Diabetes in pregnancy: are we providing the best care ... - HQIP

in order to remove any identifi able information. This included patient identifi ers, hospital identifi ers and
staff identifi ers. Where names of staff were anonymised, the designation (grade) of the staff member
was entered onto the documentation, to enable panel assessment of whether care had been provided
by the appropriate grade of staff.
4.5 Assessment of care
The scope of this enquiry included preconception care, care during pregnancy, labour and delivery, and
postnatal and neonatal care up to 3 days post delivery. A structured enquiry pro forma (see Appendix
B) was developed by the CEMACH central offi ce with advice from members of the CEMACH Diabetes
Professional Advisory Group. This pro forma contained a mixture of factual questions and assessments
of care from review of the medical records, after a round-table discussion and after panel consensus
had been reached. Panel assessors were asked to grade their opinion of the quality of care as ‘optimal’,
‘adequate’ or ‘poor’. ‘Optimal’ indicated that there were no issues with care, while ‘adequate’ indicated that
there were some issues of concern. ‘Adequate’ and ‘poor’ care were aggregated as ‘suboptimal’ care for
the purpose of analysis.
If concerns had been identifi ed, panels were asked to describe the key issues contributing to this
assessment and to code the issues according to the following categories:
PD
PO
PC
PA
PN
Duration or severity of diabetes.
Issues relating directly to the patient and/or family issues
Other complicating medical or social and / or lifestyle factors which may hinder optimal management e.g.
management-intensive medical conditions such as thrombophilia or cardiac disease, and social factors such
as housing problems or lack of family support.
Woman actively chose not to follow the medical advice given e.g. refusal to undergo induction of labour until
42+ weeks of gestation.
Woman’s actions detracted from optimal management e.g. infrequent home blood glucose monitoring,
not following dietary instructions.
Woman did not attend appointments e.g. failure to attend for clinic visits or ultrasound scans.
HP
HC
HR
Issues relating to the provision of health services
Clinical practice e.g. no timely discussion of timing and mode of delivery.
Communication. This could be a failure of communication between professionals caring for the woman
e.g. inadequate discussion between obstetrician and physician, or a failure of communication between
professionals and the woman e.g. interpreting services were not adequate despite diffi culties with English.
Resources including staffi ng e.g. no dietitian in the antenatal clinic, lack of midwifery staff on labour ward,
problems with accessing timely fetal surveillance such as growth scans.
Panels were asked to code up to four issues that were appropriate to the judgment of ‘adequate’ or ‘poor’
care. During analysis, these codes were used as a guide for the analysis of the themes arising from the
free text.
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