Supporting Home Monitoring for Pregnant Women - All Share, All Learn 10am – 12pm Monday 8 June 2020

Improvement Hub Enabling health and social care improvement Angela Cunningham MCQIC Midwifery Clinical Lead Healthcare Improvement Scotland Welcome

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Click here to introduce yourself and to ask a question at any point during the Make sure you click on presentations everyone! Recorded WebEx

Please note: this WebEx will be recorded and can be shared with your colleagues

Access to the recording will be provided to all attendees and link shared 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 Hearty Home & Mobile Health Monitoring Lead, Scottish Government TEC programme/ TEC Programme Manager NHS Lanarkshire The Scottish Background

NHS Western Isles

NHS Highland NHS GrampianNHS Tayside Scale up BP Argyle & Bute NHS Forth Valley East NHS Fife Renfrewshire, Glasgow City, NHS Lothian Inverclyde

NHS Ayrshire & NHS Borders Arran NHS Lanarkshire NHS Dumfries & Galloway The Florence Solution

“Free Automat Easy to Reports text” Free for ed change Validated in PDF or option schedule protocols patients reminder excel for s s clinicians The Lanarkshire Background

>10,000 Year 3 Year 2 5041 3019 Year 1 1251 Next generation

Our partners tell us that we need a system that…

Is Multi Gives Visual Connects to Channel Feedback to existing Patients systems Covid-19 emergency procurement Questions

[email protected] [email protected] Maureen McSherry Consultant Midwife NHS Lanarkshire

What have been the enablers? What’s worked well? Joint approach from SG with local implementers, Provision of a Stakeholder involvement/engagement from outset suite of resources for local adaption. SOP to provide consistency in process and instructions for staff. Provision of equipment /involvement of med physics. Measurement plan – understand what we are trying to achieve Florence system already used within organisation-wealth of intelligence IT Telehealth team provide in-house education /PIL on use What have been the challenges? How many women in NHSL fit the criteria? We overcame our challenges by: Wanting to run before we can walk! Will everyone read the Very early days – our challenges are still our challenges measurement plan and understand what we are trying to Use improvement methodology to monitor processes achieve? Engaging IT to create generic mail boxes. Generic e-mail boxes Learning from others – team champions to lead training more likely Staff training – reluctance to use technology to facilitate process to be midwives.

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 engage System for recording observations – ensure everyone documents in the same way. Fiona Dennison Professor of Translational Obstetrics, University of Edinburgh

Nirmala Mary Obstetrics and Gynaecology Consultant NHS Lothian

What’s worked well?

Multidisciplinary team involvement Support and enthusiasm at all levels within maternity services Early engagement with Medical Physics team Clinical champions

What have been the challenges?

Individual packs for PILs and consent forms for ease of use Designated space with computer, telephone and photocopying Face to face familiarisation and training crucial Reassurance

Recruitment Familiarisation Designated time for staff training Any top tips? Paperwork Elaine Jack – Cross site training Florence START RECRUITMENT Antony Nichol Consultant Obstetrician Jennifer Galloway Midwife NHS Tayside “Getting HBPM done”

What’s worked well? What have been the challenges? ●Dedicated team to HBPM implementation ●Delay with equipment ●Multidisciplinary team working, increased communication ●How to enhance communication with women/record readings. through zoom, email, phone and messaging ●No digital systems as of yet within maternity. Awareness of ●Support and positive encouragement from HIS governance issues/safety ●Weekly meetings to drive forward each stage ●Pilot criteria to achieve equity in access to maternity healthcare ●Time scale outlined for women at this time, prioritizing shielding/ high risk/BAME ●Willingness of colleagues within and outside maternity to share women skills and expertise ●Shortage of larger BP cuffs ●Women have been happy with information and feel supported ●Large number of different situations/scenarios to test around HBPM pilot ●Shortage of time/ competing priorities What have been the enablers? We overcame our challenges by: ●COVID-19 pandemic, national support and resources ●Good communication ●Enthusiastic team and receptive women ●Perseverance, patience and enthusiasm (PPE) ●Flo experience/ e health support from local and national boards ●Understanding of current working environment ●Good understanding of our pregnant populations needs and ●Working with community BP scheme to gather larger cuffs, shared expectations working across healthcare sectors 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 Greenock Practice Development Midwife

Vivien Crichton Midwife NHS Greater Glasgow and Clyde

What’s worked well? What have been the enablers? • Multi disciplinary working and • National and local approach and support – weekly collaboration “teams” meetings • Staggered Quality Improvement • National and local guidelines , resources and tools (QI) approach • Early support from local management and staff • Staff education and awareness • Support from local QI and Practice Development teams What have been the challenges We overcame our challenges by: ? • Early recognition that ALL staff encouraged to be involved • Speed of implementation - 5 sites • Robust education plan & consideration of local process • Fear of change, roles, responsibility • Awareness posters illustrating roles & responsibilities • Timing of recruitment & equipment • Addition of phone line in counselling room & headsets • Storage and return for BP monitors • Adaption of patient diary, e-forms on shared drive • 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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