a survey to identify who, how and what maternity data are collected in welsh maternity units
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A Survey to identify who, how and what maternity data are collected in Welsh Maternity Units. Cate Langley MSc Lead Midwife, North Powys. Accurate, reliable data. A Welsh Issue?. Not everyone appears to be collecting the same information. - PowerPoint PPT PresentationTRANSCRIPT
Cate Langley MScLead Midwife, North Powys.
A Survey to identify who, how and what maternity data are collected in
Welsh Maternity Units
Accurate, reliable data.
• Not everyone appears to be collecting the same information.• Not all units appear to be collecting ‘maternity tail’ data.• There is confusion regarding some data definitions.• There is a lack of clarity on where data goes once it leaves
the midwives.• There is a lack of clarity on what is being done with the data
nationally and locally.• There does not appear to be any information coming back to
individual NHS trusts regarding the data collected nationally and minimal feedback from local data collection.
• There is no information on the data collection systems already in use across the Principality.
A Welsh Issue?
Aim of study
To identify what data are collected, where that data are collected
and by whom in maternity services.
Objectives•To identify whether the problem of data access and quality is a local issue to Welsh maternity services or whether a body of evidence exists that identifies this as a far wider heath care issue. •To identify a means of collecting information on how and what data are collected within Wales.•Once a means of collection is identified to include all maternity services in Wales in the collection process. •To review findings and formulate recommendations for the future collection and analysis of data.
Process
• Literature review
• Design
• MREC
• R&D Approval
• Analysis
• Response
Data collection systems in Wales
Systems & methods of collecting data
1
5
1
5
1
2
2
1
Midw ives directly onto computer
Paper and computer by midw ives
Paper by midw ives and onto computerby clerical staff
Paper only midw ives
Birth notif ication only on computer, allother by midw ives on paper
Directly by midw ives onto computerand paper then computer by midw ives
Directly by midw ives onto computer,paper then computer, midw ives paperonto computer by clerical staff
All of the above
Computerised data collection
4
7
2
11
Protos
PAS
In house
Other system
SMMIS
Not everyone appears to be collecting the same information
Maternal date of birth
Maternal origin
Ethnicity (census definition)
Ethnicity (local definition)
Maternal occupation
Father’s occupation
Marital/Cohabitation status
Maternal height
Medical history
Previous blood transfusion
Maternal rubella status
Gestation at booking
Gestation by LMP
Assisted conception
AN booking appointment
Ante natal visits
Out patient ANV
Actual place of birth
Reason for change of place of birth
Presentation
Apgar score at 1 minute
Apgar scores at 5 minutes
Paediatric estimation of gestational age
Assessment of hips
Smoking history Smoking during pregnancy Parity Previous births Previous stillbirths Previous miscarriages Previous terminations of pregnancy Previous caesarean section
Antenatal in patient admissions Antenatal tests Ultrasound scansAntenatal administration of steroids Method of onset of labour Date and time of birth Method of delivery Length of 1st stage Length of 2nd stage Length of third stage Third stage management Perineal tears Episiotomy Intended place of birth
Gestation at onset of labour (LMP) Gestation at onset of labour (USS) Live or stillbirth Multiple birth Birth order Pain relief Reason for administration of pain relief Pain relief in labour Pain relief delivery Pain relief post natal Suturing of tearsMaternal complications Status of person conducting delivery Length of postnatal stay Post natal outpatients Postnatal community visits Sex of baby Birth weight Head circumference Length
Jaundice Congenital abnormalities Admission to Special care Baby Unit Neonatal resuscitation Feeding at discharge Metabolic screening Neonatal BCG Paediatric follow-up
Statistics
Smoking history Multiple birth
Smoking during pregnancy Birth weight
Onset of labour Method of delivery
Pain relief
Perineal tears
Episiotomy
Suturing of tears
Live or stillbirth
Audit of data accuracy
2
4
1
5
6 w eekly
monthly
annual
not audited
don't know
Production of statistics
6
1
6
4
1Statisticalprogramme inmaternity systemSeparate softw are
on paper
on paper andcomputer
paper and othersoftw are
4
22
4<1hour
1 w orking day
month
Don't know
Accessing missing data
“All statistics are obtained manually from delivery book entry. I’m sure information is sometimes missed out due to lack of space or error by midwife. The time it takes to collect this data means we are always at least 3-4 months behind.”
“They are probably available from the system that we use but no one trained or has time to get them”
Not all units appear to be collecting ‘maternity tail’ data.
There does not appear to be any information coming back to individual
NHS trusts regarding the data collected nationally and minimal
feedback from local data collection.
There is a lack of clarity on where data goes once it leaves the midwives.
HOSPITALCOMMUNITY
TEAM
Registrar of births
OUTSIDE AGENCIES
PEDW, WAG
MATERNITY COMPUTER
WOMEN
Paper record
Computer record
Data Flow
?
Maternity notes
There is confusion regarding some data definitions
Sharing informationAggregated Patient specificGPs GPs
LHBs Registrar of births
Regional office Child Health
PEDW
WAG
Need to knowCEMACH, CARIS
Care outside of Hospital
Time
Past and present strategies
Study limitations
How are data collected?
A mixture of computer and paper
What data are collected?
Large amounts
Who collects data?
Predominately midwives
Recommendations
•That agreement is made regarding the data items that need to be collected across Wales, to include agreement on data definitions.
•National data bases, that presently hold maternity information, be reviewed for their ability to provide the information clinicians, users, trusts and government require.
•That any future databases reflect the care given in community settings as well as hospital.
•That no new data collection process is introduced without proper analysis of the costs and benefits to clinicians, users, trusts and government.
Recommendations•That databases, whether local or national are able to provide information to users on local services, trusts on their activity and how they compare to others and individual clinicians on the outcomes of the care they give.
•That any strategies for maternity services also identify the data collection requirements necessary to prove success and ensure these are identified and collectable prior to implementation.
•That trusts are encouraged to make accurate, reliable data a priority for maternity services by identifying an individual(s) within the trust to be responsible for the coordination of data collection, reliability and completeness.
• Accuracy of data collected.• Accessibility of data collected and its
analysis.• Completeness.• Non-standard terminology.• Amounts of data collected versus amounts
used.
(Audit Commission, 1995a,1995b, 2002; House of Commons Health
Committee, 2003; WAG, 2002a
There is a lack of clarity on what is being done with data nationally and
locally
Training