Audit

Access Agreement

As self employed midwives we often have an access agreement with the local hospital. This means that we have access to the hospital to take our women there and use the birthing facilities. In our area I and the other self employed midwives I work alongside have worked in the unit and so we are familiar with its workings and routines. When we sign the agreement it stipulates our responsibility and outlines the units responsibilities to us as practioners. One element of this agreement for us is that we will attend the monthly audit meeting.

Who is there?

At our meeting there is all the obstetricians, the unit manager, as many caseloading midwives as possible, the paediatric team and representatives of the hospital management team.

What is the purpose?

The purpose of the meeting is to look over 3 cases which fit a certain criteria, the unit manager has the list of the criteria and so I have no knowledge of it. I know that a case will be choosen, for instance, where the baby has been born with low apgars. The purpose is to identify if any aspect of care needs to be improved upon.
The case is presented to the meeting. The presentation of the case used to be done by the midwife who was incharge of the case, I still prefer to do it, but recently one of the obstetricians have been presenting.

The meetings effects

As a midwife when you are told one of your cases is going to be put into the audit meeting there can be an unnecessary level of anxiety experienced. It is not pleasurable feeling like you are about to be attacked on all fronts and it is always great to look at something with the benefit of hindsight and especially when others may say they would have done something different. I have seen a number of midwives go to pieces during this process and feel swamped.

How I always approach audit.

If I ever have a case which has been choosen to be discussed I always make sure I have read the notes and familiar with the case enough to present the facts with out having to fumble through pages and pages of documentation. I also research the facts behind the case and go into audit armed with text books or National Institute of Clinical Excellence guidelines or examples of research which support the care given. If I have to I will take my laptop with me so that I have every means of reference possible and because it gives me instant access to the internet.
This means that I only make clinical arguments and I refuse to get flustered.
So my advice to anyone who has to be involved with these things prepare, prepare, prepare.