RCOG World Congress 2023

BACKGROUND

RCOG postnatal framework for maternity standards states: 'women should be offered relevant and timely information to enable them to promote their own health and wellbeing'.

The NHS London Clinical Maternity Network identified a deficiency and published guidance in 2021 to standardise postnatal guidance. This provides national, evidence-based recommendations on monitoring, follow-up and crucially, an understanding of potential risks on future health of the mother

OBJECTIVE

Assess the standard of our postnatal discharge in an East London DGH:
1. Audit discharges using NHS London Clinical Maternity Network guidance as the gold standard

2. Qualitative study of the opinions of maternity staff and postnatal women on the discharge experience

METHOD

Registered with trust
51 women who delivered consecutively in February 2023 identified from the labour ward log
Excel proforma formulated for data collection
Analysis of 51 sets of electronic notes
All maternity staff invited to participate in survey
All 51 mothers invited to participate in survey
To be communicated to team in audit meeting

Results

Postnatal reviews and discharge summaries are almost exclusively performed by SHOs: GP trainees, Foundation Year Doctors, O&G ST1, ST2
Postnatal discharge summaries are only made when medication is prescribed for TTA (to take away)
Confidence (out of 5 on Likert scale) in giving long term health and future pregnancy advice for patients with common antenatal complications was low (figure 1)
Consistent advice on each of these conditions was rarely given for future health risks and pregnancies. Where advice was given, this was not in line with the gold standard
Only women who had Caesarean section were given advice on recommended inter-pregnancy interval
Information regarding the dilatation at which an emergency Caesarean was performed was rarely documented in the discharge summary
Contraceptive options were rarely documented as being offered except for elective or emergency Caesarean deliveries

DISCUSSION

Our women are not receiving good quality, evidence-based and consistent advice at discharge in line with regional recommendations
Discharge summaries are not written unless women receive a doctor-led postnatal review

Confidence re ante/intra/post-partum complications is low among SHOs who are almost exclusively responsible for postnatal reviews and discharge letters Written or verbal advice rarely given re clinical conditions or unstandardised Contraception rarely offered

RECOMMENDATIONS

Our DGH would benefit from the following: 1.Postnatal review proforma

2. Postnatal discharge talk during induction and dissemination of regional guidance

3. Trust postnatal guidance that groups advice for women and healthcare professionals for management of common complications

RCOG World Congress 2023

Postnatal women deserve good quality, evidence-based and consistent advice at discharge

Poster Presenter

Authors

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