Delivering continuity of midwifery care to Queensland women

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Collaboration with GPs A range of mechanisms can be used to support collaborative processes with clinicians outside the service: • review of clinical cases with collaborating GPs should occur from time to time throughout the woman’s pregnancy regardless of need for consultation and referral • consultation and referral processes should be developed in conjunction with collaborating GPs and other clinicians based outside the service • information should be shared between clinicians using the Queensland Health Pregnancy Health Record and by sharing documentation including results for pathology and imaging • use of the NHMRC Guidance on Collaborative Maternity Care (2010) can assist practitioners in the planning and implementation phases to identify their roles • defining the ‘maternity care coordinator’ as per the NHMRC Guidance may assist practitioners to ensure that responsibility for ensuring completeness of care and records rests with a single practitioner, although each clinician retains their professional accountability. Other public health and community services Consultation and referral with a range of public health and community services will be essential for good care. Midwives will refer fluidly to a range of allied health practitioners, including physiotherapists, continence services, dieticians and psychology services. Community services including child health nurses are a fundamental part of the care for a majority of women. Processes for requesting consultation and referral will vary from service to service and should be clarified at the planning stage. Retrieval, RFDS, ambulance Engagement of emergency transport services is essential for timely and appropriate transfer services. Staff in the model will need communication channels and an understanding of the limitations of different modes of transport under various conditions of weather, the local environment, women’s and/or babies health conditions and retrieving agency distance. Representatives from both local emergency services and at the partner referral site, along with experienced clinicians from any linked sites, should discuss the various likely scenarios and how these can be managed. Local agreements should be determined. The Clinical Services Capability Framework (CSCF) should be referred to for any specific requirements for each level of maternity and neonatal service capability www.health.qld.gov.au/cscf References Australian College of Midwives (ACM). (2008). National Midwifery Guidelines for Consultation and Referral. 2nd Edition. Canberra: Australian College of Midwives. Homer, C., Brodie, P. & Leap, N. (2008). Midwifery Continuity of Care. Sydney: Elsevier. National Health and Medical Research Council. (2010). National Guidance on Collaborative Maternity Care. Retrieved from www.nhmrc.gov.au/_files_nhmrc/publications/ attachments/CP124.pdf Queensland Health. (2011). Clinical Services Capability Framework for Public and Licensed Private Health Facilities version 3. Retrieved from www.health.qld.gov.au/cscf 78 Delivering continuity of midwifery care to Queensland women
Section 12 Sustaining and evaluating Models need to be developed in such a way that they are able to be sustained. Strategies to enable long term viability will be discussed throughout this section. Strategies to build sustainability into the initial planning of the model are covered in Section 3. Ongoing communication within the model Communication within the model is the basis for successful implementation. It has been stated previously that in cases of poor outcomes, the great majority are found to have problems in communication as a root cause, while only a small minority result from inadequate skills. Establishing effective communication within the organisation is an essential first step to developing a model. The plan needs to include the steps that all stakeholders will take when communicating with each other. Effective communication is: • open and honest • inclusive • timely • ongoing (J. Toohill, personal communication, February 14, 2011). These factors provide impetus for building relationships and establishing trust and respect. Issues for managers The foundation of the model needs to include a shared understanding about meeting the needs of the woman and the midwife. Managers need a clear understanding that their role is to actively enable midwives to determine the way in which they work. Managers often report that midwives indicate they ‘don’t want to’ or ‘can’t’ work in continuity of care models. It is important that the midwives understand the model well and that they have the support of a manager who provides the flexibility that is required for midwives to adapt to the model and respond to clinical responsibilities. Issues for managers include: • recruitment of committed midwives who will receive unquestionable management support. The midwives will need to have a balanced perspective of work-life balance, be comfortable to seek support of their manager and have or be prepared to develop clinical skills to provide care across the continuum in line with the model of care provided • ability to trust the midwives to manage and make appropriate decisions about their practice. • an expectation that midwives will attend the majority of the births for their own caseload women, but have the opportunity to have care provided by known back up midwives • appropriate consultation about model-specific issues (demography of clients and geographic area to cover, determining numbers of women in each midwife’s caseload) • support for midwives when the woman makes an informed decision that conflicts with unit policy or consultation and referral guidelines (Homer, et al. 2008) • support and integration with core staff where these are in place • midwifery models are challenging for managers who are used to close on-site contact with their staff, managing rostered shifts and counting hours. Continuity of care models are not driven by the needs of the service but by the needs of women and therefore may be perceived as more difficult to ‘manage’. They are not difficult but do require flexibility in management, flexibility with staffing arrangements and flexibility in how care is delivered. A guide to implementation 79
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Nursing and Midwifery Office, Queen
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Nursing and Midwifery Office, Queen
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Section 9 Professional development
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4 Delivering continuity of midwifer
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5. Cultural change—building a sup
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Section 1 Why provide continuity of
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These reforms can be seen as part o
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Section 2 Midwifery continuity mode
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shifts, but also rotate across ante
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For well women, evidence supports t
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Gottvall, K., Waldenstrom, U., Ting
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• The project officer develops se
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- on-call arrangements - relief - (
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Section 4 Key elements to successfu
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Page 56 and 57: Example: A new MGP model is impleme
Page 58 and 59: References Collins, C., Fereday, J.
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Page 100 and 101: Queensland Health. (2008b). Queensl
Page 102 and 103: Acknowledgments Queensland Health w
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