Project title
The Scottish Woman-Held Maternity Record (SWHMR) Project
Update
Key dates
Start date: November 2002
Key contacts
Project Midwife: Dr Helen Bedford
Clinical midwife, seconded to NHS Quality Improvement Scotland from Grampian University Hospitals NHS Trust
Project Manager: Mrs Fiona Dagge-Bell
Professional Practice Development Officer
Women, Children & Learning Disability Services
Performance Assessment & Practice Development Unit
NHS Quality Improvement Scotland
Aim
To develop a national standardised woman-held maternity record integrated with an electronic record
Project information
A unified maternity record for Scotland has been an aspiration for women, service providers and clinicians for many years. ‘A Framework for Maternity Services in Scotland’, reiterated the case for such a record, and made it a priority through the following principle:
‘There should be a national, unified and standardised woman-held maternity record that is available and accessible to both women and professionals.’
(Scottish Executive Health Department - SEHD, 2001: 71)
This principle was elaborated by several local actions:
• A unified, multi-professional, woman-held maternity record should be developed and implemented throughout Scotland;
• A standardised national record should incorporate result reporting and discharge information;
• NHS Trusts should encourage women to contribute to their notes if they so wish;
• NHS Trusts must make sure that record keeping is an integral part of care. Documentation of every episode of care must be recorded by the professional in good time, and dated and signed with a legible signature;
• NHS Trusts should make sure that clear information is given to women locally about how they can obtain a copy of their maternity record.
(SEHD, 2001: 71)
As part of the implementation of the Framework, the SWHMR Project was established to design such a record. The SWHMR Project commenced in November 2002 within the former Nursing and Midwifery Practice Development Unit (NMPDU) – now NHS Quality Improvement Scotland. Core funding was made available from the Chief Nursing Officer.
In early 2003, a sister project to design an electronic version of the SWHMR, the eSWHMR, was established within the Information & Statistics Division (ISD) of NHSScotland. Details on the eSWHMR Project can be found below.
SWHMR Project objectives encompass the following:
• establish stakeholder involvement;
• produce a template SWHMR and guidelines for national consultation;
• collaborate with the eSWHMR Project team;
• prepare a written report for the SEHD.
Stakeholder involvement
Stakeholders have been involved throughout the SWHMR Project. All Scottish maternity units were invited to participate in the SWHMR Project at the outset. A survey on maternity record keeping and a request for a (blank) set of maternity records was sent to each maternity unit. This generated an excellent response. Analysis of these maternity records has been instrumental in designing the draft (template) SWHMR. Wherever possible this analysis has been supplemented by research evidence and national guidelines on good practice. The SWHMR has also been designed to meet the requirements of SMR02 for the collection of maternity data in Scotland.
Throughout its lifetime, the SWHMR Project has been supported by a large and diverse Reference Group, comprising of lay and multi-professional representatives who receive, deliver or plan maternity care in Scotland. The group has commented on draft papers and draft designs for the SWHMR package of a unified maternity record and associated guidance for professionals.
In consultation with the SWHMR Reference Group, the amended SWHMR drafts and associated guidance have formed the basis of the final drafts for national consultation. The final draft SWHMR has been designed in four separate parts:
• Pregnancy Record
• Labour and Birth Record Inserts (used in conjunction with the Pregnancy Record)
• Postnatal Record
• Maternity Summary Record
These parts are supplemented by relevant SWHMR inserts/continuation sheets. The draft SWHMR is accompanied by a draft guidance document for its use in maternity care settings.
National consultation
National consultation on the draft SHWHR package is currently underway (February 2004). In order to consult with as large a number of people as possible during a limited period, 500 packs of the complete draft SWHMR documentation were distributed throughout Scotland. Comments and feedback have been sought from a wide range of professionals and lay people who deliver, plan and use maternity services. The draft SWHMR documentation will be revised on the basis of this consultation.
The eSWHMR Project
The SWHMR and eSWHMR Project teams have been collaborating closely to develop a synergistic paper and electronic maternity record.
A companion secure electronic version of the SWHMR has many advantages. These include:
• Facilitating data entry: information need only be entered once onto the electronic system, and clear, legible copies can be produced;
• Acting as a back-up of information included in the SWHMR that is available in an emergency (even if the paper record is lost);
• Promoting coordination of professional input across geographical and professional boundaries (by the use of a shared dataset);
• Permitting extraction and integration of data from existing electronic systems, such as maternity systems and laboratory systems;
• Providing high quality data for planning and management at local and national level
The following requirements have been specified for the system:
• Effective integration with the SWHMR, so that the paper record can be produced and updated directly from the eSWHMR;
• An easy to use system, requiring minimal training costs;
• A web-based eSWHMR that is free to users in NHSScotland via the NHS Net and uses standard PCs;
• Accessibility from community and hospital sites;
• Security and confidentiality considerations – e.g. password protection, determining which staff are allowed to access which data items, data storage, and electronic data transfer;
• Use the national Unique Patient Identifier (UPI) number (i.e. the CHI – Community Health Index).
Many of these issues are already being addressed in the related Scottish Birth Record (SBR) Project. The SBR Project is also being undertaken within ISD. The SBR is a web-based system collecting data relating to newborn babies via the NHS Net (the private intranet belonging to the NHS). The eSWHMR Project will therefore adopt many of the facets of the SBR, and the two systems will be fully integrated. This will have a number of advantages. For instance, after a baby has been delivered, it will allow staff to enter information concerning both mother and baby at the same time.
A commercial firm with experience of developing maternity systems has started to develop a prototype of the eSWHMR system.
Details of the Scottish Birth Record (SBR) can be found at: http://www.nhsis.co.uk/sbr/
Reporting to SEHD/the next steps
It is important to note that the remit of the SWHMR Project does not include piloting and implementation. The SWHMR Project will report to the SEHD at the end of March 2004 for these activities to be considered.
FURTHER INFORMATION
You can access the text for an article on the SWHMR and the eSWHMR published in the Journal of the Institute of Health Record Information & Management (UK) (2003 – Vol. 44, No.2) by clicking the link below.
For further information on the SWHMR Project, please contact either Helen or Fiona:
Helen Bedford, Project Midwife (until 16.03.04)
Tel 0131 623 4286 or email: helen.bedford@nhshealthquality.org
Fiona Dagge-Bell, Project Manager
Tel 0131 623 4340 or email: fiona.dagge-bell@nhshealthquality.org
For further information on the eSWHMR Project, please contact:
Dr Jim Chalmers, Consultant in Public Health Medicine, ISD on:
Tel 0131 551 8662 or email: jim.chalmers@isd.csa.scot.nhs.uk
[Project no: 53]