Following the recommendation from Lord Darzi (2008) in his
High quality care for all report that all care should be measurable, chief nurse Mandie Sunderland implemented a set of nursing care and patient experience care indicators across the Heart of England NHS Foundation Trust (HEFT). The nursing care indicators were initially developed in the north west of England and are to be adopted by the National Patient Safety Agency as a national care indicator set.
The midwifery department, initially led by matron Maggie Coleman and nurse Katrina Creedon, has also produced metrics designed for maternity care. Developed within the three maternity units at HEFT, the metrics are evidence based and have been grouped into:
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Antenatal clinic – documentation of communication, health status and antenatal visits
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Delivery suite – medication, infection control, privacy and dignity, patient observations (MEWS), pain management, documentation of communication, vaginal examination and assessment of fetal wellbeing
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Maternity ward – medication, infection control, privacy and dignity, postnatal observations, pain, documentation of communication, bladder assessment and baby indicators.
A monthly metrics audit takes a random sample of ten sets of women’s notes (ten sets in each clinical area). Auditors will be senior midwives, supervisors of midwives or maternity matrons within the trust, and a peer review model will be used for objectivity.
Information is now collected electronically. This has streamlined the analysis of data and dissemination of monthly results, using a percentage tool to give a traffic-light score of red, amber or green.
This system is used to comply with the assurance framework, and parameters to start with were set as:
0-79% red
80-89% amber
90-100% green
As of July 2011, these have been increased to:
0-84% red
85-94% amber
95-100% green
The results are disseminated to ward managers, matrons and the head of midwifery, who then cascade to their teams with an aim to improve documentation. They are also on the trust’s intranet. The senior midwives meet monthly to agree targets.
For scores of less than 65%, the aim is to show an immediate improvement the following month; for scores of 65% to 89%, the aim is to show incremental improvement each month and to achieve 90% in six months; while for scores of 90%+, the aim is to sustain this standard.
With these targets in mind, an action plan is agreed and monitored monthly and a report sent to the head of midwifery.
The metrics system has been in place at the Good Hope Maternity Unit for some months now and has recently rolled out to Birmingham Heartlands and Solihull Birthing Unit.
As the lead for clinical risk, governance and the Clinical Negligence Scheme for Trusts (CNST), I have found the maternity metrics extremely beneficial in improving documentation standards and providing evidence for CNST.
In an NHS dominated by audits, the maternity metrics encompass various audits such as maternity documentation, infection control, checking of emergency medical equipment and medications, rolling them into one.
Carolyn Deegan is clinical risk midwifery manager at the Heart of England NHS Foundation Trust
References
Lord Darzi. (2008)
High quality care for all: next stage review. HMSO: London. See:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825 (accessed 22 January 2012).
