Midwifery Clinical Audit - Essay Example

Midwifery Midwifery Clinical Audit Clinical audit is a process of quality improvement that aims at improving patient care and results through incorporation of a systematic evaluation of care against an explicit criterion and the realization of change (Dulko & Mooney 2010). Selection of the features of the processes, structure and results of care is done and systematic evaluation is done against explicit standards. Where specified, there is implementation of changes by service level, a team or an individual. Further monitoring is applied in the confirmation of an improved health delivery (Peate & Hamilton, 2013). In midwifery, for instance, clinical audit is used in monitoring and improving excellence and quality of care. In the United Kingdom (UK), two major bodies help in ensuring that midwifes deliver quality services to their patients. These include the Nursing and Midwifery Council (NMC), and the National Institute of Clinical Excellence (NICE) (Marshall & Jackson, 2013). NICE offers national advice and guidance to help improve quality of health and social care. It is an agency under the National Health Service (NHS) having the responsibility of ensuring the promotion of clinical excellence of service providers in Wales and England through developing recommendations and guidance regarding the efficiency of medical and treatments procedures (Brayford et al, 2015). NMC specifically ensures provision of quality services through describing legal and ethical obligations of nursing and midwifery practice (Tingle & Cribb, 2013). With NICE and NMC in place, a standard clinic audit has been set in place for midwifery. This audit acts as a tool for quality improvement since it demonstrates whether a midwifery staff makes real efforts in delivering a professional care of high quality to all patients (Harris & Murray, 2013). An institution like the Royal College of Midwifery (RCM) plays a key role in the dissemination of information regarding professional midwifery practice; therefore it ensures that the UK has a nationwide recognized and well established platform for good midwifery practice (Jordan, 2010). Clinical audit in midwifery is generally applied in gauging devotion to clinical practice guidelines considered to be evidence-based (Spiby & Munro, 2009). This audit helps midwifes in measuring their current practice and afterward notes any gaps. The key aim of midwifery audit is to thoroughly measure how well midwifery is done and to offer feedback to make efficient the local performance of midwifery care (Bowie et al, 2011). The auditing of midwifery has the potential to improve or guarantee direct patient care; however the beneficiaries of the audit process are not only the patients (Griffith, Tengnah & Patel, 2010). The multidisciplinary team and the midwife benefit from: The feedback on performance. Improved teamwork. Knowledge development. Recognition and minimization of potential problems. The midwifery department and the clinical organization as a whole benefits from: Attaining cost benefits through best evidence application. Exhibiting accurate information concerning the performance. Risks recognition and minimization. Capacity to depict high-quality services (Steen & Roberts, 2011). Patients also benefit from: Assurance on monitored quality of care. Efficient delivery of health care (Scott & Spouse, 2012). Generally, quality management of midwifery care is a significant tool that ensures efficient and effective roll-out of new types and levels of health service, and adds to a clinical governance framework and ongoing role development of midwife practitioners (Brayford et al, 2015). Therefore, it is significant that the quality and safety of midwife practitioner gets reviewed against indicators considered appropriate to their medical service and patient results. This audit therefore provides measurement and feedback regarding the procedure and outcome midwifery practice (Jamtvedt et al, 2009). During the audit process, there are certain guidelines followed. NMC recommends that regular evaluation of the quality and safety of midwifery practitioner services be embarked on to review the performance and nature of midwifery practitioner practice, the situation under which midwifery practitioners operate and quality of midwifery service results. The recognition of the accountability for the audit process needs to be done within this model and either undertaken by a midwifery practitioner, a researcher in midwifery or other medical professional (Wheeler, 2013). The NICE has also set aside certain quality assessment framework of the structure, the process and the outcome, which acts as a relevant tool for evaluation of services in maternity care: a) Structure Evaluation comprises the identification of facilities’ adequacy, information technology (IT), access to equipment and diagnostic, and resources for the midwifery practitioner; features of development, support, and training; features of as well as the degree of integration of midwifery practitioner role in the medical facility. Tools of data collection include assessment interviews of midwifery practitioners. b) Process Audit/Evaluation of care process incorporates measurement of service outcomes, which are affected by midwifery practitioner service (like wait periods and other particular service major performance indicators; midwifery practitioner resources utilization (like referrals, prescribing and diagnostic tests); technical experience and extent of midwifery practitioner practice; use and availability of evidence-based guidelines precise to patient and the defined scope of the midwifery practitioner’s clinical practice. Tools of data collection include: stakeholders and midwifery practitioners survey interviews, patient chart review, and indicator records on applicable service main performance. c) Outcome Evaluation of midwifery practitioner service outcomes include clients/patients’ number accessing the services of the midwifery practitioner in the defined period (the midwifery practitioner model receives relevance from the measurement); cure/improvement/progress evaluation of the existing symptoms and/or condition; patient satisfaction and attitude’s evaluation; improved self-care competencies and patients’ knowledge; and recording of undesirable occurrences. Tools of data collection