The Atlas of Shared Learning

Case study

Improving vaccination uptake by changing the way pregnant women were offered and accessed services

Leading change

The midwifery team at James Paget University Hospitals NHS Foundation Trust created a process which increased the number of pregnant women being vaccinated against influenza and pertussis (whooping cough), providing vaccinations at services they were already accessing.

Where to look

The midwifery team recognised evidence of unwarranted variation with regard to how pregnant women were offered and accessed services. Influenza and pertussis vaccinations were being provided locally via CCG-funded GP services but uptake was poor – less than 40%. This, alongside information on a maternal death in a neighbouring trust and a neonatal death from pertussis prompted the team to identify changes needed to address the variation.

What to change

Influenza and pertussis vaccine uptake was low and reports suggested this was in part due to GP appointments often being at inconvenient times for women with children. The midwives believed uptake would improve if vaccines were given within the acute service that women were already accessing, streamlining their care. By making it easier, women would be more likely to protect themselves and their unborn babies.

How to change

Midwifery leaders partnered with a neighbouring trust to ask their local Antenatal and New Born Screening (ANNB) meeting to reallocate the funding to acute trusts to provide the vaccines – having received support from their CCG for this transition to happen. A pilot was agreed.

The midwifery Team at James Paget University Hospital worked together to develop a process where women could access the vaccines after their 20-week anomaly scan, at the same appointment, with no additional visits or different locations.  Women beyond 20 weeks of pregnancy were also encouraged to come and have their vaccinations, wherever possible in conjunction with another of their midwifery appointments, to improve overall uptake and to minimise the impact on this group.

In addition to sharing this change through clinical appointments and correspondence, the new service option was publicised by word of mouth, via community midwives and on social media. Training was conducted with the National Screening Committee local link, and nursing staff were asked to implement this during the clinics they ran.

Pregnant women are particularly vulnerable to severe complications of flu. During the period 2009 to 2012, one in eleven maternal deaths was due to influenza infection

(cited in Flu Plan, Winter 2017/18, Public Health England (PHE), 2017)

The primary aim of the pertussis vaccination programme is to minimise disease, hospitalisation and death in young infants.

(Pertussis Vaccination Programme for Pregnant Women: vaccine coverage estimates in England, April to August 2014, Public Health England (PHE), 2018)

Adding value

  • Better outcomes – Vaccination rates have achieved 76% coverage for influenza and 80% for pertussis, a significant increase in the rates achieved in primary care (both previously below 40%). This improvement has received recognition from Public Health England.
  • Better experience – Feedback from women was positive. By being offered vaccines at a time when they would be at an important appointment in their pregnancy anyway, they received an enhanced care option with no further need to access other services for their care.
  • Better use of resources – Midwives were able to offer an improved service within existing resources provided. The key shift was reorganising the way services were delivered to these women.

Challenges and lessons learnt for implementation

The midwifery team were able to pilot and subsequently maintain this service provision without barriers, as they were able to clearly demonstrate the patient benefit and safety components in the work. The implementation was supported as the evidence supported their change.

They learnt to:

  • Ask the question – ‘If there is something we think we can do, what can we do to make the change?’
  • Work more closely with colleagues at neighbouring Trusts/organisations.

Find out more

For more information contact:

Jayne Utting

Head of Midwifery and Gynaecology Services