This category was open to any improvement programme targeting women at any stage of their pregnancy from preconception care, though pregnancy and delivery.
PROCEED, Preconception Care for Diabetes in Derby/Derbyshire: a "Teams without Walls" model
Derby Hospitals NHS Foundation Trust
Women with diabetes are 2-4 times more likely to have a baby with an abnormality and 5 times as likely to experience a stillbirth as women without diabetes. Effective preconception care (PCC) improves outcomes, but nationally only a third access this care. To address this, Derby hospitals piloted PROCEED, a user-centred model for PCC that integrates care vertically across specialities, and horizontally across primary and secondary care. After 12 months, median waiting time reduced from 13 to 5 weeks and did-not-attend rate from 18 to 5 per cent. The PCC rate increased to 70 per cent and the stillbirth rate fell from 6 per cent in 2009/10 to 0 per cent. Women valued the flexibility and choice, describing the service as “first-class”, while savings to date are £61,000.
"Women of child-bearing age in Derby are very fortunate with the care available to them thanks to this project. It is one that should be rolled out nationally.
Enhanced referral of pregnant women with diabetes to the Portsmouth multi-disciplinary diabetes pregnancy service – a multi-faceted approach through improved networking, communication and education
Portsmouth NHS Trust
Pre-pregnancy counselling and diabetes pregnancy care have both been demonstrated to improve foetal and mother outcome, leading to the formation of Portsmouth NHS Trust’s multi-disciplinary diabetes pregnancy team (MDDPT). Its primary aim was to increase the number of referrals of pregnant mothers with diabetes to the MDDPT in a timely fashion to ensure both child and mother achieved optimised outcomes. To accomplish this, the Trust introduced enhanced pre-gestational pregnancy counselling awareness for women with diabetes and the use of a community diabetes link midwife network to help improve uptake of glucose tolerance testing (GTT). This has led to an increase in referrals for advice, while referrals to the MDDPT increased from 79 referrals between 2008-9 to 290 referrals between 2011-12. There was also an increase in GTT from 87 to 564 within a 12 month period.
Introduction of screening for Gestational Diabetes at Colchester General Hospital
Colchester Hospital University Foundation Trust
This screening programme was established to capture women who need to be screened for gestational diabetes as a result of the criteria published by NICE in the Diabetes in Pregnancy guideline 2008. The programme involves education of staff regarding awareness of criteria for screening and skills to perform the glucose tolerance test (GTT) with healthcare support workers. Results are sent directly to the diabetes specialist midwife (DSM) who arranges prompt contact with the women who have a positive result. These women are then seen, initially, for diet discussion and instruction in the blood glucose meter prior to attending the DSM’s clinic. Time in clinic can then be used to discuss any changes to care and immediate problems. The direct reporting of GTT results and early intervention appears to result in more babies being a normal weight and fewer admissions to the neonatal unit as a result of low blood glucose levels.
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