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Antenatal Care City and
Hackney Template Guide
2016/17
2
Template Control Page Antenatal Care City and Hackney Template Guide
Title Antenatal Care City and Hackney CEG
Author CEG
Version 9
Description This template supports City and Hackney Early Years Service(vr8)
Date December 2016
DOCUMENT MANAGEMENT REVISION HISTORY
Version Date Summary of Changes
1.0 October 2012 The version number starts at 1.0 to reflect rationalisation process.
1.1 16 Oct 2012 Information box corrected to show target group is 28 to 38 weeks.
1.2 April 2013 Added gravida codes and last entry of gestational diabetes.
1.3 Nov 2013 Replaced EDD diary entries with EDD read codes (to support better data collection for pertussis campaign)
1.4 June 2014 Added first presentation page, smoking page, alcohol page and immunisation page. Added Subsequent exams page for any exams done after the 16 week exam. Modified Rhesus Blood grouping picking list, Added Anti D globulin needed prompt (8B81). Added gestational calculator web link. Added A/N care social risks, A/N care Obstetric risks, Parity and Mat B1 signed, modified Pertussis information and added Diary entry for Pertussis. Removed Folic Acid Advice in 1st trimester (67AE), Vitamin D Supplements (8B73) due to Healthy Start.
Vr1 July 2014 Added to Emis Template Library so version numbering reset. Added Enhanced Service checks.
Vr 2 May 2015
Vr 3 August 2015 Replaced Pertussis codes with: 6556. Pertussis vaccination in pregnancy 65560 Pertussis vaccination in pregnancy given by other healthcare provider 8IEc. Pertussis vaccination in pregnancy declined 68NQ0 Pertussis vaccination in pregnancy contraindicated Removed Last entry of Flu jab, old code no longer used (65ED)
3
Vr4 September 2015
Added codes for the referral form. Added Last Haemoglobin value. Created a separate page for Subsequent Appointments. Added the FGM page. Added Gravida codes (after parity): Gravida 1 (1532), Gravida 2 (1533), Gravida 3 (1534) Gravida 4 (1535), Gravida 5 (1536), Gravida 6 (1537), Gravida 7 (1538),
Gravida 8 (1539), Gravida 9 (153A), Gravida 10 (153B), Gravida more than
10 (153C. Modified the ES Check information box to indicate that the Obstetric and social risks are to be done in the 4 months prior to the 16 week exam
Vr5 Nov 2015 Reinstated Boostrix code so that the woman’s Immunisation history is complete. Replaced corresponding Diary entries. Added note indicating the payment code. Added Edinburg Depression Scale page
Vr6 April 2016 Update of Information for Pertussis programme (from NHS Employer)
Vr7 June 2016 Amendments: 1st presentation page made into library item
Additions:
Section headers: Obsetric History; Examination, Antenatal Advice, Consider aspirin and iron supplements, depression
screening **A/N booking apt; A/N obstetric risks/AN Social
risks; refer to antenatal clinic for 1st presentation Prompts:
Gravida NOS (153Z)
Info on Family Nurse Partnership Referral to family nurse partnership Depression screening info Depression screening prompt Edinburgh depression scale MSU sent to lab (4615) Healthy start info to 16 week check Retired: ES Page until further confirmation
Vr8 December 2016 Added Enhanced service label ** to Social Risk assessment for 16th week exam. Updated risk assessment information to indicate that risk exams must be redone at 16 week exam.
V9 Removed referral to antenatal clinic from 16 week exam. Modified Pertussis Vaccination info. Added Flu info. Blood Test Results page added. Added UPP, Child Health Check and 16th Birthday check pages. Added web link for Healthy Start.
AUTHORISATION
Reviewed by Approved by Date Date sent to EMIS
Luis Rivas Dr Kirsten Brown
December 2015
Jo Tissier Kirsten Brown June 2016
December 20016
Library Items, and concepts used by this template
4
Library Items
Antenatal -1st presentation City and Hackney CEG
Lifestyle Intervention CEG 1.0
Female Genital Mutilation (FGM)
Edinburgh Depression Scale CEG
Ethnicity CEG 1.0
5
Prompt Code What does this prompt mean EMIS WEB Consult. Section
1st Presentation
Info CH Payment Indicator: Extended (i.e20mins) GP consultation at pregnancy presentation
**A/N booking examination
62N1 Tick box Text box: 1st Presentation Appt at practice
Info LMP and EDD must be entered. Also record patient pregnant if not recorded.
