Potentially avoidable deaths – what can maternity planners

do to help

Bronwen Pelvin Senior Advisor, Maternity Services

Clinical Leadership, Protection & Regulation

Ministry of Health

Maternity Planners

Society Women and their families/whanau Health professionals Health administrators Public servants Governments

The system we have Sector & consumer engagement Framework for maternity services Contracting for services Funding – lead maternity care

– facilities– secondary & tertiary

care Quality improvement Evidence based Midwifery-led Community based

Maternity Quality Initiative

Quality and Safety programme

Revised Referral Guidelines

National shared maternity information

Rebuilding national maternity datamart

Quality and Safety programme

National New Zealand Maternity Standards National Clinical Indicators National Maternity Guidelines Clinical Leadership - Integrated DHB & LMC

clinical leadership to drive quality improvement

Clinical Networking with all local maternity practitioners

Revised DHB maternity service specifications

Local monitoring of local data Identification of local quality improvement

priorities Local mortality reviews & healthcare

incident management Education sessions for all practitioners Greater consumer involvement in planning

and quality improvement

National Maternity Standards

Standard 1: Maternity services provide safe, high quality services that are nationally consistent and achieve optimal health outcomes for mothers and babies

Standard 2: Maternity services ensure a woman-centred approach that acknowledges pregnancy and childbirth as a normal life stage

Standard 3: All women have access to a nationally consistent, comprehensive range of maternity services that are funded and provided appropriately to ensure there are no financial barriers to access for eligible women

Clinical indicators

1. Standard Primipara who have a spontaneous vaginal birth2. Standard primipara who undergo induction of labour3. Standard primipara who undergo an instrumental vaginal birth4. Standard primipara undergoing caesarean section5. Standard primipara with an intact lower genital tract (no 1st—4th

degree tear or episiotomy)6. Standard primipara undergoing episiotomy and no 3rd—4th degree

perineal tear7. Standard primipara sustaining a 3rd—4th degree perineal tear and

no episiotomy8. Standard primipara undergoing episiotomy and sustaining a 3rd—

4th degree perineal tear9. General anaesthesia for all Caesarean sections10. Postpartum haemorrhage and blood transfusion after vaginal birth11. Postpartum haemorrhage and blood transfusion after Caesarean

section12. Premature births (delivery between 32—36 weeks)

National clinical guidelines Two guidelines almost completed – Management of postpartum

haemorrhage Care of mother & baby in the

immediate postpartum Further two in 2011/12 plus Review of breech & vaginal birth

after Caesarean guidelines

Improving relationships

partnerships women & health

professionals health professionals &

health professionals Ministry of Health,

maternity sector & women

health professionals, managers, planners & funders

health professionals ‘at the coal face’

professional colleges

Revised referral guidelines Expert working group Criteria evidence revised New categories developed –

Primary (P) Consultation (C) Transfer (T) Emergency (E)

Process maps drawn

Shared maternity information

National Health IT Board Maternity sector governance

group Software developer Two pilot sites DHB maternity IT system project

Rebuilding the national maternity data mart

It’s done !! National Minimum Data Set (NMDS) LMC claim data This month – testing Publish clinical indicators DHB primary maternity data project Resume MoH Maternity publications

Budget allocations

Quality & Safety programme implementation

Referral guideline implementation Service specification implementation Clinical guideline development DHB Primary maternity data collection Consumer education & information