AN AUDIT ON PRECONCEPTION CARE FOR WOMEN WITH DIABETES MELLITUS

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AN AUDIT ON PRECONCEPTION CARE FOR WOMEN WITH DIABETES MELLITUS Dr Jaiye Olaleye, Dr Greg Folwell & Dr Mark Evason The Lighthouse Medical Practice, Eastbourne East Sussex UK. • Fig 2: Glycaemic control in female diabetic patients in reproductive age group • DISCUSSION – CHANGES WE IMPLEMENTED • A reminder notice was included in our target patients’ records so that PCC can be offered opportunistically. • Patients were invited to attend surgery to discuss contraception , followed by telephone calls to patients that were unable to attend. • Posters were put up in our waiting areas highlighting importance of preconception care counselling. • Preconception advice was added onto the template in our routine diabetes review. • Practice nurses were updated on specific areas to look out for during routine diabetes review for patients in reproductive age group. • Results presented to the practice and important lessons emphasized e.g. coding letters appropriately. • The possibility of running a search every 6 – 12 months and creating ad-hoc preconception care clinics to be done either by the registrars / foundation year 2 doctors / HCA was also discussed. • A re-audit was performed after 6 months to give enough time for the new changes to be implemented. INTRODUCTION Current research has shown that women with diabetes mellitus are seven times more likely to have a stillborn baby than other women. They also have more than double the risk for caesarean sections and congenital malformations1. Preconception care is therefore crucial in ensuring a favourable outcome for diabetic clients in general practice as detailed in national guidelines. We audited our preconception care practice against set guidelines and demonstrated an improvement in our service provision on re-audit. RESULTS Registered patients in the practice as Jan. 2011: 14, 476 Female patients with diabetes mellitus: 357 Female diabetic patients between ages 16 – 44 years : 26 Table 1: Summary of the audit findings and re-audit improvements on preconception care The 1st audit showed only 2 (7.6%) of the 26 diabetic females in the reproductive age group had received preconception counselling. 11 (42%) of the 26 used some form of contraception. These findings were presented at the Practice’ audit meeting and recommendations for improvements made. Following implementation of the agreed changes, the re-audit demonstrated marked improvement with 7 (27%) of the 26 receiving preconception counselling and 13 (50%) taking up contraception. Fig 1 : Comparing data collection 1 and 2 Fig 1 illustrates the positive change in practice towards achieving the set standards for all criteria in the 2nd audit cycle. Half of the patients (50%) had satisfied criteria 1 & 2 in the initial audit cycle whilst a significant 77% met both criteria on the re-audit (Fig 1). AIMS This audit was carried out to determine if female diabetic patients of child bearing age in our practice have received preconception advice at least once before or if they are on effective contraception. • METHODOLOGY • It was agreed to be a relevant aspect of our service to be audited after consulting with the partners. • A list of female diabetic patients between ages 16 – 44 years in our practice, was obtained by performing a search on the EMIS web system. • A literature search was conducted and guidelines obtained [NICE2clinical guideline 63 (2008) audit support template, Diabetes UK Care recommendations3(Mar 2011)]. • A manual search was performed on the patient records using a spread sheet to obtain the relevant data. • CRITERIA • Criterion 1 – Women with diabetes who are planning to become pregnant are offered pre-conception care and advice before discontinuing contraception. • Criterion 2 - Diabetes education given from adolescence to women with diabetes (including the importance of avoiding unplanned pregnancy as an essential component e.g. use of contraception.) SUMMARY Ensuring appropriate preconception care in female diabetic patients in the reproductive age group is crucial to satisfactory outcomes. Implementing these changes in our surgery has significantly improved the care we are able to provide for this patient clientele. We now aim to achieve the highest possible standards in delivering best practice. • STANDARDS • 40% of our female diabetic patients should have had a form of preconception counseling (PCC) and advice at some point before pregnancy. • 90% of our female diabetic patients should be on a form of contraception if they were not planning pregnancy. • Why did we choose these standards? • This was going to be a relatively new aspect of care introduced into our routine diabetes clinic review. It was thus not realistic to set the target at 100%. • This took into account various patient factors such as women not being sexually active or not in a long term relationship and coding issues. • REFERENCES • 1 Diabetes UK’s Annual Conference March 2008 • 2 NICE clinical guideline 63 (audit support Diabetes in pregnancy) Issue date 2008 • 3 Care recommendations / Preconception care for women with diabetes. Available at www.diabetes.org.uk Accessed May 2011 • All Correspondence to: • Main Author: Dr Jaiye Olaleye • email: joretade@yahoo.comjoretade@yahoo.com