Value sets – OAS Obstetric surgery

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Obstetric surgery

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Concept IDDescription
236989008Abdominal delivery for shoulder dystocia
359944002Anal sphincteroplasty for current obstetrical laceration
41059002Caesarean hysterectomy
11466000Caesarean section
450483001Caesarean section through inverted T shaped incision of uterus
450484007Caesarean section through J shaped incision of uterus
46681009Cerclage of cervix during pregnancy by abdominal approach
90442009Cerclage of cervix during pregnancy by vaginal approach
265636007Cerclage of uterine cervix
708967005Cervical cerclage of internal os during pregnancy
84195007Classical caesarean section
57411006Colpoperineorrhaphy following delivery
310603006Digital evacuation of retained products of conception
176827002Dilation of cervix uteri and vacuum aspiration of products of conception from uterus
236988000Elective caesarean hysterectomy
177141003Elective caesarean section
177143000Elective lower segment caesarean section
1197219005Elective lower segment caesarean section through inverted T shaped incision of uterus
736026009Elective lower segment caesarean section with bilateral tubal ligation
177142005Elective upper segment caesarean section
736018001Elective upper segment caesarean section with bilateral tubal ligation
236987005Emergency caesarean hysterectomy
274130007Emergency caesarean section
236985002Emergency lower segment caesarean section
736118004Emergency lower segment caesarean section with bilateral tubal ligation
709004006Emergency lower segment caesarean section with inverted T incision
236986001Emergency upper segment caesarean section
736020003Emergency upper segment caesarean section with bilateral tubal ligation
236883005Evacuation of retained product of conception
274943006Examination of female genital tract under anaesthetic
40801000Exploration of pelvis by laparotomy
74770008Exploratory laparotomy
12324002Exploratory laparotomy with biopsy
310602001Expression of retained products of conception
240278000External cephalic version
5048009External cephalic version with tocolysis
57271003Extraperitoneal caesarean section
302383004Forceps delivery
71166009Forceps delivery with rotation of fetal head
89849000High forceps delivery
1359709000Hysteroscopic evacuation of retained product of conception
177219009Immediate repair of obstetric laceration of perineum and sphincter of anus
177200004Instrumental removal of products of conception from delivered uterus
274492009Insertion of pack to control vaginal bleeding
236972000Insertion of balloon catheter into uterine cavity
840831000000107Laparoscopic cerclage of cervix
446942007Laparoscopic incision and drainage of cyst of ovary with conversion to laparotomy
86481000Laparotomy
264969004Laparotomy and removal of foreign body from abdominal cavity
788180009Lower uterine segment caesarean section
18625004Low forceps delivery
28233006Manual removal of retained placenta
236946009McDonald cervical cerclage
854611000000109Medical evacuation of retained products of conception using prostaglandin
62508004Mid forceps delivery
260645006Minilaparotomy
236975003Nonrotational forceps delivery
265641004Packing to control postnatal vaginal bleeding
243414007Pelvic examination under anaesthesia
244645007Pelvic examination under general anaesthesia
13341006Reduction of volvulus by laparotomy
32023008Removal of packing from vagina
237027001Repair of complete perineal tear
359946000Repair of current obstetric laceration of rectum and sphincter ani
301858009Repair of labial tear
14764004Repair of laceration of male perineum
237029003Repair of laceration of vulva
359937006Repair of obstetric laceration of anus
441619002Repair of obstetric laceration of perineum and anal sphincter and mucosa of rectum
112925006Repair of obstetric laceration of vulva
55669006Repair of obstetrical laceration of perineum
237026005Repair of perineal tear
237030008Repair of superficial vulval tear
238255007Second look laparotomy
236947000Shirodkar cervical cerclage
310604000Suction evacuation of retained products of conception
473236004Suture of caesarean wound for dehiscence
360362007Suture of laceration of perineum
448806005Suturing of laceration of anus
69422002Trial forceps delivery
229761000000107Vacuum aspiration of products of conception from uterus using flexible cannula
229801000000102Vacuum aspiration of products of conception from uterus using rigid cannula
89053004Vaginal caesarean section

Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.