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Risk Assessment and Decision Support

Risk Assessment and Decision Support

Version

v1.0 - March 2024

Status

Published

Important Information

Within this requirements catalogue we use the terms woman, women, and pregnant women. However, we recognise that some transgender men, non-binary people and people with variations in sex characteristics (VSC) or who are intersex may also access maternity services. Maternity services and delivery of care must therefore be appropriate, inclusive, and sensitive to the needs of everyone who accesses maternity services, including those who are trans, non-binary or intersex. 

Contents

Capability M5.01

The system should support risk assessment and decision support at every antenatal encounter along with additional risk assessments during any admissions and during labour and birth. Risk assessments include low or high risk care pathway, need for aspirin prescription, fetal growth pathways and maternity Venous Thromboembolism (VTE) as well as maternal mental health screening questionnaires. Note this list is not exhaustive.

VTE: Venous Thromboembolism

M5.01.1 - Risk Assessment and Decision Support

M5.01.1 - Risk Assessment and Decision Support

DCF Core Capability

As a Health Care Professional

I want the system to support clinical practice with embedded risk assessments and decision support during:

  • Antenatal contacts

  • Admissions (including admissions to the maternity department as well as elsewhere across the Trust)

  • Labour

  • Birth

  • Postnatal contacts

  • Postnatal admissions
    Triggering relevant care pathways, which include (but not limited to) medications, referrals, appointment schedules and screening

So that I can be supported to facilitate timely safe practice, in line with national guidelines and according to each woman's individual needs

Acceptance Criteria 1

Given the Health Care Professional is logged into the system

When they initiate an antenatal, admission, or labour and birth encounter

Then the system should prompt for risk assessment

And the risk assessment should include the following parameters:

  • Low or high-risk care pathway identification

  • Aspirin prescription prompt

  • Fetal growth pathway evaluation

  • Maternity Venous Thromboembolism (VTE) risk assessment

  • Maternal mental health screening questionnaire

And the system should allow for additional risk assessments as needed

And the risk assessments and decisions support tools should be available at the point of care and regardless of care setting, i.e. hospital, GP surgery and woman's home

And the risk assessments and decision support tools must be kept up to date and in line with national guidance

Acceptance Criteria 2

Given the risk assessment tools are available in the system
When a Health Care Professional performs a risk assessment

Then the results should be integrated seamlessly into the workflow

And the system should present risk assessment outcomes clearly, highlighting any identified concerns or care pathways
And evidence-based recommendations and guidelines should be provided based on the risk assessment results
And the risk assessment outcomes should be documented and tracked for future reference

Capability M5.02

In addition to Early Warning Score (EWS) functionality in 5.03 DCF for all care settings, the solution must integrate with national Maternity Early Warning Score Systems and national Neonatal Early Warning Systems (National MEWS and NEWTT2) once released. The solution should always adhere to the most recent scoring system released.

Maternity Early Warning Score (MEWS)

Newborn Early Warning Track and Trigger (NEWTT2)

M5.02.1 - Integration with MEWS and NEWTT2

M5.02.1 - Integration with MEWS and NEWTT2

DCF Core Capability

As Health Care Professional

I want the system to integrate with the national maternity early warning score systems and national neonatal early warning systems i.e. the Maternity Early Warning Score (MEWS) and Newborn Early Warning Track and Trigger (NEWTT2)

So that I can be alerted to any changing or concerning clinical signs and take appropriate action and as a result will prevent duplication of information and save time

Acceptance Criteria

Given that there is a need to calculate the Maternity Early Warning Score (MEWS) or Newborn Early Warning Track and Trigger (NEWTT2) for a patient

When the Health Care Professional open the patient's record on the system

Then the Health Care Professional will be able to record all clinical observations within the patient's record

And the system will guide and prompt the Health Care Professional with automated alerts and warnings, as per the national scoring tools i.e. MEWS and NEWTT2

And the system should copy the observation readings into the clinical notes

And the system should be up to date reflecting national changes and guidance as soon as they are released

Capability M5.03

The solution should automatically send an electronic notification to all Health Care Professionals (HCP) involved in care at various significant events during and after pregnancy. This includes interfacing with multiple different neighbouring Trust systems.

