Summary: Record all actions and contact on the Community Midwives Caseload Card for the woman

Transcription

1 DID NOT ATTEND (DNA) OR BOOKED LATE FOR ANTENATAL CARE - CLINICAL GUIDELINE Summary: Record all actions and contact on the Community Midwives Caseload Card for the woman Woman has DNA an appointment Document on the caseload card and main health notes when available that she has failed to attend Inform the Community Midwife who will contact the woman and agree a plan for re attendance 1 st DNA Phone call rearrange appointment 2 nd DNA Write to the woman with a new appointment 3 rd DNA - Unannounced home visit. If no contact, leave appointment card. Following two missed appointments or no-access visits Escalate in line with advice in Section 2.5 Page 1 of 8

2 1. Aim/Purpose of this Guideline 1.1. This gives guidance to Midwives and Obstetricians in the identification of women who have booked late or women who did not attend for ante natal care. It gives guidance on the follow up and support of these women. 2. The Guidance 2.1. Background MBRRACE (2014) UK: Mothers and Babies; Reducing Risk through Audits and Confidential Enquiries across the UK. Saving Lives, Improving Mother s Care (2014) reported that more than two thirds of women who died did not receive the nationally recommended level of antenatal care. Access to antenatal care remains an issue and ensuring access to appropriate care for all groups must remain part of service planning. Of the women that died two thirds of the women were suffering from medical and mental health problems Main characteristics of women that are poor attenders, non- attenders or book late: Homeless or constantly changing their address Had children in care Were refugees or asylum seekers Suffered from domestic abuse Spoke little or no English Were substance misuses Lived in extreme poverty Had previous or on-going severe psychiatric illness 2.3. Late Booking Appointment Compete the routine Antenatal Booking Arrange the appropriate scan as soon as possible e.g. dating and anomaly USS If the woman has identified risks of possible poor attendance or a history of poor attendance then discuss with the woman what arrangements would best suit her circumstances A plan of care can be initiated at this stage. If this is not achievable the midwife should note the date of the next appointment; this will allow increased surveillance of attendance. A home visit for the second appointment may be a better option. Organise an interpreter for women who do not speak English via Big Word or Face to Face. Family members should not be encouraged to relay information between the woman and the health professional DNA follow-up Document on the caseload card and main health notes when available, that she has failed to attend Inform the Community Midwife who will contact the woman and agree a plan for re attendance 1 st DNA Phone call rearrange appointment Page 2 of 8

3 2 nd DNA Write to the woman with a new appointment 3 rd DNA Unannounced home visit. If no contact, leave an appointment card Record all actions and contact on the woman s Community Midwives Caseload Card 2.5. Women who continue to fail to attend for ante natal care Following two missed appointments or no-access visits an additional midwifery record should be commenced Raise your concerns at the next community team meeting Contact the woman s GP and confirm that the woman is still registered with them and inform them of your concerns Contact the Health Visitor, to see if the family is known to them. The outcome of the above enquiries should be documented in the additional midwifery record. Following 3 failed attempts to make contact with the woman a discussion must take place between the Midwife and her Team Leader to decide an agreed plan of action Document all actions taken, contact and proposed plan of care in the additional midwifery records. A copy of the additional midwifery records should be sent to the Safeguarding Midwife and added to the Safeguarding Risk Folder on Delivery Suite. If there are concerns about safeguarding, follow the RCHT Safeguarding Children Clinical Guideline for Midwives Page 3 of 8

