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(200)PurposeMid-trial, due to safety, the TA+SPU intervention was replaced with a Suture+TA+SPU group.Results: 221 patients were randomised with two post-randomisation exclusions. CVAD failure was

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to detect early deterioration and then incorporated into observation charts. Following education and clinical support for maternity staff, the observation charts and obstetric escalation criteria were introduced in November 2011. Results: Haemorrhage (66%) and sepsis (21%) were identified as the most common conditions leading to serious clinical deterioration meeting MNM criteria of childbearing women in our health service. Early warning signs of impending deterioration most frequently included respiratory dysfunction, increasing uterine fundal height, heavy postnatal lochia, pain, and 'looks unwell'. These signs often appeared prior to deterioration in blood pressure or heart rate. The maternity observation charts and escalation criteria have been in use for over 18 months. To date we have seen an increased rate of systematic observation and documentation of the vital signs and clinical status of childbearing women post birth. The charts have also supported clinicians' decision making and empowered midwives to escalate care when required. In addition, these charts are an objective tool to assist in the identification of barriers to early recognition and response to clinical deterioration, so that measures can be adopted to address these issues at an organisational level. Conclusions: The introduction of the maternity observation and response chart and associated escalation criteria are contributing to early and improved recognition and response to clinical deterioration in childbearing women across our health network.

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