+ the development of guidelines for the admission to, and transfer from midwife-led units in n....
TRANSCRIPT
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The Development of Guidelines for the Admission to, and Transfer from Midwife-led Units in
N. Ireland
Dr Maria HealyHead of Midwifery UCD & Clinical Tutor QUB/WHSCT
Dr Patricia GillenHead of R&D for Nurses, Midwives and AHPs,SHSCT/Honorary Fellow, University of Ulster
LSA Conference 30th January 2015
+Overview
Background
Aim, Objectives and Timeline
Steering & Working group membership
Process of Guideline Development to date
Consultation & Peer Review
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+Background
Steady increase in the provision of midwife-led units (MLU) in Northern Ireland, since the first unit opened in 2001
Most recent unit officially opened in January 2015
Five AMUs
Three FMUs
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Map of Midwife-led Units in N. Ireland
Altnagelvin AMU opened 2010
Mater FMU
Opened 29th April
2013
SWAHAMU
Opened 2013
Craigavon
1st AMU opened 2001
Lagan ValleyFMU
opened 2011
Ulster AMU opened 2008
DowneFMU opened 2010
Daisy HillAMU
opened 2014
+Background Individual MLUs use locally developed eligibility criteria (Healy,
2013)
Impact: Some women are unnecessarily excluded from admission to an MLU, can be transferred to an obstetric unit without good reason or inadvertently included
Contrary to the evidence – NICE (2014), Sandall et al. (2013), Devane et al. (2010)
The provision of MLUs seen as an important component in the Maternity Care Strategy and it’s implementation (DHSSPS 2012)
Midwives expressed the need for an evidence based guideline which would assist women and maternity care professionals in their decision-making processes about place of labour and birth (Healy, 2013)
Subsequently, an application to Guidelines and Audit Implementation Network (GAIN) to develop a regional guideline for admission to and transfer from midwife-led units in N. Ireland and funding granted in January 2014.
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+Project Aim:
To standardise guidance for women and maternity care staff with regard to the admission to, and transfer from MLUs, ensuring a consistent approach for women seeking access to care in a MLU across Northern Ireland.
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+Objectives To review the current local, national and international evidence for
criteria as applied to women seeking admission to, and requiring transfer from MLUs.
To develop a standardised guideline based on the current evidence in conjunction with an expert panel of maternity care staff and service users.
To disseminate guidelines to regional primary and secondary maternity care staff, MLUs and service user group in N. Ireland.
To develop and disseminate a user friendly information leaflet relating to the criteria for admission to, and transfer from, a MLU.
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Time LineTimeline On-going Work Agreed Action responsible person/s
Months 1-3(Jan 14 -Mar 14)
Define remit of guideline Plan development process Share relevant knowledge and experience Identify key questions/terms for literature
search and discuss requirements of systematic literature review (with advice from GAIN Manager)
Agree dates for meetings
1. Agree membership of Group(s)
2. Finalise remit3. Commence literature search
All
Months 1-10(Jan 14 – Oct 14)
Clarify criteria used to select or rejectpapersReview abstracts to select papers fordetailed reviewDetailed literature review, grading andsynthesis of evidence
Bring findings to steering group
1. Literature search & appraisal
2. On-going review of evidence
3. Steering group review
Working GroupMaria and PatriciaWorking Group
Months 11-13(Nov 14-Jan 15)
Draft guidelines derived and prepared from evidence review
Steering group meeting to present and discuss draft guidelines
Draft GuidelinesPresent draft guidelines to
steering group
1. Working group 2. Maria and Patricia
Months 14-16(Feb 15-Apr 15)
Feedback from steering group incorporated into draft guidelines.
Draft edited by group with assistance from GAIN Manager
Guideline sent for external peer review Feedback from external reviewers - incorporated
into draft guideline
1. Steering group feedback2. Peer review3. Peer review feedback and
final editing
1. Working Group2. Maria and Patricia3. GAIN
Months 16-18(Apr 15-Jun 15)
Review by GAIN Editorial Group Publication and dissemination
Maria and PatriciaGAIN
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+Steering & Working group membership Meetings held regularly commencing 24th Feb 2014
Membership: Heads of Midwifery, Midwife-Led Care Managers, GPs, NCT rep, MSLC Reps, Obstetricians, Anaesthetists, Paediatricians, PHA, LSAMO, DHSSPS Midwifery Adviser, NIPEC, Women’s groups, 10,000 Voices Project leads
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+Process of Guideline Development to date A Faciliated discussion at the first meeting led to the identification of key
questions about specific criteria e.g. BMI, Age, IOL, VBAC, Group B Strep, SROM
Issues relating to women’s choice and experience
10,000 Voices ‘Briefing Paper Relating to Experience of Maternity Care in Midwifery-led Units in Northern Ireland’ (August 2014)
Collation of a large range of international and national literature and evidence
Guideline developed - Inclusive approach
Identifying at each point of maternity care contact the most appropriate lead maternity care professional
Guideline currently in fifth draft
Next step involves forwarding it to the Clinical Directors for Obstetrics and Gynaecology & Heads of Midwifery of each Trust, for their comments.
Further meetings planned between February and May 2015.
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+Consultation & Peer Review
Public consultation
Peer review
Sign-off from the Maternity Care strategy Implementation project
Information leaflet for women and their families
Further work:
Evaluation of the criteria and its implementation
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+Other Work
10,000 Voices ‘Briefing Paper Relating to Experience of Maternity Care in Midwifery-led Units in Northern Ireland’ (August 2014)
NICE Intrapartum draft guideline consultation submission 24th June 2014
Input into:
Maternity Strategy Implementation project group
Community Care project group
Invitation to present at:
LSA Conference Jan 2015
RCGP – ‘Problems in Pregnancy Meeting’ Feb 2015
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Thank You
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