Transcript LAMS Opens new window - North Lanarkshire Council

LANARKSHIRE’S ADDITIONAL
MIDWIFERY SERVICE
(LAMS)
Context
Implementation of LAMS ‘one-stop-shop’
clinics throughout North Lanarkshire to
improve pregnant women, with a history of
substance misuse, engagement for antenatal
care to improve:
 stability of substance used
 outcomes on 1) pregnancy
2) newborns wellbeing
3) service provision requirements.
Improvements 1 - LAMS
 Improve pregnant women (with a history of substance
misuse) in North Lanarkshire’s engagement for
antenatal care to improve stability of substance of
choice:
1. Implementation of ‘Pathway of care’ all localities
2. All women with a history of drug or alcohol use signposted
for assessment & all care at LAMS clinics if applicable
3. Trained ‘Link’ community midwife to share care of clients
at LAMS.
4. Addiction staff educated on ‘pathway of care’ &
responsibilities
5. Multi-agency team approach of care.
Improvement 2 – ABI Screening
 To accurately screen all pregnant women on their
present and pre-pregnant alcohol consumption to
identify where an alcohol brief intervention should
be delivered and assist on future diagnosis of infants
affected by Fetal alcohol Spectrum disorder (FASD).
 collation number of women consuming alcohol in
the 3 months prior to booking, identifying possible
risk of alcohol damage 1st trimester pregnancy.
Improvements 3 - MYRAP
 To evaluate the impact of the use of
psycho-social interventions (via use of
MYRAP diary) has on reduction/
abstinence of substances where clients
are not open to or engaging with
addiction staff but are attending LAMS
clinics.
Who is involved?
 Pregnant women with a history of drug or
alcohol misuse
 Specialist Midwife substance misuse
 Seconded substance misuse midwife (EYC)
 ‘Link’ LAMS community midwife
 Community midwives.
 Integrated addiction nurse/worker
 Seconded admin support (EYC)
Data! LAMS - referrals (1)
REFERALS TO LAMS
There have been 65 clients referred between April – Dec
2014’. 46 engaged assessment with 40 receiving all
care LAMS.
71% Assessed LAMS
17% declined service
11% miscarriage
1% Unknown
87% of clients assessed received
all care LAMS
Data! LAMS - engagement (2)
 Impact implementation of LAMS clinics has had on
engagement PDSA CYCLE Bellshill clinic:
120
Seconded midwife
commenced
100
shared care with link
midwife
Percentage
80
60
link midwife trained
40
20
all clients through
LAMS pathway
nov
oct
sept
aug
july
june
may
april
march
feb
jan
0
Data! LAMS- engagement (3)
Data! LAMS- Stability (4)
 Of the 46 clients who attended LAMS clinics for assessment the following
graph shows the trend of substances used in North Lanarkshire:
Stability substance use 3mths prior to LAMS
assessment
Stability substance use after 6mths LAMS support
Data!- ABI Screening
 The following PDSA looked at accuracy of recording screening of
alcohol use of pregnant women at booking. Particular focus on No.
who advice no alcohol use prior to pregnancy.
Prior to 1st test of change.
Audit 2nd test of change.
Audit 1st test of change.
Data!- MyRap case study
 Ms A –P1 14wks pregnant
 Ref to LAMS assessed 14wks
 History – Anxiety disorder & depression
Using large amounts Cannabis treat MH
Meds stopped by GP pregnancy
External social pressures
 Commenced MyRap 16wks
 Seen fortnightly
 Identified impact drug has on various aspects life
 Motivation & confidence increased
 Identified triggers use – work on relapse prevention.
Next Steps
 LAMS clinics:
 Continue to record engagement at LAMS clinics.
 Breakdown of the non-attendance by categories: rescheduled, 1st appointment or no contact made
(identify areas to work on).
 The impact attendance has on the stabilising of their substance use will continue.
 A focus on clients with ongoing illicit use to identify risk factors having an impact on ability to
abstain.
 Audit of LAMS input on 1) Pregnancy outcome (Gest / mode & type of delivery).
2) Newborns outcomes (weight, FASD/NAS, treatment & NNU admission).
3) Service requirements.
Alcohol screening and recording :
Ongoing audit of midwives recording within notes & changes to PDSA as required.
Recording date of last alcohol use to assist in identifying alcohol use in 1st trimester of pregnancy.
MYRAP:
Currently tested with one client linked to use of cannabis. For review on both stability and
pregnancy outcomes.
The test of change will be repeated with clients with different substance use & social factors.
**Commenced Jan 15’, the specialist midwife will plan and introduce a PDSA to look at client’s
experience of attending LAMS and will implement scope for client’s vision of a service to
accommodate their needs.
Next Steps…. Future thoughts??

 Impact LAMS support has on the client and her partners knowledge of the impact
drug &/or alcohol use has on her pregnancy, newborn and parenting capacity.
 Support from smoking cessation to assist LAMS clients on abstaining from
tobacco.
 Impact use of SOLIHUL has on clients attending LAMS antenatal on their capacity
to safely care for their child where previous social work involvement has been
required.
 The effect one-to-one breast feeding workshop has on women, who are on
substitute prescribing, choosing to breast feed at birth, discharge from hospital
and 6 weeks postnatal.
 The impact new perinatal mental health centre (PMHS) has on women attending
LAMS where significant mental health issues are identified.
 Impact discussion of planned long term contraceptive device has during
pregnancy at LAMS has on uptake of same following birth. Looking at methods
used, numbers inserted prior to discharge from hospital and subsequent numbers
of unplanned pregnancies with known drug or alcohol use.
“So What?”
 Increase engagement for easily
accessible specialised antenatal care.
 Increase knowledge on the effects of
substances on pregnancy and
newborn.
 Increase stability and/or reduction of
drug use & identification and
treatment of Neonatal Abstinence
Syndrome.
 Early identification of needs, multi
agency support and sharing of
information with holistic family
centred care provision.
 Improved parenting capacity by
providing early specialised antenatal
parenting programmes, knowledge
and understanding of bonding and
attachment and the effects substance
misuse may have on parenting ability.
 Increase breastfeeding rates within
this client group.
 Increase accuracy of ABI screening and
recording resulting in improved
identification of potential FASD.
 Reduction in families affected by
domestic abuse and gender based
violence.
 Increased understanding, early
identification and appropriate support
for women and families at risk of
mental health issues.
 Increased use of long term
contraceptive devices to reduce
unplanned pregnancies.
 Reduce maternal and infant mortality
and social gradient.
 Improve maternal and infant mental,
physical, social wellbeing and reduced
social gradient, better housing and
employment opportunities.
 Provide person centred, safe and
effective care to all women and
families
Investment of Resources
 What has been invested into this improvement work?
The Specialist Midwife is currently funded through ADP & works with the
existing community midwifery & addiction staff. Funding secured the
secondment of a ‘substance use midwife- full time band 6’(incl training &
equipment) which has allowed rollout of LAMS clinics & ability to collate
data. In addition admin support of 6hrs week has aided data collation.
What resources would you hope to reduce/stop in the future by
implementing this change?
The embedding of LAMS throughout Nth Lanarkshire has been successful in
identifying the growing demands of specialist care for this vulnerable client
groups. The need for ongoing secondment of substance use midwife is
evident and would allow a vast amount of future tests/ data collation to be
carried out.
For More Information
 Insert Contact Details:
Lorraine Farrow
Specialist Midwife for Substance Misuse
Bellshill IAS
95 Main Street
Bellshill
Tel: 01698 403798
Mob: 07827983933
[email protected]