Insert name of presentation on Master Slide Transforming Maternity Services Mini-Collaborative June 2011 Philip Banfield, Consultant Obstetrician, Faculty Lead

What is this learning session about? About you! Practical data collection DVT Risk Assessment Community/Birth Centre Interventions Feedback from each Health Board Recognition and Response to Sepsis Group Work and Networking Action Planning

VTE – WebEx 24 th March VTE CEMACE – BMI 35 RCOG Green top – risk factors NICE – BMI 30 AWPAG – LMWH pregnancy unresolved SIGN – defers to RCOG Cochrane - consensus derived clinical practice guidelines

Risk – Down screening Age 22 = 1:1450 Age 32 = 1:700 Cut off for intervention = 1:150

Balance of risks / risk management* – costs and consequences Make ‘normal’ women ‘abnormal’ Risk in pregnancy is ‘managed’ Timing of delivery - IOL Epidural use Increased c/section rate and ↑↑risk Avoidance of extra risk – dehydration etc *Significant numbers have PE 1st trimester Proportion have no ‘risk factors’

Summary - ABM Total AN + PN impact = £593, Number needed to treat ~ 294 / VTE Drug cost per VTE avoided ~ £84, Wider cost of implementation - staff time Sacrifice ‘normality’? Extrapolation for Wales: –Just over 1:4 women (28%) –£3 million Thanks to Fran Rushworth and Tehmina Riaz

How do you manage your patients? Welsh Obstetrics and Gynaecology Society – Shrewsbury March 2011 n = 27

BMI for LMWH? Welsh Obstetrics and Gynaecology Society – Shrewsbury March 2011 n = 27

Pragmatic approach for Wales? Use one scoring system? English Maternity Units are looking for guidance on implementation of risk assessment BMI?

What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement Constructing a clear aim Establishing the measure Selecting the change

PDSA Cycle 1. Plan.. what needs to be done and how. 2. Do.. what you have planned to do 3. Study.. the outcomes – expected and unexpected, of the test 4. Act.. on the results and modify and improve. ActPlan Study Do Very Small Scale Test

Repeated Use of the PDSA Cycle Evidence based interventions Changes that result in improvement AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change

Usability Agree elements rather than style Local implementation Variation in what works where Other examples in How to Guide 1000 lives + web page (TBC) “DVT risk assessment on admission”* *Will form part of community care bundle as we progress

Policy Exemplar Guide A PEG on which to hang local practice or guidance to minimise variation and risk and to optimise intervention rates for the benefit of women, their families and society in general. Takes theory and trial data and recognises that patients are less perfect, less predictable and more complex. It allows for a consensus management of different risk- benefits within a dynamic evidence-based framework, because process and outcomes are monitored continuously. Uses PDSA methodology

We can jump safely because… We are together Standard by expert consensus National Endorsed by AWMSG Monitored by HBs within mini-collaborative

If we can improve care for one woman, then we can do it for ten. If we can do it for ten, then we can do it for a 100. If we can do it for a 100, we can do it for a 1000 And if we can do it for a 1000, we can do it for all women in Wales. If we do it for all women in Wales, we improve for all and may find the one