Powys Teaching Local Health Board
Directorate: Women’s and Children’s
Author: Lewis, Owen, Davies, Lister / Title: Pregnancy Information Sharing Pathway for Midwifery, Health Visiting and Primary care.
Code: to be completed by Q&S Unit if new policy

Pregnancy Information Sharing Pathway for Midwifery, Health Visiting and Primary Care

Document
Code
/
Date
/ Version Number / Planned Review Date
Jan 2012 / 1st Issue / Jan 2015
Document Owner / Approved by / Date
Women’s and Children’s Directorate / Women’s and Children’s Directorate
Clinical Effectiveness / 29/03/12
16/04/12
Document Type / Guideline

Bwrdd Iechyd Addysgu Powys yw enw gweithredol Bwrdd Iechyd Lleol Addysgu Powys

Powys Teaching Health Board id the operational name of Powys Teaching Local Health Board

Pregnancy Information Sharing Pathway for Midwifery, Health Visiting and Primary Care

Contents / Page
Validation & Ratification / 3
Equality Assessment Statement / 5
Introductions / 6
Guidelines for completion of Pregnancy Information Sharing Form [PISF1] / 6
Assessment Framework / 8
Guidelines for Midwifery Families in need report form(PISF2) / 8
Cross Boundary movement / 9
Guidelines for Information prior to primary visit by Health visitor / 10
Implementation and training / 10
Audit / 10
Guidelines for sharing Information prior to primary visit by Health visitor / 17
Appendices
1 / Midwifery & Health Visiting pathway / 11
2 / Flowchart for Child Protection / 12
3 / Neonatal Discharge Form [PISF 3] / 18

For Reviewed / Updated Policies Only:

Relevant Changes – / Date

VALIDATION & RATIFICATION

To be completed by the Author – no policy, procedure or guidance will be accepted without completion of this section which must remain part of the policy

Title: Pregnancy Information Sharing Pathway for Midwifery, Health Visiting and Primary Care
Author:Dawn Davies, Tess Lister,Donna Owen, Marie Lewis
Directorate:Women and Children’s.
Reviewed/ updated by:
Approved for submission by Cate Langley Date 28/03/12
Evidence Base
Are there national guidelines, policies, legislation or standards relating to this subject area?
If yes, please include below:
All Wales child protection procedures.
NMC guidance
Implications
CONSULTATION
Please list the groups, specialists or individuals involved in the development & consultation process:
Name / Date
Powys Midwives / 18/03/12
Supervisor of Midwives / 18/03/12
WCH Services Directorate Meeting / 18/03/12
Health visitors / 18/03/12
Safeguarding team / 18/03/12
Please insert the name of the Directorate/ Departmental/Discipline Committee or Group that has approved this policy/procedure/guidelines/protocol
Name / Date
Women’s & Children’s Directorate / 29/03/12
Clinical Effectiveness / 16/04/12
Implications
Please state any training implications as a result of implementing the policy / procedure.
Staff will require awareness / training sessions to ensure they follow procedure.
Please state any resource implications associated with the implementation.
Time implication- Staff will need to ensure formal handover takes place.
Please state any other implications which may arise from the implementation of this policy/procedure.
  • Improved communication between services therefore minimizing risk.

For Completion by Quality & Safety Unit
Checked by: / Date:
Submitted to CEC: / Date:

Equality Assessment Statement

Please complete the following table to state whether the following groups will be adversely, positively, differentially affected by the policy or that the policy will have no affect

Equality statement
No impact / Adverse / Differential / Positive / Comments
Age / X
Disability / X
Gender / X / Woman centered policy
Race / X
Religion/ Belief / X
Sexual Orientation / X
Welsh Language / X
Human Rights / X

Risk Assessment

Are there any new or additional risks arising from the implementation of this policy?
NO
Do you believe that they are adequately controlled?
N/A

Relevant to:

Local guideline for all midwives and Health Visitors working in Powys.

Purpose:

The overall aim must be to ensure safe and effective care is provided to families with effective communication between professional groups.

Responsibilities

All Midwives and Health Visitors working within Powys hold a recognised qualification, no additional qualifications are required to carry out thispolicy.

Monitoring

This policy will be monitored through clinical supervision, issues raised through training days and the Datix reporting system.

