Potentially avoidable deaths – what can maternity planners do to help

1. Potentially avoidable deaths – what can maternity planners do to help Bronwen Pelvin Senior Advisor, Maternity Services Clinical Leadership, Protection & Regulation Ministry of Health

2. Maternity Planners • Society • Women and their families/whanau • Health professionals • Health administrators • Public servants • Governments

3. 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

4. Maternity Quality Initiative • Quality and Safety programme • Revised Referral Guidelines • National shared maternity information • Rebuilding national maternity datamart

5. 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

6. 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

7. Clinical indicators • Standard Primipara who have a spontaneous vaginal birth • Standard primipara who undergo induction of labour • Standard primipara who undergo an instrumental vaginal birth • Standard primipara undergoing caesarean section • Standard primipara with an intact lower genital tract (no 1st—4th degree tear or episiotomy) • Standard primipara undergoing episiotomy and no 3rd—4th degree perineal tear • Standard primipara sustaining a 3rd—4th degree perineal tear and no episiotomy • Standard primipara undergoing episiotomy and sustaining a 3rd—4th degree perineal tear • General anaesthesia for all Caesarean sections • Postpartum haemorrhage and blood transfusion after vaginal birth • Postpartum haemorrhage and blood transfusion after Caesarean section • Premature births (delivery between 32—36 weeks)

8. 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

9. 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

10. Revised referral guidelines • Expert working group • Criteria evidence revised • New categories developed – • Primary (P) • Consultation (C) • Transfer (T) • Emergency (E) • Process maps drawn

11. Shared maternity information • National Health IT Board • Maternity sector governance group • Software developer • Two pilot sites • DHB maternity IT system project

12. 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

13. Budget allocations • Quality & Safety programme implementation • Referral guideline implementation • Service specification implementation • Clinical guideline development • DHB Primary maternity data collection • Consumer education & information