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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