4 2 Monitoring compliance and effectiveness Element to be The audit will take into account record keeping by Midwives monitored Lead Maternity Risk Management Midwife Tool Was the failure to attend for consultant or ultrasound appointment documented in the woman s main health records If the follow up of a woman failing to attend a midwifery clinic resulted in the woman attending her next appointment was this documented in her hand held notes If the woman failed to attend 2 appointments was an additional midwifery record raised If the woman consistently failed to attend 3 or more appointments was a copy of the additional midwifery record sent to the Specialist Midwife for Safeguarding Frequency 1% or 10 sets, whichever is the greater, of all health records of women who have delivered and have missed any type of antenatal care. This will be audited every 3 years or earlier if there is reason too following an incident. Reporting A formal report of the results will be received annually at the arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Maternity Risk Management or Clinical Audit Forum Any deficiencies identified on the annual report will be discussed at the Maternity Risk Management or Clinical Audit Forum and an action plan developed Action leads will be identified and a time frame for the action to be completed The action plan will be monitored by the Maternity Risk Manager until all actions complete Required changes to practice will be identified and actioned within a time frame agreed on the action plan A lead member of the forum will be identified to take each change forward where appropriate Risk Management Newsletter 3 Equality and Diversity 3.2 This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement. 3.3 Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 4 of 8

5 Appendix 1. Governance Information Document Title DID NOT ATTEND (DNA) OR BOOKED LATE FOR ANTENATAL CARE - CLINICAL GUIDELINE Date Issued/Approved: 18 th September 2015 Date Valid From: 30 th September 2015 Date Valid To: 30 th September 2018 Directorate / Department responsible (author/owner): Midwifery Matron Obs and Gynae Directorate Contact details: Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Page 5 of 8 This gives guidance to Midwives and Obstetricians in the identification of women who have booked late or women who did not attend for ante natal care. It gives guidance on the follow up and support of these women. DNA, attend, fail, late, ante, natal, care, appointment, booking RCHT PCH CFT KCCG Medical Director Date revised: 18 th September 2015 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Guideline for Women who fail to attend for antenatal care Maternity Guidelines Group Obs and Gynae Directorate Divisional Meeting for noting Head of Midwifery Clinical Governance Lead Women s and Children s & Sexual Health Division {Original Copy Signed} Internet & Intranet Links to key external standards CNST 4.2 Intranet Only Clinical/Midwifery and Obstetrics

6 Related Documents/ References. Training Need Identified? None MBRRACE-UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK(2014) Saving Lives, Improving Mother s Care National Institute for Health and Care Excellence (NICE) (2008) Clinical guideline CG62: Antenatal Care RCHT (2015) Safeguarding Children Clinical Guideline for Midwives Version Control Table Date December 2006 Version No V1.0 Initial document Summary of Changes June 2009 V1.1 Updated CMACH recommendations June 2011 V1.2 September th September 2015 Page 6 of 8 Changes Made by (Name and Job Title) Jan Clarkson Maternity Risk Manager Midwifery Matron for Community and Outpatients Services Reviewed and compliance monitoring Midwifery Matron for added Community and Outpatients Services Jan Clarkson V1.3 Changes to compliance monitoring only Maternity Risk Manager V1.4 Reviewed, no changes. Format now includes summary of guideline in a flow chart and updated MBRRACE supporting evidence Midwifery Matron for Community and Outpatients Services All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager.

7 Appendix 2. Initial Equality Impact Assessment Form Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): DID NOT ATTEND (DNA) OR BOOKED LATE FOR ANTENATAL CARE - CLINICAL GUIDELINE Directorate and service area: Obs & Gynae Directorate Name of individual completing assessment: Elizabeth Anderson Is this a new or existing Policy? Existing Telephone: Policy Aim* Who is the strategy / policy / proposal / service function aimed at? This gives guidance to Midwives and Obstetricians in the identification of women who have booked late or women who did not attend for ante natal care. It gives guidance on the follow up and support of these women. 2. Policy Objectives* To ensure that all women who book late or do not attend for appointments receive appropriate care 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. Improve pregnancy outcomes for women and babies Compliance Monitoring Tool No N/A N/A 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Page 7 of 8

8 Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. N/A Signature of policy developer / lead manager / director Date of completion and submission 18 th September 2015 Names and signatures of members carrying out the Screening Assessment 1. Elizabeth Anderson 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed: Elizabeth Anderson Date: 18 th September 2015 Page 8 of 8