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Department of Health. A First Class Service: quality in the new NHS, 1998.0ZRZNDeveloping clinical governance$Equality of access to careMultidisciplinary working Evidence-based practice High quality systems for clinical record keeping HSC 1999/065 Clinical Governance in the New NHS |" 4" " 0Access to care$RWomen s first contact with a health professional was at a median of 6 + 6 weeks gestation Women s first hospital appointment was at a median of 8+3 weeks gestationMultidisciplinary working$\ Antenatal care for women with diabetes should be provided by a multidisciplinary team, which includes a diabetologist, an obstetrician with a special interest in diabetes, a specialist diabetes nurse, a specialist midwife and a dietitian. Diabetes National Service Framework: Intervention details and draft service models; March 2002F\ZZcPrevious findings "63% of maternity units in E, W & NI reported a full diabetes multidisciplinary teamIncrease in dietitian availability from 40% to 88% of unitsIncrease in specialist midwife availability from 25% to 77% of units CEMACH Survey of Maternity Services for women with diabetes 2004BM EEnquiry findings75% of women reported to have care provided in a combined clinic Only 22% of women reported by panels to have all members of the multidisciplinary team involved in their care Professionals most likely to be missing were midwife (for 54% of women) and dietitian (for 53% of women)0APPP(Multidisciplinary working: communication Deficiencies in communication between health professionals for 56% of women: maternity staff and antenatal multidisciplinary team multidisciplinary team and other specialistsobstetrician and physician in multidisciplinary teamprimary and secondary care$OZZ4Communication between health professionals and women Deficiencies in communication between health professionals and women for 47% of women: Lack of discussion about risksPlan of care not discussedLack of professional interpreters for women with language difficulties >YZZZZ Guidelines $Maternity units asked to provide diabetes guidelines contemporaneous for 2002-03 Panels had concerns about guidelines for 72% of 386 women  lPanels concerns about local maternity unit guidelines "Some quotes from panel discussions  Wrong advice re breastfeeding  protocol stated that it increased insulin requirements and risk of infection  Protocol suggesting attendance at a combined clinic beginning only at 26/40 is considered inappropriate/poor practice  Rigid Delivery Day. No targets for blood glucose control. Routine admission of baby to NNU KPKDocumentationA woman s health record should provide a contemporaneous and complete record of the woman s treatment and related features. Standard 6: Health Records, CNST Maternity Clinical Risk Management Standards April 2006@}`\ DocumentationDeficiencies in the standard of: 44% of obstetric notes 51% of diabetes notes Main issues:Poor documentation of care given and care plansDesign of notes not fit for purpose for antenatal care of a woman with diabetesMissing notesT"0"0"Some quotes from panel discussions  No difference from normal antenatal notes so no space to record observation [and] plans relevant to diabetes.  No diabetic entries in the obstetric notes (if she had attended another unit there would have been no record in her hand held notes.  Big gaps in documentation. Very few glucose results included in notes. FPF  Conclusions $Women appear to be accessing antenatal care early in pregnancyLow reported rates of full multidisciplinary team involvement Suboptimal communication between health professionals for half of womenSuboptimal communication between health professionals and women for half of womenConcerns about local guidelines for two-thirds of women Poor documentation of carePoor design of antenatal notesZ  Recommendations ICommissioners should recognise the complexity of diabetes management and ensure that the available service provision includes all members of multidisciplinary team Patient pathways of care should be incorporated into clinical record Services should review their local guidelines ZRecommendations IIThe multidisciplinary team should provide regular educational days for all primary and secondary care professionals involved in the care of women with diabetes of childbearing age Diabetes networks should audit preconception and pregnancy servicesP/T   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@ |?" dd@   " @ ` n?" dd@   @@``PV    @ ` `p>>  O(    nAL Y?$dv418111ucPreview_imgMain#" `S  6` ,  T Click to edit Master title style! !  0ܪ 'g  RClick to edit Master text stylesSecond levelThird levelFourth levelFifth level!   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