This joint project between Queen Alexandra Hospital and Portsmouth
NHS Trust involved the diabetes team, maternity team and community
midwife team collectively improving outcomes in diabetes-related
pregnancies through a redesign of existing diabetes maternity and midwifery services - incorporating better
seamless service infrastructure and education, diabetes pregnancy awareness for patients and service delivery. The
international St Vincent's Declaration of 1989 for Diabetes declared that health care professionals should achieve
pregnancy outcomes in women with diabetes that approximate that of women without diabetes. The team believes
its outcome measures, achieved through substantive service redesign and collaboration of several multi-disciplinary
teams, demonstrate that health care professionals can step up to the challenge set by the St Vincent's Declaration.
The diabetes, antenatal and community midwife teams recognised the following challenges needed to be
addressed in order to deliver a high quality ante-natal diabetes service for the population of Portsmouth:
an exponential rise in the number of patients with diabetes related pregnancies; significant under-utilisation
of glucose tolerance tests to diagnose gestational diabetes (GDM) and reliance upon a fasting glucose
level to diagnose GDM; limited interaction between the community midwifery service and the specialist
diabetes ante-natal team; and better utilisation of limited resources within the diabetes ante-natal team and
the requirement to demonstrate need and quality outcome to support a service redesign/expansion.
To build a new model of collaborative and innovative multi-disciplinary team working involving
diabetes and antenatal HCPs as well as community midwifery team to enhance patient
continuity; improve mother and fetal/neonatal outcome; manage an ever growing diabetes
maternity population; and enhance confidence in local diabetes maternity care.
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