What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Ensuring that women are prescribed medicines that would not cause harm to a child before birth is a challenge. We need to change mindset so that childbearing potential / pregnancy is considered when prescribing. The Cumberledge report[1] identified many children who were affected because of exposure to sodium valproate before birth. Sodium valproate is now contraindicated in women and girls of childbearing potential unless the conditions of the pregnancy prevention programme are met and other treatments are ineffective or not tolerated. A recent knowledge exchange event demonstrated the passion from experts by experience to continue this important work.

Considering possible pregnancy in mind in all patients requires planning ahead.  With this funding we will support a reduction in delays in this cohort of patients receiving appropriate treatment during pregnancy and a reduction in harm caused by inappropriate medicines use before birth.

[1] First Do No Harm (immdsreview.org.uk)

What does your project aim to achieve?

We will reduce delays to receiving appropriate medication during pregnancy ensuring medication is safe for the patient and the unborn child. The MHRA have issued alerts showing more evidence of medicines causing harm before birth and we want to implement a more proactive approach when prescribing any medicines for women and people with potential for future pregnancy. This includes:

• Prescribing monotherapy for conditions such as epilepsy where appropriate
• Appropriate contraception is prescribed where indicated
• Considering vitamins needed for a healthy pregnancy
• Promoting a culture of informed decision making for patients
• Providing inclusive education so that patients know to inform the prescriber (specialist or GP) when planning to become pregnant or if pregnancy should occur.

This will result in fewer adverse effects from medication exposure during pregnancy, and reduce health inequalities for cohorts disproportionately impacted e.g., serious mental illness. Patients will be empowered to take control of their own care.

How will the project be delivered?

We would develop resources and a campaign to support prescribers to think ahead and encourage shared decision making with patients enabling informed decisions.

• A launch event
• Campaign materials for prescribers and patients
• Regular events to connect patients with support groups and charities
• Inviting keynote expert speakers and experts by experience to share their knowledge with prescribers
• Sharing recommendations of the Cumberledge Report and supporting implementation

We will maintain a multidisciplinary approach to this project including stakeholders such as:

• Medicines safety team members
• Local Mental Health Pharmacy and Maternity teams
• Maternity teams within our organisations
• ICS GP prescribing leads
• Community pharmacy
• Medications in pregnancy experts
• Communication teams
• Patient representatives / support groups.

We will be educating the clinicians and sharing this learning nationally representing value for money.

We will measure the number of incidents and near-misses, clinical knowledge, patient attendance to support groups, campaign materials distributed and prescribing data.

How is your project going to share learning?

• Producing a summary of the project and its learning and sharing with regional and national Medicine Safety Officer webinars
• Sharing materials that are produced for local adaptation
• Sharing with the local healthcare networks e.g., medicine safety meetings (primary, mental health and secondary care), GP Prescribing Lead meetings, engagement meetings with practices, Pharmacy network meetings, Community Pharmacy forums
• Submitting the project for national posters / awards e.g. The Health Service Journal Safety Awards
• Sharing at International forums e.g., Quality and Safety in Healthcare
•  Offering support to other areas who may want to develop their own QI initiatives.