Diabetes in pregnancy: are we providing the best care ... - HQIP
Diabetes in pregnancy: are we providing the best care ... - HQIP
Diabetes in pregnancy: are we providing the best care ... - HQIP
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Cl<strong>in</strong>ical governance<br />
Table 10.4<br />
Panel comments on defi ciencies of communication bet<strong>we</strong>en health professionals and women with type 1 and type 2<br />
diabetes (table conta<strong>in</strong>s <strong>in</strong>formation follow<strong>in</strong>g categorisation of free text)<br />
Number of women with deficiencies <strong>in</strong><br />
communication<br />
(N=169)<br />
No. of comments % of women<br />
Total comments* 193<br />
Suboptimal discussion about risks 77 46<br />
Plan of c<strong>are</strong> not discussed 31 18<br />
Lack of professional <strong>in</strong>terpreters for women with language diffi culties 23 14<br />
Problem with<strong>in</strong> health service (poor <strong>in</strong>ter-professional communication,<br />
poor follow-up, cl<strong>in</strong>ician’s attitude etc) 19 11<br />
Communication affected by social/lifestyle factors relat<strong>in</strong>g to woman 17 10<br />
Wrong or confl ict<strong>in</strong>g <strong>in</strong>formation given 15 9<br />
Documentation 11 7<br />
* There <strong>we</strong>re 5 comments where <strong>the</strong> issues <strong>we</strong>re not described by panels<br />
10.7 Conclusions<br />
It is encourag<strong>in</strong>g that <strong>the</strong> majority of pregnant women with pre-exist<strong>in</strong>g diabetes fi rst accessed <strong>the</strong> hospital<br />
antenatal cl<strong>in</strong>ic with<strong>in</strong> <strong>the</strong> fi rst trimester of <strong>pregnancy</strong> and three quarters attended a comb<strong>in</strong>ed antenatal<br />
cl<strong>in</strong>ic. Ho<strong>we</strong>ver, just over a fi fth of women <strong>in</strong> <strong>the</strong> enquiry <strong>we</strong>re documented to have all members of <strong>the</strong><br />
multidiscipl<strong>in</strong>ary team <strong>in</strong>volved <strong>in</strong> <strong>the</strong>ir c<strong>are</strong>, with <strong>the</strong> dietitian and midwife be<strong>in</strong>g <strong>the</strong> professionals least<br />
likely to be <strong>in</strong>volved. While <strong>the</strong>re may have been variations <strong>in</strong> <strong>in</strong>terpretation of <strong>the</strong> term ‘midwife with<br />
special <strong>in</strong>terest <strong>in</strong> diabetes’, patterns of work<strong>in</strong>g should be revie<strong>we</strong>d by local multidiscipl<strong>in</strong>ary teams to<br />
ensure that all women <strong>are</strong> receiv<strong>in</strong>g equivalent c<strong>are</strong> and advice.<br />
In both <strong>the</strong> obstetric and diabetes antenatal notes, <strong>the</strong>re was poor documentation about what c<strong>are</strong> had<br />
been given and <strong>the</strong> plans for c<strong>are</strong>. Many panels had concerns that <strong>the</strong> design of <strong>the</strong> maternity hand held<br />
notes <strong>we</strong>re not fi t for purpose.<br />
For nearly two thirds of women, <strong>the</strong>re <strong>we</strong>re concerns about local diabetes guidel<strong>in</strong>es. The ma<strong>in</strong> issues<br />
<strong>we</strong>re a lack of clarity and <strong>in</strong>suffi cient detail, no antenatal guidel<strong>in</strong>es, <strong>in</strong>adequate <strong>in</strong>travenous <strong>in</strong>sul<strong>in</strong><br />
regimes and no guidance on blood glucose targets <strong>in</strong> labour.<br />
There <strong>we</strong>re concerns about communication bet<strong>we</strong>en health professionals for half of women <strong>in</strong> <strong>the</strong> enquiry.<br />
A particular issue appe<strong>are</strong>d to be poor l<strong>in</strong>es of communication bet<strong>we</strong>en <strong>the</strong> general maternity staff and <strong>the</strong><br />
diabetes specialist team, and poor <strong>in</strong>formation shar<strong>in</strong>g with<strong>in</strong> <strong>the</strong> diabetes multidiscipl<strong>in</strong>ary team.<br />
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