include peer case evaluation of a section of patients, facility-based midwifery practitioner patient data flow, patient interviews and chart review (Downe et al, 2010). The midwifery practitioner and the medical facility must set up a framework for evaluation and review of, and constant enhancement in the quality and safety of maternity services offered by the midwifery practitioner. An interdisciplinary team evaluates the performance and features of every midwifery practitioner’s practice, the circumstance under which each midwifery practitioner works and quality of medical service results in every 12 months (Peate & Hamilton, 2013). To support the practice validated tools must be applied. Ethical and Legal Obligations One of the major codes for midwives includes the Midwives Rules and Standards (2012). It entails standards of profession, which midwives and nurses are expected to adhere to so as to get registered are receive practice licenses in the UK. Effectual as from March, 31st 2015, the Code depicts the world under which we work and live today, the ever changing expectations and roles of midwives and nurses (Dimond, 2013) (Buka, 2014). The Code is structured in such a way that it is surrounded by four themes, which include effective practice, prioritization of people, promotion of trust and professionalism and preservation of safety. It was developed in cooperation with several people who care about proper midwifery and nursing, therefore midwives and nurses use the code to reinforce their professionalism. Failure to adhere to the code can bring their suitability to practice into question (Schneider et al, 2014) (Cranmer, 2015). For purposes of practice, the code requires midwives to adhere to certain guidelines. For instance, according to the Code’s practice requirements: 1. In the instance where a midwife plans to either be present upon a baby or woman during the time of childbirth or to carry out an activity for which qualification of midwifery is needed, he or she must give notice of their intention/plan in conformity with this rule. 2. On a form offered by the NMC for purpose of midwifery, a midwife must offer notice to every local supervising authority of the place he or she intends to begin practicing, before beginning his or her practice there. 3. In situation where the midwife provides notice as indicated in paragraph (2), he/she must afterward, before the specified date by the NMC (annual notice date) on the provided form for the purpose, the midwife must provide notice in regard of every 12 month period under which they intend to continue their practice in the specified area. 4. Every notice provided under the rule will be in continuation until the subsequent date of annual notice. 5. In situation where the midwife has provided notice as per paragraph (2) or (3) and by the subsequent date of annual notice fails to provide notice of their plan to continue their practice in the specified area, they must provide notice as per paragraph (2) the next time they intend to practice. 6. Under paragraph (1), the notice to be provided may in an emergency be provided after the period when the midwife begins to practice so long as it is provided within 48 hours of them doing so (Midwives Rules and Standards, 2012). In addition, for the purpose of meeting the legal requirements for midwives’ supervision local supervising authorities must make sure that: 1) The notifications of intention to practice are sent to NMC through the date of annual submission by the NMC. 2) The notifications of intention received after the date of annual submission are sent to NMC immediately when still practicable (Midwives Rules and Standards, 2012). Further, the Code contains the scope and obligations for midwifery practice. The Code provides that practicing midwives responsible for the provision of advice and care to a baby or care to a mother during delivery must do so in conformity to the reviewed and established standards by the NMC in compliance to the Order’s Article 21(1) (a). This rule provides that: 1. A midwife in offering care to a baby or a mother during delivery must do so in compliance to the Code: Ethics and Performance for Midwifery. The midwife must have the capability of ensuring the essential skills clusters and competencies defined in Standard (17) of the Pre-registration Midwifery Education Standards, which are within their practice scope. 2. The midwife must ensure the needs of the baby and the mother are the key focus of their practice and they must work in corporation with the mother and her family, offer safe compassionate and responsive care in a suitable environment to ensure her emotional and physical care throughout the delivery process. 3. Except for an emergency, the midwife should not offer any care or commence any treatment in which they have no professional training. 4. During an emergency or in situations of a deviation from the rule, which is outside a midwife’s current capacity of practice, becomes obvious in a baby or mother during delivery, the midwife must call for social or health care professionals, as can logically be anticipated to exhibit the required experience and skills to help them in care provision. 5. A midwife must only administer and supply the drugs for which they have received training, dosage and administration methods for which they are exempt. 6. Both the midwife function and the title ‘midwife’ are protected by the law. A midwife must never, or allow anybody to arrange for any individual to substitute them, other than a fellow practicing midwife or a licensed clinical practitioner (Midwives Rules and Standards, 2012). References Bowie P, Quinn P, Power A. (2011). Independent feedback on clinical audit performance: a multi-professional pilot study, Clinical Governance. An International Journal, 14(3): 198- 214. 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Basingstoke ; New York : Palgrave Macmillan. Spiby, H & Munro, J. (2009). Evidence Based Midwifery: Applications in Context. Berlin: Springer Berlin. Steen, M &, Roberts, T. (2011). The Handbook of Midwifery Research. West Sussex: John Wiley & Sons Ltd. Tingle, J & Cribb A. (2013). Nursing Law and Ethics. London: Oxford University Press. Wheeler, H. (2013). Law, Ethics and Professional Issues for Nursing: A Reflective and Portfolio- Building Approach. New York: Routledge. Read More