Registered Advanced Midwife Practitioner (RAMP) Service improves access to care for Women with Gestational Diabetes at National Maternity Hospital (NMH)
AMP led virtual clinic eliminates need for women with gestational diabetes to come to the hospital and provides faster access to care
Virtual clinic provides care to approximately 800 women per annum
75% of these women can now have their gestational diabetes managed at home
90% of women treated within 10 days of diagnosis
70% of women treated within 5 days of diagnosis
Women with gestational diabetes, who previously had to come to the hospital every three to four weeks for the duration of their pregnancy on top of their antenatal care, currently receive the care they need in the comfort of their own homes by availing of the Gestational Diabetes Virtual Care Clinic.
Promising initial results are emerging from a study looking at maternal and neonatal outcomes in the Gestational Diabetes Virtual Service versus in-person care at the NMH, Holles Street Dublin.
The study has found that access to care through the virtual clinic is much faster with 90% of women treated within 10 days of diagnosis and 70% of women treated within 5 days of diagnosis. Feedback about the clinic from women who attend is also very positive with women not needing to travel for appointments, along with no requirement for child-care or to take time off work to attend the hospital.
Ciara Coveney works as an RAMP in the area of Diabetes in Pregnancy (DIP) at the NMH. This covers a maternal and foetal medicine service which has a team comprising of Obstetricians, Endocrinologists, Dietitians, HSCP’s and administrative staff. Her primary responsibility is providing diabetes care in pregnancy for women with pre-gestational diabetes T1/T2, cystic fibrosis and gestational diabetes.
Ciara has led and innovated the implementation of the Gestational Diabetes Virtual Care Service which is the first of its type and size nationally. This virtual clinic eliminates the need for women with gestational diabetes to come to the hospital. Ciara, who is supported by midwives Eimear Rutter and Shauna Callaghan provides care to approximately 800 women per annum and up to 75% of these women can now have their gestational diabetes managed at home. The women in the service have access to online education sessions and have virtual reviews with a member of the specialist midwifery team. The team use digital health technology such as glucometers which hook up to the patient’s smart phone, this communicates the data back to the hospital and allows the team to have all the information to hand to provide a comprehensive assessment when they see the women at the clinics.
Speaking about the service, Chief Nursing Officer Rachel Kenna said: “Advanced Practice Nurses and Midwives have made significant positive impacts on patient experience and access to treatment. Advanced practitioners have enabled access and choice in care for women through the four core elements of clinical practice, leadership, education, and research. Having advanced practitioners at the point of care delivery will support and lead the delivery of integrated care across our health services and will be a key enabler for delivering Sláintecare. Ciara and the team in NMH have demonstrated the possibilities and the CNO office will continue to support the development of advanced practice for patient care across the system.”
Ciara said: ‘The Registered Advanced Midwife Practitioner DIP clinic is key to the successful management of diabetes in pregnancy and supporting positive pregnancy outcomes. This is achieved by ensuring there is continuity of expert professional evidence-based care for women with DIP. Governing the RAMP DIP practice are the core midwifery values outlined in The Values for Nurses and Midwives in Ireland (Department of Health 2016) compassion, care and commitment. Key components of the RAMP DIP clinic are the therapeutic relationships developed between the woman and the RAMP DIP and the continuity of care provided by the RAMP. The development of an autonomous midwifery led clinic not only enhances the patient flow through the healthcare system but also releases the medical team to manage more complex cases.’
Minister Donnelly said: “The results of the study from the NMH are very encouraging and entirely in line with Sláintecare. The effect of their work is reflected in this study where we can clearly see the benefits for the women being able to access this health service virtually at home. I want to thank Ciara and the team in the Gestational Diabetes Virtual Care Service. The virtual clinic in NMH and a similar Gestational Diabetes virtual service at University Maternity Hospital Limerick (UMHL) goes a long way towards ensuring that care is delivered to the right person, at the right time and in the right place.”
“Promoting Women’s Health is a priority for me and the government and was strongly supported in Budget 2022, with €31 million additional funding for new developments in women’s health. The investment and developments we are seeing in women’s health demonstrate that this area is now receiving the focus and support it needs to provide timely and effective services to the women of Ireland. AMPs play a vital role in supporting the Sláintecare agenda by enabling care virtually and in the community, closer to home.”
Notes to Editors:
The Registered Advanced Midwife Practitioner (RAMP) service in the National Maternity Hospital, Holles Street is provided by midwives who practice at a higher level of capability as independent, autonomous and expert advanced practitioners.
Highly trained and skilled advanced practitioners provide a complete episode of care in response to patient needs which includes patient assessment informed by relevant examinations and diagnostics, medication prescribing, patient referral and follow up as required.
The overall purpose of the service is to provide safe, timely, evidenced based midwife-led care to women and babies at an advanced midwifery level. This involves undertaking and documenting complete episodes of maternity care, (assess, diagnose, plan, treat and discharge women and babies), according to collaboratively agreed local policies, procedures, protocols, guidelines and scope of practice in the clinical setting.