Infectious Diseases in Pregnancy screening: checks and audits to improve quality and reduce risks What This is what we recommend you do Why These are the reasons we are recommending this How This is how you might do this When This is how we recommend you undertake the action/check In addition to failsafe Identify the eligible population; have systems to: record all pregnant women booking for antenatal care (including women who book late or present unbooked in labour) record the screening offer, test or decline in the eligible population in every pregnancy collect and submit data for IDPS standards and/or Key To make sure the eligible population who accepted the offer complete screening. Timing is crucial to facilitate timely entry into treatment and care We have evidence from screening safety incidents of: who are not offered screening, including women presenting unbooked in labour or with no laboratory Maintain an accurate record of the eligible population which includes screening tests and declines date of completion of the screening tests processes in place for notification of declines to the screening team and follow up processes in place for notification to screening team of unbooked women presenting on delivery suite with no reliable evidence of screening results Weekly Submit quarterly data on coverage KPIs (ID1, ID3 and ID4) to the NHS screening programmes
Declined screening; have systems to record screening declines for any of the 3 infections in order to: facilitate a formal reoffer of screening by a member of the team (MDT) before 20 weeks gestation or as soon as possible if booked after this gestation make sure there is an outcome of the offer of screening To make sure that the benefits of screening for the woman and her baby are communicated and understood Have a process in place to ensure the receipt of the notification of a decline by the screening team The healthcare professional responsible for offering screening should: record the decline in the maternity notes/system notify the screening team immediately of any declines if screening is declined for one or two conditions complete the details on the request form and send to the laboratory marked ‘decline’ for those infections A member of the MDT should: make a formal reoffer of screening at a face to face appointment at or before 20 weeks gestation inform the woman that she can have screening at any point during the pregnancy if she changes her mind or if she deems herself at risk Contemporaneously when screening is declined Review and monitor rates of declines as detailed in the annual standards data report and investigate any inequalities that may exist and any significant changes Annual of the formal reoffer of screening by 20 weeks gestation for women who decline screening at booking
Laboratory analyses sample and report results as per national guidelines; have systems in to comply with the programme laboratory handbook To make sure there is a timely and consistent approach to the management of screening samples, including analysis and reporting of results We have evidence from screening safety incidents of: laboratories reporting screening results before confirmatory tests have taken place no system in to follow up samples with incorrect or incomplete request forms no system in place to follow up requests for repeat samples mismanagement of inconclusive results inappropriate reporting of results on an IT system and not directly to screening team manual decapping of samples resulting in cross contamination of samples Have mechanisms in to: participate in UK national external quality assessment service schemes for laboratories (all that apply) monitor repeat tests for inconclusive results and samples not fit for purpose (between screening team and laboratory) a communication process in place between lab and screening team for direct notification and recording of receipt of result As per quality assurance scheme requirements Weekly Submit annual data on standard 4: Test turnaround time (HIV, hepatitis B and syphilis) Annual audit of repeat requests for samples not ‘fit for analysis’ Trust response: this row for you to enter results or summarise whether you have these checks in place or not and if not to identify gaps and develop an action plan
positive women; have processes to: make sure women enter the treatment pathway as quickly as possible repeat tests and alert laboratory of known positive infection on request form as per local protocol notify known positive infection to the screening team with a face-to-face appointment with the screening team within 10 working days of the known status being reported to the screening team screening for conditions offered and take a blood test if accepted offer screening for syphilis in every pregnancy irrespective of previous results To ensure timely discussion of options and onward referral for women with known infections All women require triage in every pregnancy to make sure they have information on current infection status and management and treatment options The appointment also facilitates health promotion and information on their care including neonatal care and vaccination schedules We have evidence from screening safety incidents of women with known positive infections who were not seen appropriately within specialist services The healthcare professional responsible for offering screening should: record the disclosure of known positive status in the maternity notes/system notify the screening team immediately of any known positives have a process in place to ensure the receipt of the notification by the screening team if infection status is for one or two infections complete the details on the blood request form and send to the laboratory marked ‘decline’ A member of the screening team should: make a timely appointment with the woman record information in the maternity notes/system Contemporaneously at the time of booking or transfer of care Submit annual data for IDPS standard 5 Submit quarterly data for KPI ID2 Annual audit of standard 5 to establish why some women with known infections are not seen within 10 working days of disclosure Trust response: this row for you to enter results or summarise whether you have these checks in place or not and if not to identify gaps and develop an action plan
What This is what we recommend you do Why These are the reasons we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check In addition to failsafe Confirmed screen positive result; have systems to make sure: the laboratory records the confirmed result on the IT system the laboratory contacts the screening team directly to inform them of the result women should be invited for specialist assessment within 10 working days of the positive result being available to the maternity service results are documented in the maternity records women who are hepatitis B positive (new and high infectivity) should be seen by a specialist within 6 weeks of the positive result To ensure timely discussion of options and onward referral for women with a screen positive result. We have evidence from screening safety incidents of: inappropriate reporting and management of results delay in discussion and referral of screen positive women delayed diagnosis and/or treatment Have a communication process in place between laboratory and the screening team for direct notification and recording of receipt of result Check that all women with a positive result are offered a face to face discussion within 10 working days of result of the results by the screening team and document attendance or decline and reason for decline Complete a neonatal alert to identify babies who will need neonatal assessment and treatment Weekly Submit annual data for IDPS standard 5 Submit quarterly data for KPI ID2 Annual audit of standard 5 to establish why some women with screen positive results (including known infections- see above) are not seen within 10 working days of availability of the positive result
What This is what we recommend you do Why These are the reasons we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check In addition to failsafe Follow up of babies born to screen positive women; have systems to make sure the baby’s care is managed in line with national guidance. HIV – paediatric assessment in line with BHIVA and CHIVA guidelines Hepatitis B – administration of vaccination (+/- HBIG) within 24 hours of birth and transfer of information to CHIS and GP to schedule further vaccinations/serology in line with Green Book guidance Syphilis – paediatric assessment and treatment in line with BASHH guidelines To make sure babies born to mothers with an infection receive appropriate care We have evidence from screening safety incidents of: babies not given appropriate neonatal assessment and treatment or subsequent entry into paediatric care delays in or failure to administer Hepatitis B vaccinations (+/- HBIG) non-compliance with the neonatal immunisation schedule Neonatal and birth plan completed by the multi-disciplinary team (MDT) antenatally. Follow up by screening team for all neonatal outcomes. Weekly Tracking process by screening team for all babies due to deliver Report neonatal outcomes to IDPS outcomes systems (ICH). Submit data for IDPS standard 7 annually BHIVA – British HIV Association, CHIVA- Children’s HIV Association, HBIG- hepatitis B immunoglobulin, CHIS- Child Health Information Service BASSH –British Association for Sexual Health and HIV, ICH- Institute of Child Health Trust response: this row for you to enter results or summarise whether you have these checks in place or not and if not to identify gaps and develop an action plan