Ireland's Association of General Practitioners

	Ireland's Association of General Practitioners

Centre for Maternal and Child Enquiries CMACE Ireland

CMACE Ireland aims to make pregnancy safer by carrying out confidential reviews into maternal deaths in order to learn lessons and use the findings to formulate and disseminate recommendations.

CMACE Ireland

Funded and endorsed by the HSE, CMACE Ireland* is a ‘stand alone’ office working in partnership with CMACE UK by carrying out confidential enquiries on all maternal deaths in Ireland. The remit of CMACE Ireland does not currently include Child Health Enquiries.

The establishment of CMACE Ireland was with the support of the State Claims Agency and marked a significant step forward in supporting a culture of patient safety in Ireland and ensuring the continuous improvement of healthcare services.

CMACE Ireland was launched as the Confidential Enquiry into Maternal and Child Health (CEMACH) Ireland in April 2009 by the Minister for Health and Children Mary Harney.

On the 1^st July 2009, in partnership with CEMACH UK, the organisation changed its operational title to the Centre for Maternal and Child Enquiries (CMACE).

Objectives

To assess the main causes of and trends in maternal deaths.
To learn lessons by identifying any avoidable or sub-standard factors which may be causally related to adverse outcomes.
To make recommendations concerning the improvement of clinical care and service provision that will save yet more mothers lives, and reduce the numbers who suffer severe maternal morbidity.
To produce a triennial report.

Background

Reported maternal deaths are thankfully rare in Ireland. However, it is known that in the absence of active case ascertainment under reporting and misclassification of maternal deaths occurs in developed countries (1.2.3.4). Maternal deaths can occur in units other than maternity units and in the community.

Although some maternal deaths are unavoidable, there is evidence that women are still dying needlessly. Deaths can be prevented in the future only if lessons are learnt and acted upon, a process that begins with confidential enquiries into such cases (5).

Confidential Enquiries into Maternal Deaths have been carried out in the UK for over 50 years and is presently under the auspice of the Centre for Maternal and Child Enquiries (CMACE) UK.

CMACE UK produces a Triennial Report that currently covers all cases of Maternal Death in England, Wales, Scotland and N Ireland.

The overwhelming strength of successive Enquiry Reports has been the impact their findings have had on improving standards of care and clinical governance in the UK maternity service and further a field

From January 2009 Irish Maternal Mortality data will be included in the CMACE UK Triennial Report.

Definitions

The Role of Health Professionals.

Notification

Notify CMACE Ireland in the event of a Maternal death occurring during or within one year of the pregnancy. Maternal deaths can occur in units other than maternity units and in the community.

A dedicated CMACE Maternal Death Notification Form will be available in all maternity units and acute hospitals, as well as from the CMACE Ireland office / web site

Confidential Enquiry

Provide the CMACE Enquiry with a full and accurate account of the circumstances leading up to the maternal death with supporting records.

Learn the lessons

All health professionals in maternity units and the community should be aware of, and where applicable, implement recommendations contained within the triennial report

The Enquiry Process

Based on a two-stage process of Irish data collection and assessment of the case followed by a central (UK) assessment to enable aggregation into a fully anonymised overall Triennial Report

The confidential enquiry into Maternal Deaths does not preclude the necessity for a local enquiry into maternal death or critical incident review. Results of these reports should be made available to CMACE as part of the documentation for its review process.

Who are the Irish and Central Assessors? :

They are multidisciplinary clinicians who work independently of CMACE but contribute to the Maternal Death Enquiry. Nomination is by the relevant multidisciplinary faculties.

Biographies of the Irish assessors can be accessed on our web site: http://www.ucc.ie/en/cmace

CONFIDENTIALITY IS ASSURED IN THE ENQUIRY PROCESS

Through a process of anonymisation of data prior to assessment of the reported case
CMACE Information Security Guidelines safeguards any identifiable data for the duration it is held
No disclosure of information to unauthorised people or agencies
No Discoverability
Before publication of the Triennial Report, all documentation is destroyed and all electronic data is irreversibly anonymised.
Current data protection legislation places no bar on the disclosure of patient information concerning maternal deaths to CMACE

Triennial Reports

Saving Mothers Lives (5)

7^TH and most recent triennial report
Leading causes of maternal deaths.
Top 10 recommendations and auditable standards.
Key issues and lessons for specific health professionals.
Near misses UKOSS.
MMR in the UK 2003-2005 identified by death certificate data alone = 7 per 100,000 maternities
Proactive inclusive approach of UK Confidential Enquiry 2003-2005 identified = 14 per 100,000 maternities
(G. Lewis, Saving Mother’s Lives 2007)

CMACE Ireland activities to date.

Confidential maternal death enquiries: Since its inception CMACE Ireland has been actively ascertaining cases of maternal deaths in Ireland which have become part of the enquiry process.
Interactive workshop :
A multidisciplinary interactive workshop was held in Limerick on December 9th which focused on the reporting process of the enquiry process and dissemination of recommendations with ‘auditable standards’ from the most recent triennial report, ‘Saving Mother’s Lives.

It is envisaged that future workshops will be held on an annual basis.

CMACE welcomes invites from external conference organisers who want us to present on CMACE work.

How to contact CMACE Ireland

CMACE Ireland Coordinator :Ms Edel Manning

CMACE Ireland

5^th Floor

Cork University Maternity Hospital,

Wilton,

Cork

Email : cmace@ucc.ie

Telephone : 021 420 5042

Floor

References:

1. WH0,UNICEF,UNFPA and The World Bank. Maternal Mortality in 2005. Geneva: WHO 2005

2. Atrash HK, Alexander S, Berg CJ. Maternal Mortality in developed countries: not just a concern for the past. Obstet Gynecol. 1995 Oct; 86: 700-5

3. Deneux-Tharaux C et al. Underreporting of pregnancy-related mortality in the United States and Europe. Obstet Gynecol 2005; 106:684-692

4. Karimian-Teherani D et al. Under-reporting of direct and indirect obstetrical deaths in Austria, 1980-98. Acta Obstet Gynecol Scand 2002;81:323-327

5. ‘Saving Mothers’ Lives’, The Confidential Enquiry into Maternal and Child Health (CEMACH). http://www.cmace.org.uk