A multi-professional approach to improve postnatal care in the community

A multi-professional approach to improve postnatal care in the community (Poster 1)

Introducing MSW’s as part of the Postnatal Pathway (Poster 2)

Background & Problem

In 2016 Better Births-Improving Outcomes for Maternity Services in England was launched. This followed a national review of maternity services across England. The report recommended improvements to postnatal care focusing on multi-professional and cross boundary working. The report highlighted a seamless transition between professionals including Health Visitors (HV) and GP’s and the introduction of new roles eg. Maternity Support Workers (MSW’s) to support postnatal care provision allowing greater midwifery flexibility to support continuity of midwifery care and women’s choice. A local user engagement event (Whose Shoes) identified a lack of clarity for women and families around the roles of health professionals, in particular the HV role. Women wanted more consistent information and support between health professionals for breastfeeding and emotional wellbeing. Prior to the introduction of the new pathway the care provided was task orientated and not particularly woman focused. Typically women were discharged by midwives at Day 10 -14 (not necessarily by the named midwife) leaving gaps in care or duplication of visits with the HV. Often there would be no further face to face contact until HV contact at 6 weeks postnatal.

Aim

To Improve the quality of postnatal care for 20% of women in Gloucestershire by December 2018 by using a collaborative approach to develop & implement a multi-professional integrated postnatal pathway.

Method

A multi-professional integrated community pathway was developed in collaboration with Health Visitors and other stakeholders including service users.

MSW’s were introduced to support greater flexibility within the postnatal pathway ensuring that all women receive care appropriate to their level of need.

MSW’s received a comprehensive training programme including competency to undertake the Newborn Hearing Screening Programme (NHSP) and Newborn Blood Spot (NBBS)

A standardised handover tool for handover to Health visitor was developed as part of pathway.

A tool was developed to signpost women to HV services at the earliest opportunity.

The pathway was launched and piloted in the South Hub in the Stroud and Cirencester with Midwifery and Health Visitor Teams.

Data was collected on the following outcomes

• Women receive care on the appropriate pathway by the appropriate professional,
• reduction of duplication of Midwife/HV visit,
• improved communication between maternity and HV service,
• increased understanding of role of HV by women,
• number of women who had a formal discussion with their named midwife regarding their birth experience prior to discharge,
• Reducing the number of avoidable NBBS repeats and NHSP referrals.

Results

• Nearly 80% of women seen during the pilot were seen on the correct pathway.
• Women received postnatal care 50-60% of their postnatal appointments by their own named midwife compared to previous audit results of 10.5%.
• A previous baseline audit demonstrated that only 50% of women were discharged by their named midwife. With the introduction of the new pathway this increased to an average of 90%.
• The new pathway enabled midwives to discharge women to the care of the Health Visitor beyond day 10 –14 to support reduction of duplicated visits by HV & Midwife sometimes visiting on the same day. In addition increasing support for women between Day 14 and HV contact at 6 weeks
• Whilst during the pilot only 58% of women were discharged beyond day 14, as the pathway has embedded this is slowly increasing as confidence in the pathway grows.
• 100% of women were given information regarding the HV role and signposted to the HV website at first contact.
• The introduction of the Maternity Support Workers has improved the key performance indicators across the newborn screening programme.

Implications

Working across professional boundaries in terms of governance, training, policies and referral pathways has been challenging and we underestimated the reluctance of health professionals to embrace change to their roles. In hindsight, the project would have benefitted from a Health Visitor on our project team to support timely cascade of information to HV colleagues. This would have supported a smooth introduction and evaluation of the integrated care pathway. The pilot demonstrated that the MSW’s have vastly improved newborn screening KPI’s, previously subject to an NSC Improvement Notice, due to a task orientated approach of a much smaller workforce. .

Next steps include the development of a SOP between Health Visiting & Midwifery supporting cross organisation working, the development of Community Hubs where local services can be wrapped around women and their families and the potential for health professionals to be co-located together. Further evaluation would include women’s feedback and impact of the pathway on longer term health outcomes for mother and baby.

Our results support roll out to all community areas.