In this blog article, Laura Keeble, of East Suffolk and North Essex NHS Foundation Trust (Ipswich Hospital), explains the failsafe processes that help her team make sure pregnant women who screen positive for infectious diseases receive prompt and appropriate follow-up care.
It is vital that women who screen positive for HIV, syphilis or hepatitis B in pregnancy receive the appropriate follow-up care and do not slip through the net.
But how do we make sure these women get timely referrals to specialist services?
This is always a hot topic at national and regional meetings relating to the NHS Infectious Diseases in Pregnancy Screening Programme.
Discussions with colleagues in other trusts highlight the challenges other maternity providers face in making sure strong processes are in place. They also enable providers to reflect on the practices in their own trusts.
Failsafe process is a team effort
As an antenatal and newborn screening co-ordinator I am always looking at how I can strengthen our failsafe processes by reviewing what works well and areas we can improve upon.
I hope I can help other providers by sharing in this blog post our failsafe processes to make sure women with screen positive results are referred into specialist services in a timely way.
I am very lucky to have good communication links with the consultant microbiologists here at Ipswich and the laboratory staff – the senior biomedical scientist is the laboratory lead for the IDPS programme.
All maternity blood samples are requested on a specific antenatal screening request form. This means they can be easily distinguished from any of the trust’s other requests.
When a sample is sent to the reference laboratory for confirmatory testing, we (myself and my team) are notified via secure email. We log that the sample was sent and then check daily on our pathology system for confirmation of the results. The consultant microbiologist will also call us directly when a screen positive result is obtained from the reference laboratory. In addition to this, our failsafe officer logs the blood results daily for all women in our booked population and notifies us of any screen positive results.
All referrals to specialist services are made electronically and we have effective communication with our colleagues in genitourinary medicine and gastroenterology. All referrals are acknowledged and we are advised of appointment times, follow-up arrangements and outcomes, including any women who do not attend.
We log and track all women with screen positive results on a spreadsheet to make sure:
- they are seen by myself or my deputy and advised of their results within 10 working days
- they are referred to and seen by specialist services within 6 weeks
- child health department is notified
We also make sure care plans are in place for both mother and baby and that any treatments or vaccinations start before discharge from hospital.
Enhanced hepatitis B pathway
We have recently been looking at how we can improve our communication with GPs, community midwives and health visitors in relation to the enhanced hepatitis B pathway.
We have updated our discharge paperwork to better highlight when a baby has received vaccination and/or hepatitis B immunoglobulin and now include health visiting colleagues in our notifications to child health.
Effective communication and team working are crucial to make sure women with screen positive results are identified and referred into specialist services in a timely fashion. I am extremely grateful to all colleagues who work alongside me to care for these women because I certainly could not do it in isolation.
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