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

10. Clinical governance
Learning points
• Only a fi fth of women were reported to have had all members of the multidisciplinary team
involved in their care.
• There was poor documentation of obstetric and diabetes care for more than half of
women in the enquiry.
• In a fi fth of cases there were concerns that the design of the maternity notes was not
fi t for purpose for antenatal care of a woman with diabetes.
• There were concerns about the standard of local maternity units’ diabetes guidelines for nearly
three quarters of women.
10.1 Introduction
Providing a high standard of clinical care is a central tenet of clinical governance. This needs to be
supported by effi cient referral pathways, multidisciplinary working, good documentation, evidencebased
guidelines and clear lines of communication between health professionals and between health
professionals and patients. The Clinical Negligence Scheme for Trusts (CNST), administered by the NHS
Litigation Authority (NHSLA), has defi ned minimum standards for maternity units in all these areas. This
chapter examines some of the issues identifi ed by panels for women with type 1 and type 2 diabetes using
maternity services.
10.2 Access to maternity care
Women with pre-existing diabetes should be referred promptly from primary care to the diabetes specialist
team as soon as pregnancy is confi rmed 1 , for review of glycaemic control, assessment for diabetes
complications and a dating fi rst trimester ultrasound scan. It is encouraging that women in the enquiry had
their fi rst contact with a health professional at a median of 6+6 weeks, and their fi rst hospital appointment
at 8+3 weeks.
10.3 Multidisciplinary working
Women with pre-existing diabetes require the clinical expertise of a number of different professionals
during pregnancy. The Diabetes NSF recommends that antenatal care should be provided by a full
multidisciplinary team comprising an obstetrician, diabetes physician, diabetes specialist nurse, midwife
and dietitian. 1 In the CEMACH survey of diabetes maternity services 2 , 63% of maternity units in England,
Wales and Northern Ireland reported a full multidisciplinary team, and there had been an increase in
specialist staff compared with the last national survey 8 years previously. 3 In particular, the availability of
a dietitian in the antenatal clinic had doubled from 40% to 88% of units and the availability of a midwife
specialist had tripled from 25% to 77% of units.
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