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A Framework for maternity services in Scotland
Risk assessment and management
 This
section seeks to ensure that risk management strategies and processes are in
place and operational.
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Principle 22
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All health professionals must have a clear understanding of the concept
of risk assessment and management to improve the quality of care and safety
for mothers and babies, while reducing preventable adverse clinical incidents.
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Local Action
- NHS Trusts should make sure that, whenever possible, women referred for
obstetric consultant care are seen by a consultant obstetrician;
- NHS Trusts must make sure that risk assessment and management is carried
out in partnership with the woman, her partner and appropriate professionals
recognising their individual needs. For example, language, translation, braille,
audio and other mechanisms must be in place to make sure the information is
understood;
- NHS Trusts should develop local risk minimisation programmes and make sure
that maternity services demonstrate a risk management culture to include ongoing
peer review;
- NHS Trusts should develop a strategic plan for risk assessment to facilitate
discussion with women about risk to inform their Birth Plan;
- Women, doctors and midwives should consider and discuss all the available
evidence to balance risks and advantages of possible places for the birth
of the baby in different care settings;
- When complications arise in a remote and rural setting, they are more difficult
to manage. NHS Trusts must put in place guidelines to make sure that the decision
on location of delivery is taken in discussion with the woman and her partner,
and on the basis that the safety of mother and baby is paramount;
- NHS Trusts in remote and rural areas must make sure that risk assessment
before, during and after labour is based on the individual woman's obstetric
and medical condition, and takes into account the geographical setting, climate/weather
and available maternity services;
- NHS Trusts should have in place a comprehensive programme of emergency drills
to make sure that systems are robust;
- NHS Boards must make sure that clinicians, service planners and women are
made aware of the geographical context of research and audit data. For example,
information gained from an urban maternity unit may not be readily transferrable
to a remote geographical context;
- NHS Boards must make sure that clinical and non-clinical risk is identified,
evaluated and managed in accordance with the requirements of the Clinical
Negligence and Other Risks Indemnity Scheme (CNORIS);
- NHS Boards must make sure that significant events and issues which are the
subject of complaint or litigation are regularly and systematically investigated
and analysed, leading to changes in practice.
Further Work to be undertaken
- The Scottish Executive Health Department should consider commissioning work
on the accuracy and validity of risk assessment in maternity care. This might
be appropriate for the Royal Colleges, the Clinical Effectiveness Programme
within the Clinical Resource and Audit Group and CNORIS.
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