Quality standard

Quality statement 7: Transfer of information about ongoing management

Quality statement 7: Transfer of information about ongoing management

Quality statement

Women who have had hypertension in pregnancy have a plan for ongoing antihypertensive management included in their postnatal care plan, which is communicated to their GP when they are transferred to community care after the birth.

Rationale

There are particular risks to women who have had hypertension in pregnancy (such as the risk of stroke) in the immediate postnatal period. The development of an individualised care plan for women who have had hypertension in pregnancy before they are transferred to community care should support ongoing antihypertensive management and enable risks to be monitored and addressed, including variations in blood pressure.

Quality measures

Structure

Evidence of local arrangements to communicate a plan for ongoing antihypertensive management for women who had hypertension in pregnancy to their GP when they are transferred to community care after the birth.

Data source: Local data collection.

Process

The proportion of women with hypertension in pregnancy for whom a plan for ongoing antihypertensive management is communicated to their GP when they are transferred to community care after the birth.

Numerator – the number of women in the denominator for whom a plan for ongoing antihypertensive management is communicated to their GP when they are transferred to community care after the birth.

Denominator – the number of women who have given birth who had hypertension in pregnancy.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that local arrangements are in place to communicate a plan for ongoing antihypertensive management to GPs of women who had hypertension in pregnancy when they are transferred to community care after the birth.

Healthcare practitioners communicate a plan for ongoing antihypertensive management to GPs of women who had hypertension in pregnancy when they are transferred to community care after the birth.

Commissioners ensure they commission services that communicate a plan for ongoing antihypertensive management to GPs of women who had hypertension in pregnancy when they are transferred to community care after the birth.

What the quality statement means for patients, service users and carers

Women who had hypertension (high blood pressure) in pregnancy have a plan for continuing management of their blood pressure, which is communicated to their GP when they go home after their baby is born.

Source guidance

Definitions of terms used in this quality statement

A plan for ongoing antihypertensive management should include information about postpartum management, including a plan for ongoing management. NICE clinical guideline 107 recommends that a care plan should be written for women with gestational hypertension or pre-eclampsia who have given birth and are being transferred to community care that includes all of the following:

  • who will provide follow-up care, including medical review if needed

  • frequency of blood pressure monitoring needed

  • thresholds for reducing or stopping treatment

  • indications for referral to primary care for blood pressure review.

The plan for women with pre-eclampsia should also include self-monitoring for symptoms.

Community care Transfer to the care of a community midwife or health visitor.

Hypertension in pregnancy This definition includes chronic hypertension (present at the booking visit or before 20 weeks of pregnancy; this could include pre-existing hypertension), gestational hypertension (new hypertension presenting after 20 weeks without proteinuria) and pre-eclampsia (new hypertension presenting after 20 weeks with significant proteinuria [urinary protein:creatinine ratio greater than 30 mg/mmol or a validated 24‑hour urine collection result greater than 300 mg protein]).