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August 2022 Update

What could you learn from self assessment?

Kate Mulley, Director of Research, Education and Policy at Sands

As the NHS begins to restart planned improvement work whilst continuing to experience constraints, the National Bereavement Care Pathway Self Assessment Tools will help you identify the right starting point for improving your bereavement care.

Download any of our 8 self assessment tools to check how much has already been achieved in your unit or service and where to focus your improvement efforts. You might want to do this as an individual or with a group of staff. Our early adopter project leads found that reaching out to groups of staff provided a more detailed and accurate picture.

Looking back at the self assessments carried out by our NBCP early adopters suggests that reviewing bereavement care for miscarriage, ectopic and molar pregnancy loss could be an important place to start.

In 8 units and services across 6 very different hospitals, the project leads found that the most consistently good care was when staff are supporting parents with Marking loss and making memories. The poorest care - where 6 or more units and services report that they are not always providing good care was for the steps taken after diagnosis of a suspected issue - see Next steps after diagnosis. Staff said they did not consistently

  • Aim for continuity of carer where possible.
  • Advise the woman sensitively that she may miscarry while on the toilet and offering information regarding what to expect.
  • Provide a named person to contact if
    • the woman changes her mind about her care or has any questions about labour and delivery in 2nd trimester loss
    • the woman and partner want to ask questions or seek advice in an ectopic loss.

    Our early adopters’ self assessments highlight some marked disparities in care after diagnosis of a suspected issue which suggest improvements could be made by sharing good practice across Scotland. 4 units and services reported that they are providing good care in the following areas but 4 said they did not do so consistently.

    • When an issue is identified or confirmed by an ultrasound scan, ask the woman and partner if they want to be shown what is seen on the screen, and if the woman would like to get dressed and sit up and if they would like to see the screen while the findings are explained – see When a pregnancy issue is suspected.
    • Transfer a woman as soon as possible after diagnosis from A&E to an appropriate unit or ward or offer support to go home.
    • Offer to tell the woman and partner what they might expect the remains of their baby or pregnancy to look like, depending on the gestation and the type of management used in an ectopic loss.

    Lastly, most units and services reported that they are not always providing good bereavement care when women and partners are seen for antenatal care in the next pregnancies after miscarriage, ectopic or molar pregnancy loss. This includes being aware of the need some women will have for emotional support and potential referral to mental health services as well as offering to provide a certificate of the previous loss – see Next pregnancies.

    How will NBCP support you with self assessment?

    You can register interest in self assessment if you are using any of our tools. We will tell you about online events later this year with NHS colleagues from across Scotland. If you choose to, we will also let you know when other staff from your Board register (unless they don't want us to).

    The NBCP partner charities and professional organisations appreciate the commitment of NHS staff working together with us on this journey to increase the quality of bereavement care and reduce local and national inconsistencies so all bereaved women, partners and families in Scotland receive compassionate, person centred care.

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