Staff Perceptions of Antenatal Risk Assessment and its Documentation
Sophie Curran (1), Nicola Hawes (2), Lara Waite (2), Melissa Whitten (1,2)
1EGA Institute for Women’s Health, University College London, London, UK; 2Women’s Health Division, Elizabeth Garrett Anderson Wing, University College London Hospital NHS Foundation Trust, London, UK
Background and Introduction:
Risk assessment = identifying factors which could place a pregnant woman and/or her child at increased risk of adverse outcomes
•Affects decisions about patient care and should be done at every encounter, therefore accurate and up-to-date documentation of risk assessment is vital1
•Highlighted as essential and sometimes inadequate in recent MBRRACE-UK2 and Ockenden reports3
•This study used qualitative and quantitative methods to assess staff perceptions of risk assessment and their documentation on an electronic health records system (Epic) within a tertiary centre maternity care setting.
Methodology:
Staff Survey
•Questionnaires distributed to all staff involved in maternity care
•10 core questions: 7 free text (qualitative data) and 3 Likert-scale (quantitative data)
•Thematic analysis of qualitative data using the Braun and Clarke method4
•Aimed to assess staff perceptions of risk assessment and use of Epic; problem list and ‘pink sticky notes’ (virtual pop-up notifications of key patient information)
Review of Risk Assessment Documentation in Patient Notes
•Important information such as interpreter needs, safeguarding and allergies were noted
•Problem list analysis: number of problems, whether obstetric or non-obstetric and the most common obstetric problems documented
•Congruence between patient information and problem list was assessed
Qualitative Survey Themes - 84 responses
Risk assessment themes:
•Risk is dynamic
•Joint discussion with patients and MDT communication is important
•Assessing mental health and domestic violence risk is important
•Lack confidence in assessing risk
•Risk assessment processes should be improved
•More consistent documentation methods required
Epic-related themes
•Mixed opinions on usefulness and ease of use of Epic
•Limited access to Epic was a problem for some staff
•Wanted further training
•Pink sticky notes useful for highlighting information, especially in emergencies
•Pink sticky notes are not consistently used and hence important information can be missed
•Problem lists can become out of date and inaccurate
Key points:
Risk is dynamic and its assessment is vital to patient care and safety; staff felt that documentation mechanisms could be improved
Junior staff and MSWs had lower confidence with documentation processes and found systems less useful
Review of risk assessment documentation:
•Inconsistent documentation of safeguarding, allergies and interpreter needs
•Presence of non-problems in problem list; e.g. “normal pregnancy” or “gestation 16 weeks”
•Incongruent documentation; eg. “normal pregnancy” alongside “reduced fetal movements”
•Duplication of problems; e.g. “anxiety” and “anxiety disorder”
•Five patients had not had their smoking status assessed in the last year
Conclusions:
1)Risk assessment is crucial for patient care and safety, as evidenced by recent reports on maternity care in the UK
2)This study highlighted the need for improved documentation processes and understanding of risk assessment by staff
3)A local maternity risk assessment working group has been convened to address these issues, in addition to ongoing Epic optimisation processes
