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

10.3.1 Enquiry fi ndings
Seventy five percent (329/441) of women in the enquiry were reported to have care provided in a combined
clinic. However, only 22% of 441 women were reported to have had all members of the multidisciplinary
team involved in their care. The professionals most likely not to have been involved were the midwife and
the dietitian (for 54% and 53% of 441 women respectively). This is surprising in view of the findings of the
previous CEMACH survey. A possible reason is that women were not easily able to access dietitians and
midwives even though they were members of the multidisciplinary team, perhaps due to patterns of working
within the antenatal clinic. However, it is also possible that there were panel variations in interpretation of the
term ‘midwife with special interest in diabetes’ which was used in the enquiry pro forma.
10.4 Documentation
Clear documentation of care given and plans of management enables different clinicians to effectively
follow up individual women. The CNST ‘Health Record’ standard states that a woman’s health record
should provide a complete and contemporaneous record of her treatment and related features. 4
10.4.1 Enquiry fi ndings
Enquiry panels’ consensus was that there were defi ciencies in the standard of 44% of 436 obstetric notes
and 51% of 439 diabetes notes.
For both diabetes and obstetric notes, the main issue identifi ed for 55% and 61% of women respectively
where defi ciencies were identifi ed, was poor documentation of what care had been given and the plan of
care (table 10.1). In many instances diabetes information was so scanty that panels questioned whether
the diabetes notes had been written elsewhere. In a fi fth of cases there were concerns that the design of
the notes was not fi t for purpose for antenatal care of a woman with diabetes.
Table 10.1
Panel comments on defi ciencies in obstetric and diabetes notes (table contains information following
categorisation of free text)
Obstetric notes
(N=192)
Diabetes notes
(N=224)
No. of comments* % of notes No. of comments % of notes
Total comments* 210 236
Poor documentation of care given
or care plans 105 55 136 61
Poor design of notes 40 21 53 24
Missing notes or CTGs 30 16 40 18
Fetal growth not plotted on scans 14 7 - -
Grade of staff not recorded 8 4 3 1
Illegible writing 9 5 3 1
Date/time not recorded 4 2 1 0
* In 1 panel comment, the issue was not specifi ed.
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