Patient currently pregnant
621 Tick box History
Last menstrual period -1st day
1513 Tick box Date prompt
History
Gestational calculator - http://www.patient.co.uk/doctor/Obstetric-Calculator.htm
Estimated date of delivery from last period
15140 Tick box Date prompt Text box: Enter number of weeks
History
Length of Gestation 62X Tick box Enter number of weeks
History
Risk Assessment Info
Info Conduct a risk assessment to ensure all social and medical issues are discussed with the pregnant woman
**A/N care obstetric risks
A/N care: H/O poor obstetric history (6236) A/N Care: No obstetric risk factors identified (EMISNQAN31) Text box for details
History
**A/N care social risks
A/N care: social risk NOS (625Z) A/N Care: No social risk factors identified (EMISNQAN30) Text box for details
History
Parity Nulliparous (1521) Para 1 (1522) Para 2 (1523) Para 3 (1524) Para 4 (1525) Para 5 (1526) Para 6 (1527) Para 7 (1528)
History
Antenatal Care City and Hackney Template Guide
6
Gravida Gravida 1 (1532) Gravida 2 (1533) Gravida 3 (1534) Gravida 4 (1535) Gravida 5 (1536) Gravida 6 (1537) Gravida 7 (1538) Gravida 8 (1539)
History
Gravida 9 (153A) Gravida 10 (153B) Gravida more than 10 (153C) Gravida NOS (153Z)
Obstetric History
H/O Obstetric problem
H/O: Eclampsia (15A3) H/O: Pre-Eclampsia (15AB) H/O: Caesarean Section (15A2) H/O: Perinatal Fetal Loss (15A8) H/O: Manual Removal of Placenta (15A5) H/O: Previous Forceps Delivery (15AA) H/O: Obstetric Problems NOS (15AZ) Select more than one Text Line: Give detail
Examination
BP 246 Value Examination
O/E – height 229 Tick box Examination
O/E - weight 22A Tick box Examination
BMI 22K BMI Widget, click to obtain BMI score Assessment
Info Use Lifestyle Intervention Page to record smoking, alcohol, exercise and diet advice
Family Nurse Partnership Visibility rule: Age less than 20 CEG
Info Family Nurse Partnership is a support programme for first time young mothers (and fathers) aged 19 or under. Find referral form in documents tab.
**Referral to family nurse partnership
8T0a Tick box
Info AND refer to antenatal clinic
Referral to Antenatal Clinic
**Referral to antenatal clinic
8HT9 Tick box
Antenatal Advice
Pregnancy 67A Tick box Additional
7
advice
Info Every expectant mother is entitled to free Healthy Start vitamins from her booking visit until her child reaches 1 year. Women who receive benefits may also be entitled to vouchers for fruit, vegetables and milk. For more information see Healthy Start leaflets
Healthy Start guidance
Hyperlink http://www.blizard.qmul.ac.uk/~ceg01?opt=general&alias=ch-guidance-for-health-and-care-professionals
Healthy Start Program
6B7 Tick box Additional
Advice about Antenatal screening
EMISNQ AD49
Tick box
Additional
Click here for diet and lifestyle advice during pregnancy leaflet
http://www.patient.co.uk/health/diet-and-lifestyleduring-pregnancy
Click here for pregnancy screening tests
http://www.patient.co.uk/health/pregnancy-screeningtests
Folic Acid and Aspirin Advice
Info Folic acid 400mcg or folic acid 5mg if diabetic, BMI>30, on anti-epileptic medication, history or family history of neural tube defects. Check that aspirin has been prescribed to high risk women.
Click here for Folic Acid Advice and Vitamin D Advice
Hyperlink http://blizard.qmul.ac.uk/~ceg01?opt=Antenatal&alias= folic-acid-and-vitamin-d-guidelines-may-2016
Click here for aspirin advice
Hyperlink http://blizard.qmul.ac.uk/~ceg01?opt=Antenatal&alias= aspirin-in-pregnancy
Info Use medication module to code medication review done.
Depression Screening
Info During the past month have you often been bothered by:
1. Little interest or pleasure in doing things?
2. Feeling down, depressed or hopeless?
3. Is this something you would like help with?
8
Depression screening using questions
6896 Tick box Additional
Info Use Edinburgh Page to assess depression
Diary Dates
Info Use Immunisations Page to record diary entry for Pertussis vaccine
A/N 16 week examination due
62N3 Diary entry Additional
**16 week examination Page
**16 week examination **indicates locality payment
Info CH Payment Indicator: Extended consultation to women for the 16 week antenatal review.
