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