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Archive for October 27th, 2007

If anyone wonders what a community midwife does in an average day,here is a snapshot.

8.30      Unload on-call equipment, large hold all, two entonox cylinders + tubing, resuscitation equipment

8.35      Collect and respond to messages. Answer phone

8.45      Sort out visits, continue answering the phone

8.50      Check pethidine, sign drugs book. Pass key over to next holder and record new holder

8.55      More phone calls

9.00      Request any scan appointments. Send off paperwork from yesterday

9.10      Enter data and print off personalised growth scans

9.15      Leave office

9.25      Arrive at G.P’s surgery for antenatal clinic. Pickup messages. Log-on to computer

9.30      First patient – 17 weeks, has not received appointment for anomaly scan. Phone scanning department. Will not arrange over phone. Fax over request form. Now running 10 minutes late. Next patient, with severe latex allergy who suffered anaphylactic shock during last birth leading to intensive care for 4 days, has not had consultant appt. despite referral from G.P and myself. Contact antenatal clinic, after 5 minutes explaining to receptionist why patient requires early review and plan for care she agrees to look for paperwork and before I can stop her puts me on hold. 5 minutes later, the paperwork has been found, and the patient has an appointment. The clinic is now running 25 minutes late.

12.15    Last patient. Caesarian section next week. Hospital has sent her to have pre-op             bloods taken. Fine, except that this is not the hospital our bloods are taken to so will have to take them in to them, 30 mile round journey, plus she has rubbish veins.

12.30    Clinic has finished. Cup of coffee

13.15    Leave surgery after reading and actioning practice notes and E-Mails, printing off blood forms and completing individualised ‘contact’ form to prove how many patients at clinic

13.25    Homebirth booking and routine antenatal at woman’s home. Re-inforcement of our previous discussions. Who to contact when in labour. Possibility that midwives may already be at a homebirth. Limitations of equipment. Transfer in emergency. Give patient my phone number as I will go on-all for her, except for this Saturday and next weekend.

14.10    Meeting with practice manager at other surgery to introduce new job-share

14.40    Day 5 visit to C.S woman, Baby – bloodspot screening, weigh, Mum – Suture removal

15.10    Day 3 visit to C.S woman. No answer. Phone. Husband answers, he hasn’t heard me knock, am I sure I did? Duh! Opens the door, eventually. Mum feeling well. Baby – Yellow, has fed 3 times since birth. Watching baby as it ‘jitters’ away. Pick baby up,handles well. Take baby’s clothes off, notice meconium nappy. Change nappy, vigorously. Baby now awake, suggest to Mum that now might me a good time to feed.Baby to breast, slight adjustment to position, baby guzzling, Mum’s milk is in. Chat to Mum and Dad about jaundice, blood sugar levels and the wisdom of  frequent feeds.

16.00    Drive to other hospital to drop off bloods

16.45    Stretch and sweep at 41 weeks. Another latex allergy. Drive to office to procure vinyl gloves.

17.00    Back to stretch and sweep. Cervix posterior. 1 cm long. 2cms dilated. Presenting part -2 above spines. Comprehensive stretch and sweep performed.

17.40    In office. Forget the paperwork, I’ll do it on Sunday. Message left re. jaundiced baby.Try and phone woman re. booking visit. No answer

17.50    Go home.

18.00    Get changed. Have coffee, and cigarette.

18.15    Phone woman and arrange visit. Finished. No break. Nothing to eat except one chocolate digestive. Two cups of coffee. Why have I got a headache? 

So. Not including final half hour I was working for just over 9 hours. Of that I spent 5 ½ hours with patients and the other 3 ½ on paperwork, at a meeting or on the phone. I’m useless with percentages but even I can see that over 33% of my time is spent on extraneous stuff, which wouldn’t show up on any of the forms I have to complete to show how much work I do, as it’s not patient contact. At least 10% of my working day is spent on tasks that anyone could do. This is what needs looking into as a way to save money and imprve patient care. 

I officially work a 7 ½ hour day. Today I worked an extra 1 ½ hours, which I won’t get paid for, and that’s why no one will do anything. 5 midwives in the office yesterday, if all of us worked the extra time then that’s the equivalent of an extra midwife, free. Where’s the incentive to improve the time we have to spend with patients?

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