**AN 16 week exam
62N3 Tick box Tool tip: CH Payment Indicator: Extended (i.e20mins) GP consultation at 16 weeks
Examination
Estimated date of delivery from scan
15141 Tick box Date prompt
History
Gestational calculator - http://www.patient.co.uk/doctor/Obstetric-Calculator.htm
Length of Gestation 62X Tick box Text: Enter number of weeks
History
Risk Assessment Info
Info Conduct a risk assessment to ensure all social and medical issues are discussed with the pregnant woman, if not already done. This is additional to the risk assessments done at presentation.
Recheck social risk and consider if any further action needs to be taken (including safeguarding issues)
**A/N care obstetric risks
A/N care: H/O poor obstetric history (6236) A/N Care: No obstetric risk factors identified (EMISNQAN31) Text box
History
**A/N care social risks
A/N care: social risk NOS (625Z) A/N Care: No social risk factors identified (EMISNQAN30) Text box
History
**Discussed Screening results.
41C3 Text box Additional
Examination
9
**Blood Pressure
246 Value Examination
Urine Protein Test
Urine protein test not done (4671) Urine protein test negative(4672) Urine protein test = trace(4673) Urine protein test = +(4674) Urine protein test = ++(4675) Urine protein test = +++(4676) Urine protein test = ++++(4677)
Result
Urine test for glucose
Urine glucose test not done (4661) Urine glucose test negative (4662) Urine glucose test = trace (4663) Urine glucose test = + (4664) Urine glucose test = ++ (4665) Urine glucose test = +++ (4666) Urine glucose test = ++++ (4667)
Result
MSU sent to lab
4615 Tick box Test result
Info Use Lifestyle Intervention Page to record smoking, alcohol, exercise and diet advice
Antenatal Advice
Pregnancy advice
67A Tick box
Click here for diet and lifestyle during pregnancy leaflet
http://www.patient.co.uk/health/diet-and-lifestyleduring-pregnancy
Info Every expectant mother is entitled to free Healthy Start vitamins from her booking visit until her child reaches 1 year. Women who receive benefits may also be entitled to vouchers for fruit, vegetables and milk. For more information see Healthy Start leaflets
Healthy Start guidance
Hyperlink http://www.blizard.qmul.ac.uk/~ceg01?opt=general&alias=ch-guidance-for-health-and-care-professionals
Healthy start programme
6B7 Tick box
Aspirin and Iron advice
Info Check that aspirin has been prescribed to high risk women
Click here for aspirin advice
http://blizard.qmul.ac.uk/~ceg01?opt=Antenatal&alias= aspirin-in-pregnancy
Info Investigate a haemoglobin level of less than 11g/dL and consider iron supplementation if indicated
Haemoglobin 423 Last entry of code Include child codes
Info Give information on anomaly scan
10
Info Use medication module to code medication review done
Family Nurse Partnership Visibility rule: Age less than 20 CEG
Family Nurse Partnership is a support programme for first time young mothers (and fathers) aged 19 or under. If not already referred find referral form in documents tab.
Referral to Family Nurse Partnership team
8T0a Tick box
Info OR refer to antenatal clinic
Depression Screening
Info During the past month have you often been bothered by:
