https://phescreening.blog.gov.uk/2019/05/16/learning-from-the-experiences-of-others-in-antenatal-screening/

Learning from the experiences of others in antenatal screening

I hope you saw our recent blog about how one NHS trust is ensuring pregnant women who screen positive for infectious diseases receive prompt and appropriate follow-up care.

This follow-up article is about sharing further points of learning from antenatal screening safety incidents. I hope it provides plenty of ideas to take away and ask of your screening service.

Learning from experience

Every 3 months PHE Screening looks at reported screening incidents to see what we can learn. We then highlight these incidents with regional quality assurance teams and screening and immunisation leads, who in turn share the themes and learning with providers.

There's a quote by an American author Rick Warren about shared learning which I really like. Rick says:

While it is wise to learn from experience, it is wiser to learn from the experiences of others.

Improvement is an ongoing process. While we have seen improvements in failsafe processes for antenatal and newborn screening pathways across maternity services in England, our work is not done.

Eligibility for screening

Evidence from safety incidents show that some women who are eligible for screening are not offered screening at their booking appointment. Sometimes it only becomes apparent that these women were missed when data is collated for key performance indicator submissions.

But does this matter?

Women can be offered screening for infectious diseases, sickle cell and thalassaemia at any point in the pregnancy, so you may think nothing lost, right?

However, it’s not quite so simple.

This is because the aim of screening is to offer women a personal informed choice. Choices are limited if screening happens later in pregnancy.

It also means that women who screen positive later inevitably experience delays to their treatment.

We have resources for health professionals to find out more about the benefits of early access to screening, including:

Weak points in the fetal anomaly screening pathway

Image shows cartoon man holding together 2 pieces of chain in his arms.
Being aware of weaknesses helps us to develop more focused failsafe processes

There are defined ages for when Down's syndrome, Edwards' syndrome and Patau's syndrome screening using the combined or quadruple test can be carried out.

If the opportunity to make an informed choice is missed for combined screening, then the woman can be offered a quadruple test, but this is a less sensitive test.

We are aware of screening incidents where women book in time to be offered a combined test but this is not offered when it should have been.

We know there are weak points in the fetal anomaly screening pathway. Being aware of these weaknesses means maternity services can use them as triggers to check and develop more focused failsafe processes.

What to look out for

Triggers maternity services should be looking out for include:

  • the quadruple test not completed in cases where the nuchal translucency could not be measured
  • nuchal translucency measured but blood sample not taken
  • blood samples not reaching the screening laboratory
  • appointments for dating scans not made at the right time as staff booking the appointment are not aware of the gestational age parameters (which also applies to fetal anomaly ultrasound 18+0 to 20+6 weeks)

Women presenting in labour

Women who present for screening for the first time in labour (un-booked women) are eligible for infectious disease, sickle cell and thalassaemia screening.

Maternity services should work with their screening laboratories to agree a local policy about out of hours laboratory service in these instances. Screening results must also be checked and actioned prior to discharge from hospital.

Let’s all keep improving together

Please share all these learning points with your screening service to ensure we continue to improve our failsafe in antenatal screening.

If you have any questions, don't hesitate to get in touch.

PHE Screening blogs

PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.

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