Background
While most pregnant women need only be scanned at 12 and 20 weeks gestation, there are several indications for a more robust series of scans: these typically take place at 28, 32, 36 and around 40 weeks gestation.
The dates of these scans are held on the electronic booking system rather than in the body of the patient record - this caused a hindrance to communication between professions, particularly if there was an ad hoc presentation between appointments. It was felt that reviews did not always follow the agreed pattern and "scan on demand" slots were too often used as an alternative to the agreed protocols.
Diagnosis
In essence, the problem was seen to be twofold: adherence to protocol, and communication of the care plan. It was therefore proposed that each indication for serial scans should have a protocol, and that a printed copy of this should be held in the paper record so that it could be accessed by any professional to whom the woman may present. This would be helpful for staff both in clinic and the Daycare Unit where ad hoc presentations are seen, and women would be better enabled to adhere to their treatment plan as a result.
The team realised that the range of protocols could be brought together to create a single Serial Scan Sticker: this has spaces in which to highlight the scans required and the indication risk factors identified. A smaller version of the sticker was also created for the woman's hand-held record, and this then informs the woman, her community midwife, and any other professional involved in ad hoc care.
Outcomes
The sticker has been in place since August 2018 and has proven popular with the staff. Women now have a visible care plan in place which has improved communication across the service: it is clear from picking up any set of notes what the indication is for serial scans and whether the patient is on the correct serial scan pathway.