The maternity vital signs chart is part of a comprehensive maternity early warning system that supports a safe environment for women and clinicians. The system includes:

  • a standardised maternity vital signs chart (or electronic equivalent) with an early warning score
  • a localised escalation pathway
  • effective clinical governance and leadership
  • appropriate clinical and non-technical education and training
  • ongoing measurement for improvement
  • an escalation process for clinician, woman, family and whānau concerns. 

The system is designed to identify acute deterioration in women who are admitted to a hospital during pregnancy or within 42 days of birth (not routinely during labour). 

Preparing your DHB for the next step

Now the system has been evaluated and is being nationally rolled out these are some of the things you can do to prepare your maternity service for implementation.  

  • Know your starting point

    Your organisation may already have established some components of the maternity recognition and response system. Document what you currently have and what processes are working well or need improvement.

    Find out what data is currently collected about maternal deterioration, who uses it, where it is reported and what it is used for. This could include data from audits, National Minimum Dataset reports, complaints, adverse event reporting, intensive care, transfers to other hospitals and global trigger tool reviews.

    Here are a few questions you can ask yourself:

    1. Is the data telling you what you need to know about your system from a process, outcome and balancing perspective? For instance, for antenatal and postnatal admissions:
    • what are the rates of rapid response team calls to maternity (per 1,000 admissions)?
    • how often are urgent calls made for severely unwell women and how timely are the responses?
    • what is the rate of unplanned transfers from maternity services to higher levels of care (such as intensive care or another hospital)?
    • is your current escalation pathway used as intended?
    • do you have the right team members responding to escalation?
    1. Are there specific observations in your current system that are frequently not recorded? If so, this could be an opportunity for targeted education. 
    2. Do the recordings (and scoring system if you have one) on your current maternity observation chart ensure care is escalated appropriately for women who are well? If not, how can this be addressed to improve the current process?
  • Consider your clinical governance

    If you already have a maternity early warning system, consider how the current system and audit feeds into the maternity clinical governance; ensure it is a standing item on the agenda.

    You could also take the opportunity to learn from your DHB’s implementation of the adult recognition and response systems as part of the national adult deterioration programme. Find out what stage your DHB is at. Talk to the project team to understand what challenges they faced and what they learnt from preparing and implementing their recognition and response systems. This may be useful when it comes to implementing the maternity early warning system into your maternity service.

    If you need to know who the key contacts are in your DHB please email us at mews@hqsc.govt.nz and we will link you to your DHB’s patient deterioration team.

  • Review your communication processes

    Clinical communication tools assist with clear clinical information-sharing and will be useful when you introduce the maternity early warning system. Find out if there is a clinical communication tool currently used within your maternity service or DHB. If so, is it used effectively? Many DHBs use tools such as ISBAR. You may wish to introduce this if there is no tool already in use. Here is an example of a tool with a maternity scenario: https://www.hqsc.govt.nz/our-programmes/other-topics/publications-and-resources/publication/3487/.

  • Do a stocktake of your existing clinical equipment

    Make sure there are sufficient blood pressure machines, that they are calibrated for maternity (if electronic), and that you have a variety of cuff sizes attached to every machine. Every machine must have a pulse oximeter and all staff must have the same type of thermometer to use. This will reduce time looking for equipment and improve collection of the vital signs.

  • Plan for the switch to the new chart

    Compare the national chart with your local chart and note any differences. If there are parameters on the local chart that are not on the national vital signs chart, consider how these will be recorded and monitored in the future.

    Be careful not to overstock the current charts, because these will need to be replaced with the national vital signs chart if the maternity early warning system is approved for national rollout.

For further information, please contact us at mews@hqsc.govt.nz

Last updated 19/07/2019