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EP9.02
Metrics for Obstetrics – evidence based targets for clinicians and organisations in preconception & early antenatal care

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Metrics for Obstetrics

Evidence based targets for clinicians and organisations in preconception & early antenatal care     

T.Adams1, J.Cooper1, D. Rowlands2, L.Bricker1 on behalf of the NHS Northwest Birth and Newborn Clinical Pathway Group.

1 Liverpool Women’s Hospital NHSFT, Crown St, Liverpool UK

2Wirral University Teaching Hospitals NHSFT, Wirral, UK

 

Preconception Metrics

Cardiac

•90% of females of childbearing age, who are not planning a pregnancy, who have had any form of cardiac surgery, pre-existing heart disease, diabetes, mental health problems, hypertensive disease, etc  received appropriate contraceptive advice at each review meeting, whether that was in adult, paediatric services, or primary of secondary care setting.
•90% of women with cardiac disease (or prospective fathers with cardiac disease) had discussed the implications of pregnancy prior to conception with a practitioner with specialist knowledge about pregnancy, cardiac disease and health.

Diabetes

•90% of women with diabetes had discussed the implications of becoming pregnant prior to conception with a suitably qualified professional
•100% of women with diabetes planning a pregnancy had 5mg folic acid prescribed to them.
•90% of women who have had advice had booking HbA1C results of 6.1% or less

Epilepsy

•100% of women with epilepsy planning a pregnancy had 5mg folic acid prescribed to them.
•90% of women with epilepsy had discussed the implications of becoming pregnant prior to conception with a suitably qualified professional
•50% of women with epilepsy had registered with Epilepsy UK Epilepsy and Pregnancy web at their booking appointment with their maternity caregiver.

Hypertension

•90% of women using pharmacological methods of treating hypertension had discussed the implications of pregnancy prior to conception with a practitioner with specialist knowledge about pregnancy and hypertension.
•0% of women of pregnant women should be on an ACE inhibitor

Mental health

•90% of women with a mental health problem had discussed the implications of becoming pregnant  (including drug therapy) prior to conception with a suitably qualified professional

Alcohol

•90% of women were able to describe the safe limit of alcohol in pregnancy at the booking appointment.
•90% of women seeing a health care professional who drink over the safe limit had documented evidence of a brief intervention

Smoking

•100% of women planning a pregnancy had been advised not to smoke by a health professional

Asylum seekers

•90% of women of childbearing age received information about their local maternity services in their own language or in illustrated form within 14 days of referral to primary or secondary care services.
•90% of women of childbearing age were offered  blood borne disease screening and pregnancy testing within 14 days of referral to primary or secondary care services
•100% women who are identified, prior to pregnancy as having undergone FGM were referred to the appropriate specialist as necessary.

Obesity

•All health care providers ensured that they had standard advice about healthy eating and weight gain during pregnancy for women seeking advice.
•90% of primary health care teams ensured they had suitable weight loss advice strategies in place for women under the age of 28 or those with medical problems who have a BMI >30.
•All women seeking advice about weight loss had at least two ways of losing weight discussed with them (eg increasing activity and eating less fried foods)

Black and ethnic minority women

•All health care providers have readily accessible literature (including illustrated literature) about healthy pregnancy in languages suitable for 90% of their client base.
•Health care providers have strategies in place (which may include link clinics, translating services and women-only clinics) to be able to offer effective pre-conceptual care services to 90% of their local ethnic and minority groups.
 
Antenatal Metrics
 
•There is documented evidence of a full booking assessment for 90% of pregnant women by 12+6weeks.
•There is documented evidence of a clear and simple referral system, utilised prior to 12+6 weeks to, for example, health visitor, obstetric services, Children’s Social Care, Children’s Centre, smoking cessation services, dietetics, medical practitioner, mental health services
•100% of women booking for pregnancy care were offered referral to their local Children’s Centre (where there is one).
•50% of women registered with their local Children’s Centre during their pregnancy.
•50% of women take folic acid prior to 14 weeks
•90%  of women take a vitamin D supplement  during pregnancy who are deficient
•50% of women eligible for Healthy Start vitamin supplementation, have taken it up.
•90% of women were given suitable information regarding food preparation and safe eating.
•90% of women who smoke in pregnancy or live with those who smoke were given information on smoking cessation services and were offered referral, after discussion on the implication of smoking/being subjected to passive smoking during pregnancy.
•No access/did not attends for initial visit recorded for each woman ≤1.
The number of no access/did not attend instances are recorded, along with the action taken to follow up missed appointments
 
Postnatal Metrics
 
•Within 24 hours of birth, 90% of women had discussed, agreed and written a plan for postnatal care with their caregiver(s).
•90% of Trusts had a procedure which enabled women to meet with their caregivers and discuss their labour and birth.
•90% of mothers gave consent to notification of the birth being sent to their local Children’s Centre, GP, health visiting services and registrar of births
•90% of Children’s’ Centres, GP services, health visiting services had suitable, confidential ways of receiving this information
•100% of women  had a 24 hour contact number for maternity services  from which they can get support and advice
•100% of women knew when they will next have contact with maternity services (date, time, location)
•90% of women knew how to contact breastfeeding support services
•90% of women and families were given written or pictorial guidance (in a suitable language) on when and how to seek further advice (this must include factors relevant to both mother and baby).
•90% of women and families were given information about postnatal and neonatal changes in the first few weeks following birth. This should be individualised where possible, for example to discuss care of sutures, recovery from caesarean section.
•90% of women and families were given information about hearing screening, blood screening and vaccination programmes available to them and are encouraged to access these.
•100% of women knew how to access breastfeeding advice, including peer support services.
•100% of women understood what might signify the need for extra support (for themselves and their baby).
•100% of women who were breastfeeding their babies had been shown how to use hand-expression of breast milk.
•100% of families who chose to use formula milk had a 1:1 session to discuss sterilising bottles and making up formula safely.
•90% of families had been given relevant advice on safe sleeping, co-sleeping, smoke free homes, room temperature,

There is documented evidence that 90% of women had been given information on what constitutes an emergency situation for themselves or their baby, and the appropriate measures to take. This would include for example recognising a post-partum haemorrhage; symptoms of pre-eclampsia ; symptoms of infection; symptoms of pulmonary embolism; symptoms of deep vein thrombosis; recognising the signs of a ill baby (for example, non-responsive, not feeding, lethargy)

 
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