Process

Introduction

This Information Sharing pathway is intended to assist in the transfer of information from midwife to health visitor and vice versa (refer to appendix 1). If the midwife identifies any child protection/cause for concern, domestic abuse and mental health issues during the ante-natal period she must inform the Health Visitor, GP, Mental Health team and Safeguarding children team as per AWCPP [All Wales Child Protection policy and procedures]and in accordance with local safeguarding children guidelines.

Guidelines for Completion ofPregnancy Information Sharing Form (Notification of booking form) (PISF 1)

In order to make an informed assessment of the needs of the woman and her family, it is important wherever possible to undertake the booking visit in the woman’s home. If this is not feasible a clear reason should be documented in the woman’s handheld record and a future arrangement to see the woman at home for an alternative appointment is made.

  • Discuss with the woman the routine nature of this information gathering and seek consent. This should be documented in the pregnancy hand held record (PHR). If consent is declined and there are no known child or adult protection issues, information will not be shared with other health professionals or other agencies. This should be revisited as the pregnancy progresses and the outcome of these conversations should be clearly documented in the PHR.
  • If there are child protection concerns the woman’s consent for information sharing is not required (All Wales child protection procedures)
  • Notification of booking form (PISF1) to be completed by the midwife at booking. After booking this form is to be sent to Health Visitor (H/V) and G.P. for any medical, social or family history which may be relevant to the pregnancy.
  • If the midwife has concerns, medical or social, these should be listed in the ANY CONCERNS or RISK FACTORS box prior to this form being sent.
  • Indicate on the Notification of booking form that forms have been sent to the relevant health professionals
  • If it is identified that there is information to be shared, the professional with the information is to make arrangements to communicate with the relevant professionals as soon as possible.
  • The form is to be filed in the PHR.
  • If there is cause for concern/child protection issues or the midwife identifies a Vulnerable adult, the midwifery cause for concern process will be initiated and referral made to Social Services as appropriate. A telephone referral to social services will be followed up by a written multi-agency referral form within 48 hours. AWCPP procedures will be followed. This may include details of the woman’s partner if relevant issues are raised and it is in the interest of the child to share these.
  • If concerns are identified a chronology of events should be commenced by the named midwife.
  • If there any change of circumstances during the pregnancy for example, a new partner, the professional aware of this information should notify the named midwife for the woman. The midwife will share this information with the HV, GP and safeguarding team when appropriate to do so.
  • Where mental Health issues have been identified communication and involvement with the Mental Health team is essential and this should be communicated to the Health Visitor on handover.

The pen-profile midwives will provide support to the midwifery team as they encounter safeguarding issues. The Powys tHB Safeguarding team is available when further support is required by staff in relation to cause for concern and child protection. They should both be notified of all new cases, or any change in circumstances.

Circumstances in which a referral to Children’s services would be appropriate are where:

  • Previous children in the family have been removed because they have suffered harm.
  • The woman’s or her partner’s children are currently in the care system.
  • Concerns exist regarding either parent’s ability to protect.
  • There are concerns regarding parenting capacity, particularly where parents have significant learning difficulties or mental health problems.
  • Alcohol or substance abuse is thought to be affecting the health of any unborn baby, or where alcohol or substance abuse may significantly impair parenting skills;
  • The expectant parent is very young and a dual assessment of her/his needs as well as her/his ability to meet the baby’s needs, is required.
  • There is a previous history of post-natal psychosis.
  • Other children in the family have their names included on the Child Protection Register and therefore have Child Protection Plans.
  • There is concern about the new parents’ capacity to parent and it is believed that any child of the family might suffer significant harm.
  • The woman has previously abused or allegedly abused a child.
  • The woman has a partner, or is in contact with someone, who has abused a child.
  • There are known to have been incidents of domestic abuse within the relationship.
  • The lifestyle of the expectant mother and/or the people she is in contact with is such that the child may be at risk at birth.
  • Persistent non-attendees/defaulters – no access visits.
  • The woman is in the care of the Local Authority.
  • Identified vulnerable adult

This list is not exhaustive therefore professional insight should be used. If youare aware there are concerns regarding a family seek further advice from the child protection pen profile midwife or in their absence the safe guarding team.

If the unborn child is on the child protection register[CPR], the Social Worker[SW], Health Visitor and Safeguarding team need to be aware that the baby has been born and the child protection plan updated - the SW needs to be told immediately in order for the child to be put on the CPR with all current details

Common Assessment Framework

If the pregnancy will result in a ‘Child in Need’ then the All Wales Assessment Framework must be adhered to

The mother may be “a child in need” and consideration will have to be given to refer appropriately within the Assessment Framework.

