+ The Development of Guidelines for the Admission to, and Transfer from Midwife-led Units in N. Ireland Dr Maria Healy Head of Midwifery UCD & Clinical.

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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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