Consumers & Informed Choice

1. Translating Research Evidence in Practice: Safety and Quality Innovation Towards Safe and Effective Vaccination Practice: Postnatal Measles, Mumps and Rubella (MMR) - Vaccination for Woman Identified as Susceptible to Rubella Infection Following Routine Antenatal Rubella Screening Alison Evans RN Midwife MN (Clinical), Safety & Quality Consultant, Safety & Quality Unit, Tasmanian Health Organisation – South Aim To ensure safe and effective immunisation practices to include obtaining valid and Informed consent for postnatal woman with serology identifying low or sero-negative rubella titres with routine antenatal screening. Objectives To implement a system, and supportive resources, to ensure safe postnatal MMR immunisation practice and a woman centred approach in the promotion of safe and quality care within Maternity Services the Royal Hobart Hospital. To implement an evidence based clinical protocol and supportive processes in order to inform the health care team of their professional responsibility and accountability in safe immunisation practices in line with national guidelines. Woman - Centred Care The philosophy of health promotion is concerned with empowering people to make well informed choices within the context of their culture and socio-economic background. Midwifery and obstetric care aims to reflect family and community needs and perspectives, while at the same time providing individualised care, to enable women to take responsibility for their own health. There is strong evidence to support that good communication between healthcare professionals and women is essential. Effective communication should be supported by evidence-based, written information tailored to the woman's needs. NICE Clinical Guideline 62 – Antenatal Care p.7 • Quality Improvement The outputs developed aimed to be directly linked to the outcomes for the initiative and designed to be utilised by the health professional in the setting to ensure the success of the outcomes. 2011 - Evidenced based clinical protocol and associated documents/resources to guide and inform changes in practice. Outputs and products produced were endorsed through requisite organisational processes and include: • STAHS - Consumer Information Brochure: Postnatal MMR Vaccination • STAHS - Postnatal MMR Vaccination Consent Form • STAHS - Postnatal Measles, Mumps and Rubella (MMR) Vaccination Protocol • Specific information tools to inform and allow the acceptance of the process, with key content to inform practice development and support change management: • Postnatal MMR - Fast Facts for Health Professionals - Education • Supportive Decision Making Tool - Specifically Designed Flow Chart - Visual Prompts The primary purpose of rubella vaccination is to prevent the occurrence of congenital rubella infection (including congenital rubella syndrome, CRS) WHO 2000 Understanding Safe and Quality Vaccination Practice: Postnatal MMR In 2011 an informal review of immunisation practices, both within the Royal Hobart Hospital and a range of maternity services across Australia, identified: 1; Current practice for the pre- administration of MMR vaccine for women, identified as low or no immunity to rubella, did not require obtaining informed or written consent as part of routine practice 2.: Lack of evidenced based or quality consumer information on postnatal MMR vaccination promote woman centred care with attention to a woman’s needs, values and preferences Medical Research Council (NHMRC) The Australian Immunisation Handbook, 9th ed. Canberra: Australian Government Publishing Service; 2008 • Evaluation & Monitoring Systems Improvement in review process of antenatal serology testing for rubella susceptibility to include provision of consumer information on postnatal MMR vaccination • Improving Care: Utilising a Practice • Development Methodology • A facilitated practice development approach was adopted to link clinician-led innovation to the context of the • workplace and lead to the development and implementation of an evidence-based practice protocol. • Practice development is focused on person-centred clinical effectiveness, the delivery • of quality care and advancing the use of evidence-based approaches to care • Transforming the contexts and cultures of care • Continuous improvement and systematic approach to effect changes • Applying evidence in practice and knowledge translation Improved understanding of professional and medico-legal responsibility prior to postnatal MMR vaccination undertake pre-screening to minimise risk of adverse event and obtaining informed & valid consent Photo: DHHS Library High level of compliance with protocol and completion of all postnatal MMR documentation Stakeholders Consumers: Women Multidisciplinary Team: Midwives, Medical Team Safety & Quality Unit /RHH Practice Development Unit/RHH Medical Legal Unit/PEHS - Communicable Disease PreventionPublic and Environmental Health Service/Serology Services Consumers & Informed Choice The overall aim of health care is to deliver high quality care for all, all of the time. A range of heath care literature suggests that the way a patient is treated as a person has for some time been seen as a corner stone of quality. Woman-centred maternity care has become a familiar phrase in today's maternity services, however, the actual practice can be identified as more staff-centred than woman-centred. The initiative aimed to promote evidence based practice that supports the value of a woman’s preferences, beliefs and experience to inform clinical decision making. Informed and valid consent with good communication enhances interaction with the healthcare team, supports responsive woman centred care and safer vaccination practice. Overall, the initiative reflects the philosophy of midwifery, woman-centred care and evidence based practice and gives priority to the wishes and needs of the user, and emphasises the importance of informed choice. Improved knowledge and skillls in safe prescribing, vaccination practice and recognition /management of anaphylaxis Improved systems for vaccine management and tracking for adverse events Best Practice: Recommendations to Inform and Guide Practice ‘Women found to be sero-negative on antenatal rubella immunity testing should be vaccination after delivery and before discharge from the maternity unit’. The Australian Immunisation Handbook 2008 9th edn. p. 279 Sharing Knowledge & Informing Practice RHH Protocol adopted by THO North West implemented in Maternity Services • Bergeson, S, & Dean J, 2006, ‘A systems approach to patient-centred care’, Journal of the American Medical Association, vol.296, no.23, pp.2848-2849.Department of Health & Human Services, Tasmania’s Health Professionals Leading the Way: Shaping Future Care Discussion Paper Version 1.0 2009, ‘Leading the Way’ Taskforce, pp.1-55. • Page, L & Percival, P 2000, The New Midwifery: Science and Sensitivity in Practice, Elsevier Health Sciences, Churchill Livingston, pp.1 -7. • The Department of Health and Human Services - Tasmanian Health Plan May 2007, viewed at 11 March 2009, <http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0008/28484/HealthPlanSummary_nav.pdf>. • Zwelling, E, Phillips, C 2001, ‘Family-Centered Maternity Care in the New Millennium: Is It Real or Is It Imagined?’ The Journal of Perinatal & Neonatal Nursing, vol.15, no.3, pp.1-12. Bibliography WHO recommendations support Measles, Mumps and Rubella (MMR) vaccine (Priorix) as the internationally recognised trivalent live attenuated vaccine to protect women of childbearing age not previously protected against rubella. “Immunisation gives a very good level of protection against many serious diseases. It uses your body's natural defence mechanism – the immune response - to build resistance to specific infection”. PEH – DHHS Website http://www.dhhs.tas.gov.au/peh/immunisation