Guidelines for Use ofReport for Children and families in need (PISF 2)

Where an unborn child has been identified as a child in need or is at risk of suffering significant harm, a telephone referral to Social Services is required. AMulti Agency Referral Form must be completed and sent to social services within 2 working days of the initial telephone referral.

  • A copy of theMulti-agency Referral form or the Child / Family in Need form (PISF 2) to raise the concern will be sent to the Lead Midwife, Named midwife for child protection, pen profile midwife and Safeguarding Children’s Team
  • If the woman is to deliver ina neighboring hospital,A copy of the Multi-agency Referral form or the Child / Family in Need form is to be forwarded by Named Midwife caring for this woman to the DGH Named Midwife for child protection or nominated deputy within 24 hours of receipt. This is to be supported by telephone communication.
  • If there is any likelihood that the mother will change her booking at last minute or attend another hospital for delivery, a copy of the Multi-agency Referral form or the Child / Family in Need forms to be forwarded immediately. This is to be supported by telephone communication at the same time.
  • Health Visitor and GP to be informed thatConcerns have been identified.
  • Womenare to be informed that there are child protection concerns, and that the midwife will contact the Named Midwife for child protection or nominated deputy for advice and support unless it is felt that this will place the child at risk.

Cross Boundary Movement

  • When awoman about whom concerns have been raised, delivers in or moves into another health board area all information pertaining to these concerns must be passed on to the new area.

It is the responsibility of the midwife holding the information to:

  • Whenever possible ascertain the new home address and GP.
  • Immediately inform own Lead midwife or named midwife for Child protection within Powys LHB by telephone, and the Safeguarding Childrens’ Team.
  • Follow up within 2 working days in writing, which will include copies of all documentation. Original documentation to be filed for future access as agreed within LHB protocol.
  • Named midwife/ Specialist Nurse Safeguarding Children will alert equivalent colleague in the new area by telephone, with follow up in writing within 2 working days, which will include copy of documentation.
  • Follow the missing person protocol if new address is not known.
  • Guidelines for Sharing of Information to the Health Visitor
  • The midwife is to complete the neonatal discharge form (PISF 3),detailing if there are child in need/protection concerns, or any mental health and /or domestic abuse issues identified. This will be sent to the health visitor, GP and child health department immediately on discharge frommidwifery service.
  • Any concerns identified should be discussed with the Health Visitor prior to discharge from the Midwifery service.
  • If concerns or issues have been identified during a home risk assessment: Eg Large dogs/snakes, it is the responsibility of the Midwife to ensure that these are discussed with the health visitor
  • The midwife will contact the health visitor around day10 to arrange handover of care which may formally be between days 10 and whenever most appropriate based on clinical need. This will include a plan for further care with the appropriate professional input and arrange the transfer of the Single hand held records.
  • A copy of the form is to be kept within the Maternal Records.
  • Handover will include details of when Domestic Abuse routine enquiry was carried out and if not carried out why this was not possible.
  • With Child Protection cases, Midwives will be part of the multi-agency input,discharge from Midwifery service will occur based on the need of the woman and baby.

In the case of child protection cases, the named Midwife for child protection and the Specialist Nurse Safeguarding Children will be informed of the transfer from the Midwifery service to the Health Visiting service. The midwives will prepare a postnatal summary for the safeguarding team. If the unborn child is on the child protection register, the Social Worker, Health Visitor and Safeguarding team need to be aware that the baby has been delivered and the child protection plan updated.

Implementation and Training

The Information Sharing Pathway will be implemented as part of the rolling workshops for revised and new guideline implementation, which will include training for both Midwifery and Health visiting Staff.

Training for the use of the documentation will be part of all health professional’s induction plan and regular updating in records management and multi-agency working.

Audit

The pathway will be audited through regular Midwifery and Health Visiting records audit in the Women and Children’s Directorate.

Also refer to:

Single Child Health Record Pathway

Health Visiting Operational Policy

Midwifery Operational Policy

All Wales interim policy and procedures, children of parents with mental health problems

Maternal Mental Health Guideline.

Appendix 1

Midwifery referrals to Health Visitors

Appendix 2

Flowchart for Child Protection