Report Broken Link

Recognising and responding to acutely deteriorating women in New Zealand maternity wards: A literature and environmental scan

Abstract:

Background: A significant body of evidence now demonstrates that early warning, recognition and response systems can help to prevent harm associated with in-hospital clinical deterioration. Systems for early recognition of, and response to, pregnant or recently pregnant (<42 days) women whose conditions are acutely deteriorating in hospital maternity settings have been recommended in other countries as a useful way of supporting rapid intervention and treatment, but it was not known what systems were in place in New Zealand (NZ) hospitals. The Maternal Morbidity Working Group (MMWG), within the Perinatal and Maternal Mortality Review Committee, has recommended the development of a national approach to detecting and responding to acute deterioration in inpatient pregnant women to align with the national patient deterioration programme currently in implementation. Aim: The aim of this project was to investigate current practice nationally and internationally, by identifying the evidence related to early warning systems and tools, and investigating current models in place at NZ district health boards (DHBs) that support the early identification and treatment of an inpatient pregnant woman’s deteriorating condition. Method: We performed a literature search and environmental scan. The search strategy incorporated both academic and grey literature databases using the same search terms. The environmental scan involved contact with all NZ DHB midwifery leaders to request information on early warning systems and tools currently in use. Findings: Sixteen papers met the inclusion criteria for the literature scan. The majority of evidence about the role of maternal early warning systems in preventing morbidity comes from retrospective case reviews, retrospective cohort studies, cross-sectional surveys, and validation studies, with some prospective evidence where early warning systems were evaluated after implementation. There were some indications that early warning systems can contribute to earlier identification of deterioration and cost-effectively reduce harm, although there is wide variation in the parameters used. The environmental scan found that 15 of the 17 DHB maternity services who responded (from 20 total services) have introduced, or are in the process of introducing, modified obstetric early warning systems. There is wide variation in the designs, parameters and thresholds of these scores, as well as the recognition and response systems in use. Conclusion: A substantial proportion of DHBs are developing and implementing tools and early warning systems for maternity care. There is significant variation in the tools and approaches in current use. The MMWG and the Health Quality & Safety Commission have recommended development of a nationally standardised recognition and response system for use in NZ hospitals for pregnant or recently pregnant (<42 days) women to align with the national patient deterioration programme.

 view online article View Document

early warning, maternity, physiological deterioration, recognition and response, score, system, track and trigger tools