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Maternity at Southport & Ormskirk: ‘They’ve got Information they didn’t Previously have’.

Community midwives can find it challenging to keep track of paper notes, says Janet Calland.

Ask Janet Calland to name the biggest challenge that community midwives at her trust encountered before ditching paper notes and she doesn’t hesitate.

“The key issue we had is when notes went missing,” remembers Ms Calland, matron for maternity services at Southport and Ormskirk Hospital Trust. “The women had hand-held notes and then we had the hospital notes that were stored in the hospital. If the women lost their notes then details of all the antenatal care that we’d done out in the community was missing because we didn’t have that anywhere else.”

It was an issue which, she says, ranked highly on the trust’s incident register. And it is one she says has been solved by moving over to an entirely electronic system.

It was back in 2016 that the trust went live with System C’s Medway Maternity system. The software makes it possible for midwives to create electronic rather than paper records. In so doing, it instantly removes the problem of women misplacing their notes, and of notes only being able to be in one place at one time.

Rather than recording information in a handheld paper record, community midwives now have a laptop, smartphone and wifi dongle in their arsenal. “They plug in their dongles into their laptop, and then they will see what they would see if they were here – they’re straight through into the trust systems then,” explains Ms Calland. “They can see everything out in the community that they could see if they were here in the hospital.”

And any data inputted is synced live. “So if they see a woman out in the community, they’re typing straight into her record. If they then refer the woman to the hospital, it’s already there in her records when she arrives at the hospital, because they’ve been doing it live.”

Ms Calland reports the major benefit for midwives working in the community is “they’ve got information they didn’t previously have, at the point of care”. She says this is “great for them, and also for women, because it means that they can give them immediate feedback on things and they don’t have to then say: ‘I’ll call you when I get back to the hospital.’ So it’s much more fluid what they’re doing.”

Simpler too, she says, is audit work. Previously, all data had to be hand collected and reviewing it was a case of sifting through handwritten notes. “When we were reviewing incidents, when there were serious incident reviews, we were trying to interpret people’s handwriting – which was often challenging.”

Now it is completely different. “For ad hoc audits that someone might do in response to, say, an incident or a complaint, the midwives just go into the records and can pull that information off the records quite easily. And then there’s the bigger audits that are just pulled off at the back end of the system by the data analysts.”

The trust now submits data to the national Maternity Services Data Set, published by NHS Digital on a monthly basis to build a national picture of maternity activity. “Before we weren’t actually achieving that,” says Ms Calland. “But with the system, it’s made that much, much simpler to do.”

Which is not to say implementing a major new electronic system was entirely effortless and pain-free. There was recognition this would be a big change for staff – not least since the system went entirely live across all trust maternity processes at the same time – and needed to be treated accordingly. Two dedicated IT midwives were identified to ensure a good connection between clinical practice and electronic practice. Training was also vital, says Ms Calland.

“I think it’s key that staff fully understand what’s happening and what that’s going to mean, so they go with you on it and are not resistant to the change. So we did do a lot of training for our staff.”

She adds: “It was quite a big learning curve. For the staff particularly, because I think it’s quick to write things in pencil and then the system maybe takes them a little bit longer.”

Almost two years down the line, though, the system has simply become part of daily practice. More developments are planned – electronic versions of individualised growth charts for babies, important for monitoring their development, and records of fetal heartbeat among them. All will further help midwives in the community provide the best possible care, and consign the frustrations of paper notes to ever-more distant history.

This case study originally appeared in Nursing Times, November 2018.