4. Little interest or pleasure in doing things?
5. Feeling down, depressed or hopeless?
6. Is this something you would like help with?
Depression screening using questions
3896 Tick box
Info Use Edinburgh Page to assess depression
Diary Dates
Info Use Immunisations Page to record flu and pertussis vaccine
F/up antenatal examination due
62N Diary entry
Subsequent Appointments Page
Subsequent appointments
Antenatal examination
62N Tick box Examination
Estimated date of delivery from scan
15141 Tick box Date prompt
History
Gestational calculator - http://www.patient.co.uk/doctor/Obstetric-Calculator.htm
Length of Gestation 62X Tick box History Enter number of weeks
Examination
O/E BP 246 Value Examination
11
Urine Protein Test Urine protein test not done (4671) Urine protein test negative(4672) Urine protein test = trace(4673) Urine protein test = +(4674) Urine protein test = ++(4675) Urine protein test = +++(4676)
Result
Urine protein test = ++++(4677)
Urine test for glucose
Urine glucose test not done (4661) Urine glucose test negative (4662) Urine glucose test = trace (4663) Urine glucose test = + (4664) Urine glucose test = ++ (4665) Urine glucose test = +++ (4666) Urine glucose test = ++++ (4667)
Result
MSU sent to lab
4615 Tick box Test Request
Info Use Lifestyle Intervention Page to record smoking, alcohol, exercise and diet advice
Fetal Presentation
O/E - fetal movements
O/E - no fetal movements (2751) O/E - fetal movements seen (2752) O/E - fetal movements felt (2753) O/E - fetus very active (2754) O/E - fetal movemnt.diminished (2755) O/E - fetal movements NOS (275Z)
Examination
O/E - Fetal Heart Heard
O/E - fetal heart not heard (2761) O/E - fetal heart 80-100 (2764) O/E - fetal heart 100-120 (2765) O/E - fetal heart 120-160 (2766) O/E - fetal heart 160-180 (2767) O/E - fetal heart 180-200 (2768)
Examination
Fundal height 27D Tick box Examination
Info Fetal presentation to be checked from 36 weeks gestation
O/E - Fetal Presentation
O/E - vertex presentation (2721) O/E - breech presentation (2722) O/E - oblique lie (2723) O/E - transverse lie (2724) O/E - multiple presentation (2725) O/E -fetal presentation unsure (2726) O/E - fetal presentation NOS (272Z)
Examination
O/E - presenting part station
O/E - presenting part free-5/5 (2741) O/E - presenting part free-4/5 (2742) O/E - partial engagement - 3/5 (2743) O/E - partial engagement - 2/5 (2744) O/E - presentation engaged-1/5 (2745) O/E - fetal station NOS (274Z)
Examination
Antenatal Advice
Pregnancy advice
67A Tick box
12
Click here for diet and lifestyle during pregnancy leaflet
http://www.patient.co.uk/health/diet-and-lifestyleduring-pregnancy
Info Every expectant mother is entitled to free Healthy Start vitamins from her booking visit until her child reaches 1 year. Women who receive benefits may also be entitled to vouchers for fruit, vegetables and milk. For more information see Healthy Start leaflets
Healthy Start guidance
Hyperlink http://www.blizard.qmul.ac.uk/~ceg01?opt=general&alias=ch-guidance-for-health-and-care-professionals
Healthy start programme
6B7 Tick box
Additional
Anti D globulin needed
8B81 Tick box Text box Result
Place of delivery booked
Home delivery (62B2) Consultant unit (62B4) Midwife unit (62B8) No place booked (62B1)
Additional
Mat B1 signed
9542 Tick box Additional
Breastfeeding Education
8C1H Tick box Additional
Antenatal Education
679E Tick box Additional
Depression Screening
Info During the past month have you often been bothered by:
7. Little interest or pleasure in doing things?
8. Feeling down, depressed or hopeless?
9. Is this something you would like help with?
Depression screening using questions
3896 Tick box
Edinburgh postnatal depression scale
3885 Assessment
Diary Dates
F/up antenatal examinations
62N Diary Entry
Blood Test Results Page
13
Haemoglobin Estimation 423 Value Date prompt
Result
Serum Ferritin 42R4 Value Result
ABO Blood Group Blood Group A (4312) Blood Group B (4313) Blood Group AB (4314) Blood group O (4315) Date prompt
Result
Rhesus Blood Grouping Rhesus negative (4321) Rhesus positive (4322) Rhesus blood group phenotyping (4324) Rhesus and Kell blood group phenotyping (4325)
Result
Rhesus Antibody Rhesus antibody absent(4361) Rhesus antibody present (4362) Date prompt
Result
Hep B Antigen SH Antigen negative (43B3) Hepatitis B surface antig +ve (43B4) Date prompt
Result
HIV Status HIV negative (43C2) HIV positive (43C3) Date prompt
Result
Syphilis Syphilis titre test negative (4381) Syphilis titre test positive (4382) Date prompt
Result
HbA1c (IFCC) 42W5 Value Result
Glucose Level Plasma glucose level (44g) Serum glucose level (44f) Date
prompt
Result
Glucometer Blood Sugar 44T9 Tick box Result
Glucose Tolerance Test Glucose tolerance test normal (44V1) Glucose tolerance test impaired (44V2) Glucose tolerance test diabetic (44V3)
Result
Immunisations Page
Administration
Influenza vaccination invitation letter sent
9OX6 Tick box Additional
14
Influenza vaccination telephone invite
9OX7 Tick box Additional
Seasonal Influenza
Info Flu vaccination to be given at any time during pregnancy
*Seasonal Influenza vaccination
65ED Tick box Procedure
* Seasonal Influenza vaccination by other healthcare provider
Seasonal Influenza vaccination by other healthcare provider (65E20) Seasonal Influenza vaccination by pharmacist (65ED0) Text box
Procedure
Flu Vaccine Exceptions
Seasonal influenza vaccination declined (9OX51) Seasonal influenza vaccination contraindicated (8I2F0) Seasonal influenza vaccination not indicated (8I6D0) H/O: influenza vaccine allergy (14LJ)
Additional
Seasonal influenza vac due
65ED Diary Entry Date prompt
Pertussis
Info Pertussis vaccine as part of Booxtrix-IPV should be offered to all pregnant women, including those immunised in childhood, as early as possible, after 16 weeks gestation and by week 40 of pregnancy. It can be offered at the same time as the flu vaccine, but in a different site. Vaccination against influenza should not be delayed to be given alongside pertussis vaccine. There’s a New Homerton Antenatal Vaccination Service, they will notify practices of patients who do not get vaccinated or decline at their anomaly scan. Vaccination may also be offered beyond week 38 40, including new mothers who have missed the opportunity to be vaccinated during pregnancy and who have not previously been vaccinated to provide protection against pertussis, up to when their child receives their first vaccination.