M5.03.1 - Electronic Notifications for Health Care Professionals

M5.03.1 - Electronic Notifications for Health Care Professionals

DCF Transformation Capability

As a Health Care Professional

I want the system to send an electronic notification to all Health Care Professionals involved in care at various significant events during and after pregnancy

So that other Health Care Professionals can be informed of key pregnancy, birth and postnatal events between multidisciplinary teams, regardless of care setting, safely and in a timely manner

Acceptance Criteria

Given that a woman's record has been created on the system

When the woman goes through the various significant events during and after pregnancy

Then the system will send electronic notifications to all Health Care Professionals involved in care at the key events listed below during pregnancy, birth and following birth:

  • Receipt of referral into maternity services

  • Booking

  • Pregnancy admission

  • Births

  • Pregnancy loss

  • Transfer home following birth

  • Postnatal admission and discharge from care, for woman and neonate as relevant

And the electronic notification will be sent from the system regardless of borders interfacing into multiple care systems for GP, Maternity and Health Visitor access and visibility

And the system will also be able to notify all Health Care Professionals independently, in the event of special causes i.e. adoption, fostering, surrogacy, safeguarding

Additional Information

This included GPs, midwives, health visitors, child health and social services at various events e.g. at booking, as soon as a pregnancy loss occurs (i.e. before discharge), a move out of area or birth.

Standards Compliance

STD041 Healthy Child Record Standard
STD076 Secure Email
STD009 Birth notifications

Capability M5.04

The solution should incorporate logic responding to changes in care pathways in an appropriate manner.

M5.04.1 - Logic for Care Pathways

M5.04.1 - Logic for Care Pathways

DCF Innovation Capability

As a Health Care Professional

I want the system to seamlessly and safely support changes in clinical care pathways

So that I can focus on completing only the relevant information in a timely manner, that fully completes my clinical notes for safe care, and mandatory fields for national reporting

Acceptance Criteria

Given that the Health Care Professional is permitted to add clinical information to a woman's record on the system

When the Health Care Professional is adding clinical information related to changes in care pathways to a woman's record on the system

Then the system will prompt the Health Care Professional to do the following:

  • complete relevant forms, pathways, and question sets

  • record data for mandatory reporting in all care pathways, with mapping to ensure the required data items are suitably embedded within logical questions and answers

And the embedded logic should trigger the inclusion of relevant and the removal of irrelevant questions, pathways, assessments, and or forms

And if the question on a form is irrelevant to the pathway but a response is required for national reporting, a response of "Not Relevant" or "Not Applicable" must be included

And the system must be kept up to date to reflect changes in national clinical pathways and guidelines

Additional Information

For example if the woman has a caesarean section they are automatically transferred to consultant led care, or for example, if a woman has a planned/elective caesarean section, the solution should not prompt for stages of labour information.

Standards Compliance

STD080 SNOMED CT: UK Edition

Capability M5.05

The solution must contain all theatre checklists including the World Health Organisation (WHO) surgical safety checklist. This must be locally configurable for maternity modifications.

M5.05.1 - Theatre Checklist

M5.05.1 - Theatre Checklist

DCF Innovation Capability

As a Health Care Professional

I want to be able to record data for maternity theatre pathways with the relevant woman's data populating the theatre checklists, including the World Health Organisation (WHO) surgical safety checklist

So that I can record clinical safety checks within the woman's record on the system

Acceptance Criteria

Given that the Health Care Professional is permitted to add clinical information to a woman's record on the system

When the Health Care Professional performs the theatre checklists for a woman

Then the Health Care Professional will be able to record on the system both the Trust's theatre and World Health Organisation (WHO) surgical safety check lists, using maternity pathways and forms

And the theatre checklists must be configurable on the system to meet the maternity setting requirements

And it will be possible to enable workflows on the system and forms can be kept up to date to ensure data populates the checklist requirements

Standards Compliance

STD144 WHO Surgical Safety Checklist
STD130 Global Medical Device Nomenclature (GMDN)

Capability M5.06

The solution could identify immediate neonatal problems and suspected congenital anomalies via the Newborn and Infant Physical Examination Screening Management and Reporting Tool (NIPE SMART). This could include the ability to record clinical comments and send this information to NIPE SMART.

NIPE SMART - Newborn and Infant Physical Examination Screening Management and Reporting Tool

M5.06.1 - Neonatal Anomaly Detection and Referrals

M5.06.1 - Neonatal Anomaly Detection and Referrals

DCF Innovation Capability

As a Health Care Professional

I want to be able to record the following on the system:

  • care or observations of any neonatal problems

  • suspected congenital anomalies

  • clinical comments or notes

So that the system can send this data to the Newborn and Infant Physical Examination Screening Management and Reporting Tool (NIPE SMART).

Acceptance Criteria

Given that the Health Care Professional is permitted to add clinical information to a woman's or neonate's record on the system

When the Health Care Professional adds the following to a woman's record on the system:

  • care or observations of any neonatal problems

  • suspected congenital anomalies

  • clinical comments or notes

Then the system will use this data to create the required alerts for the Health Care Professional

And the system will send the above-mentioned data to the Newborn and Infant Physical Examination Screening Management and Reporting Tool (NIPE SMART).

And the Health Care Professional is alerted to missed neonatal examinations

And the system will prompt the Health Care Professional for relevant referrals

Standards Compliance

STD080 SNOMED CT: UK Edition
STD041 Healthy Child Record Standard