RCOG World Congress 2025

Enhancing Postnatal Care: A Single-Center Quality Improvement Initiative
Laxmi Venkatachalam, Stanley Ugochukwu, Doaa Zeidan

Objective

The aim of this quality improvement project was to enhance the standard of postnatal care at our trust by addressing issues in

•Analgesia management

•Bowel care

•VTE prophylaxis

•Documentation.

As a secondary objective, we identified the need for a structured pathway to ensure all postnatal re-admissions receive a consultant review within 6 hours.

Design

Individualized postnatal care must aim to promote and maintain optimal health and well-being in the woman and her baby. The project involved-

•Review of current practice

•Retrospective audit

•Peer-reviewed interventions

•Focus on continuity, safety, and maternal experience

Method

Data was collected for 14 patients over a single day to evaluate adherence to protocols. Any discrepancies between observed practices and established guidelines were documented. Key stakeholders, including midwifery, pharmacy, and medical teams, were engaged to develop and implement changes. This was presented at the local governance meeting and the suggestions from this peer review were collated and presented in a resident doctor teaching session.

Results-in graph

28% of patients missed postnatal analgesia

83% did not receive laxatives despite being prescribed dihydrocodeine

Regularly prescribed analgesia was missed in 100% of women

VTE assessments, we were 100% compliant in completing them, but we were routinely overprescribing tinzaparin and not aligning with RCOG guidance—particularly for those with a VTE score of 3.

For documentation, we use BadgerNet, and we highlighted that postnatal plans were documented in incorrect sections in 43% of cases.

We also found we were not meeting the standard of a consultant review within 6 hours for postnatal readmissions—a target set by NHS England for units with 24-hour consultant cover on the floor.Under 50% of postnatal readmissions received a consultant review within 6 hours

Conclusion

•Resident doctors to re-prescribe all medications, before patients leave delivery suite, ensuring this becomes a part of the midwife handovers. Also, our anesthetic team now prescribe analgesia +/- laxatives regularly for our post-op women before they leave theatres.

•Management plans should be documented in the appropriate section of Badger Net to improve communication with the community.

•Good compliance of VTE assessments but align prophylaxis durations with RCOG guidance.

•Creation of a pathway (in line with the 7-day working standards from NHS England) ensuring consultant reviews within 6hrs of postnatal readmissions is recommended to improve outcomes for unwell postnatal women.

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These measures were also aimed at reducing postnatal readmissions due to pain, constipation, and wound breakdown.

Implementing the following changes, creating awareness, and a re-audit in 6 months to assess compliance in our maternity unit would complete the quality improvement project.

RCOG World Congress 2025

Enhancing Postnatal Care: A single-center quality improvement initiative

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