Care pathway for postnatal women with hypertensive disorders

This Tairāwhiti postnatal māmā hypertension follow up service provides funding for up to two GP/NP consults per māma for up to 8 weeks post-delivery.

1. National guidelines recommend daily BP recording from hospital discharge up to a week following the birth, then weekly up to the 6th week postnatally when the woman would normally see her GP.
2. Women who fit the criteria for hypertension will be reviewed by an O&G postnatally.
3. An adequate and complete postpartum inpatient management plan will be written in the woman’s MCIS records by the O&G.
4. Once the woman has birthed and settled into a postnatal room she will be provided with a self-monitoring BP machine and record card and taught how to use these.
5. She will be required to sign an agreement for being responsible for the BP machine and the arrangement for and/or its safe return to maternity at 5weeks postnatally. This date will be written on her BP recording card. See appendices 1 for agreement and 2 for card and 3 for loan agreement record.
6. The BP recording card will be used to record her morning BP recording on the day of discharge. This will demonstrate the woman is able to take this recording so she and we know she is confident and capable of using this piece of equipment correctly and recording it on the card daily as expected once discharged home. (Do not use another hospital BP machine to compare any recordings as this will not be an option once she goes home).
7. The woman and her LMC are to be involved in the discharge planning discussion, so that the woman knows which days her LMC/LMC team member will be visiting.
8. Prior to discharge home the O&G will record a postnatal management plan for use at home. This will be recorded in the medical discharge letter which can be found in the events tab of the appropriate admission. This in turn populates the discharge summary which will be printed along with the labour and birth summaries on the day of discharge. Three copies are required as one is for the LMC, one for the woman and a copy left in her file which will be sent to the GP.
9. On discharge the core midwife/nurse will enter the woman’s details in the maty schedule on the days she is to text/phone in with her BP recording for the initial 2 weeks post birth and record in the woman’s card. This will enable the shift co-ordinator to ensure this information is received and follow up if text/call not received. Also enter BP machine details in loan book.
10. All discharge summaries will be sent to the GPs daily Mon to Friday subject to public holidays by the receptionist.
11. The woman will use her BP card to record her BP on the day of discharge and then continue recording her BP as instructed at home. The card contains the hospital mobile number to text/telephone daily with this information.
12. BP recordings are to be recorded at 10am daily then weekly.
13. The LMC will record the BP on this same card when visiting the woman postnatally.
14. If the LMC has concerns about the woman’s BP during a visit within the first two weeks postnatally she can consult with the on call O&G directly, if after two weeks then this would be the GP.
15. If the woman has concerns about her BP on a day the LMC is not visiting she will know to call the hospital number she has been given or the GP if after first two weeks and be able to share her BP history, the GP should have received the medical discharge information.
16. The date 2wks from the birth will be recorded on the card, so the woman knows to contact the GP and not the hospital from then on if she has any further concerns regarding her BP as the GP will then be responsible for her on going care.
17. The woman will be adviced to make a double appointment for herself and baby to see the GP at 6 weeks and to take her BP card with her.
18. When a BP machine is returned, please clean this down using a clinell wipe, ensure it still works correctly. Then store back in CMMs office with loan book completed recording the return of this machine.