Supporting Home Monitoring for Pregnant Women - All Share, All Learn10am – 12pm Monday 8 June 2020

Improvement Hub

Enabling health and social care improvement

Angela CunninghamMCQIC Midwifery Clinical LeadHealthcare Improvement Scotland

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Recorded WebEx

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Jacqueline Lambert Professional Advisor, Midwifery & Perinatal Care, Scottish Government

Key groups identified for Rapid implementation of ‘Near Me’ for essential care

• Oncology and Haematology

• Maternity and neonatal • Respiratory

• Specialties supporting patients with solid organ transplant or taking immunosuppressant therapy

• Paediatrics

• Mental Health

Priority groups to focus on for implementation

1. Complex medical – Women with pre-existing medical conditions – heart, lung, diabetic type 1—

that attend medical clinics and home monitoring essential & specific shielded group.

2. Planned obstetric outpatient – questions to resolve locally - how to undertake observations

e.g. midwife with woman or woman have kit or monitoring pod

3. Unplanned obstetric review or consultation/triage

4. Regular midwife to woman appointments – questions as above

5. Neonatal review – to prevent admission support early discharge or to maintain contact (link

perinatal network)

6. Diagnosed perinatal mental – health (link perinatal mental health network)

Priorities

• Maintain good quality care

• Reduce footfall

• Keep women and workforce safe

• Continue person centred relationship based care

Policy Context pre-Covid

Best Start recommendation 62:

• “A working group should be set up to explore the potential for enhanced use of telemedicine in maternity and neonatal services”

Findings

• The group also identified that the following gaps exist within Technology Enabled Care in Boards:

• Consistent approach across boards

• Clear strategy to embed TEC as standard work to facilitate care provision .

• Appropriate support

Best Start Recommendation 14:-

• ‘NHS Boards should redesign maternity services with a focus on local care, built around the concept of community based hubs, with the majority of women being offered routine care and services through these hubs...’

Which appointments can be provided differently?

Morag HeartyHome & Mobile Health Monitoring Lead,

Scottish Government TEC programme/

TEC Programme Manager

NHS Lanarkshire

NHS Ayrshire & Arran

NHS Lanarkshire

East Renfrewshire, Glasgow City,

Inverclyde

NHS Western Isles

Argyle & Bute

NHS Lothian

NHS Tayside

NHS Highland NHS Grampian

NHS Fife

NHS Borders

NHS Dumfries & Galloway

NHS Forth Valley

Scale up BP

The Scottish Background

The Florence Solution

Free for

patients

Validated protocols

Automated

reminders

Reports in PDF or

excel

“Free text”

option for

clinicians

Easy to change

schedules

The Lanarkshire Background

Year 1

1251

Year 2

3019

Year 3

5041

>10,000

Next generation

Our partners tell us that we need a system that…

Is Multi Channel

Gives Visual Feedback to

Patients

Connects to existing systems

Covid-19 emergency procurement

Questions

nss.tec@nhs.net

nss.tec@nhs.net

Maureen McSherryConsultant Midwife

NHS Lanarkshire

What have been the enablers?Joint approach from SG with local implementers, Provision of a suite of resources for local adaption.Provision of equipment /involvement of med physics.Florence system already used within organisation-wealth of intelligence IT Telehealth team provide in-house education /PIL on use

We overcame our challenges by:Very early days – our challenges are still our challengesUse improvement methodology to monitor processesEngaging IT to create generic mail boxes.Learning from others – team champions to lead training more likely to be midwives.

What’s worked well?Stakeholder involvement/engagement from outsetSOP to provide consistency in process and instructions for staff.Measurement plan – understand what we are trying to achieve

What have been the challenges?How many women in NHSL fit the criteria?Wanting to run before we can walk! Will everyone read the measurement plan and understand what we are trying to achieve?Generic e-mail boxesStaff training – reluctance to use technology to facilitate process

Any top tips?SOP – provides standard approach and guidance to all staff.Provide teach back questions – what are the key ones to ensure women understand what it is they are being asked to do.Sell the benefits of the new home monitoring to staff...more likely to engageSystem for recording observations – ensure everyone documents in the same way.

Fiona DennisonProfessor of Translational Obstetrics,

University of Edinburgh

Nirmala MaryObstetrics and Gynaecology Consultant

NHS Lothian

Any top tips?

What’s worked well?

Multidisciplinary team involvementSupport and enthusiasm at all levels within maternity servicesEarly engagement with Medical Physics teamClinical champions

What have been the challenges?

Individual packs for PILs and consent forms for ease of useDesignated space with computer, telephone and photocopyingFace to face familiarisation and training crucial Reassurance

FamiliarisationPaperworkFlorence

RecruitmentDesignated time for staff training Elaine Jack – Cross site trainingSTART RECRUITMENT

Antony NicholConsultant Obstetrician

Jennifer GallowayMidwife

NHS Tayside “Getting HBPM done”

What have been the enablers?●COVID-19 pandemic, national support and resources●Enthusiastic team and receptive women ●Flo experience/ e health support from local and national boards●Good understanding of our pregnant populations needs and expectations

We overcame our challenges by:●Good communication●Perseverance, patience and enthusiasm (PPE)●Understanding of current working environment●Working with community BP scheme to gather larger cuffs, shared working across healthcare sectors

What’s worked well?●Dedicated team to HBPM implementation●Multidisciplinary team working, increased communication through zoom, email, phone and messaging●Support and positive encouragement from HIS ●Weekly meetings to drive forward each stage●Time scale outlined●Willingness of colleagues within and outside maternity to share skills and expertise●Women have been happy with information and feel supported around HBPM pilot

What have been the challenges?●Delay with equipment●How to enhance communication with women/record readings. ●No digital systems as of yet within maternity. Awareness of governance issues/safety●Pilot criteria to achieve equity in access to maternity healthcarefor women at this time, prioritizing shielding/ high risk/BAMEwomen●Shortage of larger BP cuffs●Large number of different situations/scenarios to test ●Shortage of time/ competing priorities

Any top tips?●Find experts within your board already working on project parts e.g. Florence, equipment loans or HBPM●Shared experience and learning from national and local teams, reach out to others●Don’t give up think outside the box

JoAnna GreenockPractice Development Midwife

Vivien CrichtonMidwife

NHS Greater Glasgow and Clyde

What have been the enablers?• National and local approach and support – weekly

“teams” meetings• National and local guidelines , resources and tools• Early support from local management and staff• Support from local QI and Practice Development teams

We overcame our challenges by:• Early recognition that ALL staff encouraged to be involved • Robust education plan & consideration of local process• Awareness posters illustrating roles & responsibilities• Addition of phone line in counselling room & headsets• Adaption of patient diary, e-forms on shared drive

What’s worked well?• Multi disciplinary working and

collaboration• Staggered Quality Improvement

(QI) approach• Staff education and awareness

What have been the challenges ?• Speed of implementation - 5 sites• Fear of change, roles, responsibility• Timing of recruitment & equipment• Storage and return for BP monitors• Environment and Technology

Any top tips?• Involve and listen to the people who are going to deliver the

service, they know what could work and what might not• Capture women’s and staff feedback• Make the process straight forward for women and staff by introducing &

testing tools that are easy to access & appropriate for local use• Take a cautious approach to allow process to evolve i.e. QI approach - PDSA

Q&A

Thank you!

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Any questions please email: hcis.MaternitySPSP@nhs.net

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