Key Change 1: Support in Early Pregnancy & Beyond
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2 Amanda Cronin Key Change Improvement Advisor Key Change 1: Support in Early Pregnancy & Beyond
3 Rate per 1,000 births 9.0 P' Chart for Quarterly Stillbirths in Scotland, UCL Average Rate LCL Quarter
4 What do we know?
5 16 No. of Reported Improvement Projects - Early support for pregnancy & beyond
6 Is it effective? O Can it spread? O Is it measureable? O Can we define what actions we are taking? O What does success look like?
7 Aim Primary Drivers Interventions Reduction of prescribed medication in pregnant women. Early Support in Pregnancy and Beyond Specialist community perinatal mental health
8 Reduction of Substitute Prescribing in Pregnancy Mary Garven Team Leader for Vulnerable Families March 2015
9 Background North Ayrshire Statistics 5Aug 2012 October pregnant substance users (Approx 70 Ayrshire & Arran) 88% Methadone 15% Heroin 38% Benzodiazepines 50% Compound use (Similar clinic in Fife for 10 years has 8% incidence of NAS compared to 42% in A&A.) Outcomes for Babies In babies diagnosed with NAS. 7 admitted to NNU (average length of stay 35 days. 23% under 10 th centile (small for dates) Placental insufficiency Risk of stillbirth 42% admitted to neonatal unit for DWS >12
10 Background Risks for Mothers Chaotic lifestyle Risky behaviour Criminal justice Risk of BBV Violence Exploitation Reduced AN care Pre-Eclampsia Abruption Risks for Fetus Miscarriage Congenital abnormalities Placental insufficiency IUGR Preterm labour Abruption Stillbirth Transmissions of BBV Drug dependence
11 Length of Stay Length of stay ranged from 1-35 days 476 per night for baby 997 per night for mother In babies diagnosed with NAS. 7 admitted to NNU (average length of stay 35 days.
12 AIM : 30% of pregnant substance users within North Ayrshire locality to reduce the amount of substitute prescribing by the end of their pregnancy. SUB AIM : To reduce the length of stay in NNU of babies affected by Neonatal Abstinence Syndrome (NAS) by 30% by November 2015.
13 Monthly multi agency addiction clinic to be commenced within NHS addiction services Monthly multi agency addiction clinic commenced within NHS addiction services (Dec 2014) Women offered an intense 2 wkly VIP support at clinic or at home (NAC addiction worker asked to attend) Women offered an intense 2 wkly VIP support at clinic or at home (NAC addiction worker asked to attend) Compass clinic removed from main AN clinic and to be commenced within VIP clinic Compass clinic removed from main AN clinic and to be commenced within VIP clinic NHS Addiction workers abandoned due to difficulties in sessions attending and sessions at requests and of at women requests of women NHS Addiction workers abandoned due to difficulties in attending NHS addiction workers asked to attend clinic to improve multi agency working NHS addiction workers asked to attend clinic to improve multi agency working Appointment time changed to end of clinic as was holding up Consultant clinic Appointment time changed to end of clinic as was holding up Consultant clinic Pregnancy pathway paperwork tested on 3 women within Compass clinic Pregnancy pathway paperwork tested on 3 women within Compass clinic Pregnancy pathway paperwork tested on 3 women within Compass clinic
14 median New clinic commenced within NHS addictions services
15 Staff resources Challenges Difficulty in contacting wider agencies Meetings cancelled or postponed Women failing to attend appointments Women resistant to change Strong culture exists in Ayrshire regarding substitute prescribing in pregnancy Inconsistent advice given via agencies regarding opiate reduction in pregnancy
16 Key Learning Project should not be person specific Small steps required to implement change Training and updates of staff essential Communication between agencies essential Some women unable to reduce substitute prescribing in pregnancy Difficulty in changing attitudes and behaviours.
17 Monthly multi agency addiction clinic to be commenced within NHS addiction services Women offered an intense 2 wkly VIP support at clinic or at home (NAC addiction worker asked to attend) Compass clinic removed from main AN clinic and to be commenced within VIP clinic NHS Addiction workers abandoned due to difficulties in attending sessions and at requests of women Appointment time changed to end of clinic as was holding up Consultant clinic Pregnancy pathway paperwork tested on 3 women within Compass clinic Pregnancy pathway paperwork tested on 3 women within Compass clinic
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