This evaluation was a joint project between, Worcester Royal Hospitals NHS Trust, University Hospitals Coventry and Warwickshire NHS Trust and the Perinatal Institute

Project lead at each hospital:
Judy Byrne, Senior Midwife, Worcester Hospitals NHS Trust and
Carmel McCalmont, Acting Head of Midwifery, Coventry and Warwickshire University Hospitals NHS Trusts.

Aim

The aim of the field trial was to assess the ‘user friendliness’ of the notes. Whether the notes fulfilled the role they were intended to, i.e. clear, logical documentation of the intrapartum event.

Methods

200 sets of notes were issued, 100 to each site. It was anticipated the trial would take approximately 4 weeks to complete based on the two unit’s annual delivery rates. However, if longer was required to ensure a sufficient quantity of notes were used this was acceptable.

The trial started on 4th August 2003. One unit decided to gradually introduce the use of the notes, starting with women who presented in spontaneous labour, then for women who required induction of labour and finally for women who were undergoing a planned caesarean section.

The other unit decided to use the notes to record the birth event for all women admitted from the onset of the trial.

Evaluation forms were attached to the notes, which asked five questions relating to the layout, progression and usefulness of the document for recording the birth event. This enabled the midwives to provide feedback and make suggestions about changes they would like to see made.

Results

Only 50% of evaluation forms were returned, however one of the reasons for this was because, when midwives used the notes on a subsequent occasion they did not feel the need to complete another evaluation form if their comments remained the same.

Redditch

The majority of the feedback was positive, most staff felt the notes were clear and displayed logical progression. Other staff felt unsure at first, but commented that they thought the navigation through the notes would improve with familiarity.

When questioned as to what they liked best about the notes, the most common response was that the notes were presented as a booklet, all documentation was together and all professionals write chronologically in it.
Another positive comment received was that the risk assessment pages really made the midwife think about the significance of antepartum events prior to the intrapartum period, this was encouraging because this was the intended purpose of the risk assessment.

What was least liked, was that the size of some of the text boxes was considered too small, and there were comments that too many questions are asked at the initial assessment.

Some respondents’ felt there was repetition and too many signatures were asked for.

When asked what else should be included, again the response was varied; from nothing- because either they felt the document was about right as it was or there was too much in it already.

A common request was for stickers to record findings from vaginal examinations, these will be included in all orders.

Coventry

The unit wanted to be involved in the field trial as they felt it was important to be involved in regional developments. The senior midwives also felt if the unit had been involved in the field trial and influenced changes in the document it may have a proactive influence on any future implementation issues.
The feedback from the unit was again mainly positive, although there was some initial reservations and apprehension about trying something new, these did appear to reduce as the midwives became more familiar with the notes.

The comments mirrored those received from Redditch that: progression through the notes was logical and every one writes in the same document. As with Redditch it was felt the initial assessment and identification of risk factors were good and that plans for labour were clear.

They felt the notes facilitated good documentation and the partogram was comprehensive. When writing contemporaneous records, the birth summary was clearly laid out with adequate spaced allocated for documentation of a multiple birth. The ‘explanation of procedures’ page was also liked by the midwives, as it demonstrated what procedures had already been discussed.

The aspects of the notes that were least liked were there was little space on the partogram to record vaginal examinations. It was explained to the midwives that vaginal examination stickers will be produced and distributed with the birth notes; unfortunately these were not available at the time of the trial.
Some staff felt the layout was initially not easy to follow, but acknowledged this was probably due to unfamiliarity with the document. The more familiar they became with the notes, the more favourably they appeared to view them.

There was a comment that there was not enough space to write up a procedure on the operative delivery page, this has been addressed and more space allocated. The midwifery managers would have welcomed more feedback from medical staff.

Conclusions

The field trial of the notes was successful. It allowed us to confirm that the notes will fulfil the role they are intended for, which is clear, contemporaneous documentation of the intrapartum event.

The trial also gave invaluable feedback to develop and improve the notes further. The result from the feedback confirms the need for adequate training of professionals prior to use to aid implementation and familiarity of the document.

Acknowledgements

We would like to thank all the midwives and obstetricians from the Alexandra Maternity Unit, Redditch and the Coventry Maternity Unit, who took part in the field trial. We thank them for not only using the notes to record the care they gave but also taking time to complete the evaluation forms.

We would also like to thank Judy Byrne, senior midwife, Worcester hospitals NHS Trusts and Carmel McCalmont, acting head of midwifery, Coventry and Warwickshire University Hospitals NHS Trusts. Both of whom agreed to lead the project and whose findings of the evaluation, where presented at a regional forum.

To view the presentation from Coventry click here.
To view the presentation from Redditch click here.

Kate Morse, Specialist Midwife, Perinatal Institute.