appointment Thursday AM - bloods will be taken at PAC.

If an additional Thursday LSCS list is mobilised, an additional PAC on Tuesday PM will also be mobilised.

What happens in PAC?

• Bloods

• Patient's questions answered 

• SAMS process explained 

• Tour of HDU

Labour Ward 6F

Code 708010

Postnatal 8F

Code 708015

Triage 6E

Code 708007

Exception reporting (O&G trainees) - for missed training opportunities or working outside your contracted hours

@HAMER, Lucy (BARTS HEALTH NHS TRUST) can help with access to this.

Educational supervisors - you can use your monthly meetings with your supervisors to raise training issues (or email at any time)

College tutor - any time, but especially via the JS meeting 

Deputy DME - @ZELIN, Jill (BARTS HEALTH NHS TRUST)

DME - @CHEEROTH, Salim (BARTS HEALTH NHS TRUST)

Escalate all training issues outside of the hospital by contacting the TPDs for NCEL. 

ST1-5 - @KALIDINDI, Madhavi (BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST)

ST5-7 @PAUL, Carolyn (WHITTINGTON HEALTH NHS TRUST)

Lead TPD - @KINGMAN, Charlotte (HOMERTON HEALTHCARE NHS FOUNDATION TRUST)

Foundation Training - Foundation TPD @SANGHI, Anita (BARTS HEALTH NHS TRUST)

GP trainees - @BENNETT-RICHARDS, Phillip (NHS NORTH EAST LONDON ICB - A3A8R)

Rota issues (annual leave/study leave/ problems with health roster etc)

Email - bartshealth.rlh.obsandgynlocumpay@nhs.net 

@ALI, Mohammed (BARTS HEALTH NHS TRUST) - and @ALEXANDER, Jacqueline (BARTS HEALTH NHS TRUST) are the named people for the health roster and can direct you to a member of the Healthroster team. 

Escalate to the Rota consultant @MORIN, Amelie (BARTS HEALTH NHS TRUST)and the College tutor.  should you need to 

All TOIL requests for non-mandatory training need to be approved by the College Tutor before requesting it on Health Roster. 

If the matter is still not resolved, you can escalate to the following 

Clinical directors @CHALIHA, Charlotte (BARTS HEALTH NHS TRUST) and @PEREIRA, Susana (BARTS HEALTH NHS TRUST)

Divisional director @MAY, Caroline (BARTS HEALTH NHS TRUST)

Finance and payment issues (issues with being paid on time/ incorrect salary)

Please email general manager @ANDERSON, Shannon (BARTS HEALTH NHS TRUST) and cc the Clinical Directors, Rota consultant and the College Tutor, and medical HR. 

 HR representative is @WOODMAN, Lesley (BARTS HEALTH NHS TRUST)

Finance representative @WILTON, Ella (BARTS HEALTH NHS TRUST)

If this isn't addressed, then escalate to 

Divisional Director for operations @LOGAN, Thomas (BARTS HEALTH NHS TRUST) 

Locum payment 

Email - bartshealth.rlh.obsandgynlocumpay@nhs.net 

Escalate to rota consultant & service manager @O'BRIEN, Regan (BARTS HEALTH NHS TRUST) including Bank Partners - @Hannah.Emberton@bankpartners.co.uk.

Escalate to the general manager & Clinical Directors 

Escalate to divisional director and divisional manager 

Request/add: refer to SDEC RL

Then fill up all the mandatory yellow boxes

?DVT

Review at maternity triage (so that patient will be send back to triage for review of the results)

• Consultants on ANPNR and Registrars on Triage/6E to routinely check the shared inbox daily and respond to incoming emails. On average, there are approximately 5–10 emails per day.

• Any prescriptions should be sent electronically to the RLH pharmacy. Please reply to the original email once the prescription is completed, so that the midwife can notify the patient for collection.

• If it is deemed that antibiotics are not clinically indicated based on MSU results, please inform the midwife accordingly.

• All consultants and registrars have access to the shared inbox and are encouraged to check it regularly.