Low dose diphth, tet, acellular pert and inactiv polio vacc
65I8 Diary entry: pertussis Date Prompt
Low dose diphth, tet, acellular pert and inactiv polio vacc
65I8 Tick box and enter vaccine details Procedure
Info Box For payment purposes also tick Pertussis vaccination in pregnancy
15
**Pertussis vaccination in pregnancy
6556 Tick box Procedure
Pertussis vaccination given in pregnancy by other HCP
65560 Tick box Procedure
Declined/contraind icated
8IEc. Pertussis vaccination in pregnancy declined 68NQ0 Pertussis vaccination in pregnancy contraindicated
Additional
Edinburg Depression Scale Page (Library Item)
Edinburg Scale Instructions
Ask the patient how they have felt in the PAST 7 DAYS Questions are scored differently as follows: QUESTIONS 1, 2, & 4 Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3 QUESTIONS 3, 5-10 Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0 Press 'Calculate' button to record their score (each question must be answered)
EPND score question 1
EMISHG T021
Q1. I have been able to laugh and see the funny side of things Enter Score: 0 - As much as I always could 1 - Not quite so much now 2 - Definitely not so much now 3 - Not at all
EPND score question 2 - enjoyment
EMISHG T022
Q2. I have looked forward with enjoyment to things Enter score: 0 - As much as I ever did 1 - rather less than I used to 2 - Definitely less than I used to 3 - Hardly at all
EPNDS question 3 - blame
EMISHG T023
Q3. I have blamed myself unnecessarily when things went wrong Enter score: 3 - Yes, most of the time 2 - Yes, some of the time 1 - Not very often 0 - No, never
EPNDS question 4 - anxiety
EMISHG T024
Q4. I have been anxious or worried for no good reason Enter score: 0 - No, not at all 1 - Hardly ever 2 - Yes, sometimes 3 - Yes, very often
EPNDS question 5 - panic
EMISHG T025
Q5. I have felt scared or panicky for no very good reason Enter score: 3 - Yes, quite a lot 2 - Yes, sometimes 1 - No, not much 0 - No, not at all
16
EPNDS question 6 - overcome
EMISHG T026
Q6. Things have been getting on top of me Enter score: 3 - Yes, most of the time I haven't been able to cope at all 2 - Yes, sometimes I haven't been coping as well as usual 1 - No, most of the time I have coped quite well 0 - No, I have been coping as well as ever
EPNDS question 7 EMISHG T027
Q7. I have been so unhappy that I've had difficulty sleeping Enter score: 3 - Yes, most of the time 2 - Yes, sometimes 1 - Not very often 0 - No, not at all
EPNDS question 8 - sadness
EMISHG T028
Q8. I have felt sad or miserable Enter score: 3 - Yes, most of the time 2 - Yes, quite often 1 - Not very often 0 - No, not at all
EPNDS question 9 - crying
EMISHG T029
Q9. I have been so unhappy that I have been crying Enter score: 3 - Yes, most of the time 2 - Yes, quite often 1 - Only occasionally 0 - No, never
EPNDS question 10 - selfharm
EMISHG T030
Q10. The thought of harming myself has occurred to me Enter score: 3 - Yes, quite often 2 - Sometimes 1 - Hardly ever 0 - Never
Score EMIS Customs Calculati on
Add up scores of each of the above questions: Score = q1+q2+q3blame+q4anxiety+q5panic+q6overcome+q7sleep+ q8Sadness+q9crying+q10selfharm
Interpretation Maximum score is 30 Possible Depression is 10 or greater Note: Always look at item 10