CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Guideline on the Use of the Interpreting Services within the maternity services Implementation date Version Supersedes April 2015 One This is a new guideline Contact Name and Job Title (author) Jane Pidgeon Maternity Risk Co-ordinator / Supervisor of midwives 57119/64211 Date of submission December 2014 Date on which guideline must be reviewed (this should be one to three years) Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis) Abstract Key Words Statement of the evidence base of the guideline has the guideline been peer reviewed by colleagues? December 2019 All women Interpreting, urgent situations, interpreter Evidence base state highest level from (1-5) 1a meta analysis of randomised controlled trials 1b at least one randomised controlled trial 2a at least one well-designed controlled study without randomisation 2b at least one other type of welldesigned quasi-experimental study 3 well designed non-experimental descriptive studies (ie comparative / correlation and case studies) 1
4 expert committee reports or opinions and / or clinical experiences of respected authorities 5 recommended best practise based on the clinical experience of the guideline developer Consultation Process Senior Midwives, Consultant Anaesthetist, Consultant Obstetricians. Nottingham Guidelines Development Group Target audience All midwives and obststricians This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. NHS Nottingham City and Nottingham University Hospitals NHS Trust are committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation. The Trusts are committed to ensuring that the public and staff are given information in a clear and concise way and in a manner that people understand. In situations where there are concerns about an individual s ability to understand information or consent to treatment because a medical condition has affected their cognitive functioning and mental capacity please refer to the Mental Capacity Act intra-agency guidance and complete appropriate documentation. 2
Guidance for the Use of the Interpreting Services within the Maternity Services Interpreting services are used to facilitate good communication between parties who do not share a common means of communication. In maternity services, it should permit the woman s voice to be heard and the professional to enter into dialogue about management and choices. Ideally, communication should be directly between the professional and the woman, this guideline has been developed for situations when this is not possible. Professional language interpreting and translation services provided by thebigword can either be via face-to-face interpreters or by a telephone interpreting service. The process of accessing these services can be found via the Trust internet site: http://nuhnet/human_resources/interpreting_translation/pages/defa ult.aspx The telephone interpreting main number is: 0800 8620653 The emergency contact line number is: 0800 8620625 Polish interpreters are provided by the Trust and can be contacted using the link: http://nuhnet/human_resources/equality_diversity/interpreting_tran slation/polish_interpreting/lists/polish%20facetoface%20interpre ting%20diary/calendar.aspx and are booked directly into the diary. There are three means of providing interpretation 1. Face-to-face with an interpreter present - allows the interpreter to read visual cues as well as verbal cues - allows the professional to keep hands free when performing clinical tasks - allows the professional to discuss issues that require diagrams or charts, eg the Diabetic Clinic or the FGM Clinic (female genital mutilation). - can be intrusive with a third party involved in the discussion 3
- lacks anonymity because the woman is disclosing details to a third party who might be part of her immediate local community - impinges on issues of dignity when the woman needs to be examined with the interpreter present 2. Telephone interpretation (this should be on a dual handset telephone) - allows anonymous interpretation - takes the third party out of the room and so respects the woman s dignity - with dual handsets, it is no more time consuming than have a third party present - is cumbersome if the professional is performing any type of procedure 3. Family members/friends - might be someone the woman trusts to communicate effectively and might empower her to express her own opinion - usually immediately assessable and accompanies the woman throughout her care - leaves the woman vulnerable to others judgement of what information she needs to know - uses an interpreter who may also have a limited understanding of English, this magnifies error - prevents the woman disclosing sensitive issues that she wishes to keep from those she knows Ideally, the interpreter should not be known to the woman. A minimum requirement is that a neutral interpreter is used to ask the woman which family members she is happy to use to speak on her behalf. The acute nature of obstetrics and maternity care requires us to be pragmatic about the above, it is better that any means of communication is used in the acute situation than that the woman is left ignorant and unknowing. 4
Use of a designated family member Women may wish to identify their own interpreter (from their family / friends) and bring them along to their appointments The woman must have attended a consultation where a face to face interpreting service is used, she may then confirm that she is happy for a named relative to interpret for her, this may even be her preference. The name and relationship of this specified person must be documented in Part One record, on Systmone and on Medway and should include preferred contact details. The record should also include in which situations that particular family member can be used to interpret. This does not negate the need to use a neutral party to ask about issues such as domestic violence and take consent. It is important to provide the opportunity for the woman to speak when her relatives are not present. Family members should not be used to take consent Children (under the age of 16) should not be used to interpret. There are situations when face-to-face interpretation is the only option eg for deaf women who sign. In such cases an interpreter should be present at all planned visits. When the interpreter is present, a written list of likely emergency scenarios should be made and explained in full so that basic information can be communicated when it is not possible to obtain interpreter at short notice. In Non-urgent Situations: Times when face to face should be used: At the booking appointment Consider when asking about domestic abuse, but bear in mind that a woman may not disclose to an interpreter who is a member of her immediate community, telephone interpretation may be more appropriate When teaching women who have been diagnosed as having gestational diabetes to discuss dietary changes and to show them how to undertake blood glucose monitoring At antenatal clinic appointments when discussions are likely to be complex (eg with complex feto-maternal issues) 5
At an early postnatal visit in the community when issues such as consent for the Newborn Blood Spot, and key public health messages need to be discussed. If concerns regarding mental capacity and ability to give consent to care are raised In most cases, face to face interpretation will only be required at the initial visit and efforts should be made to cover all the relevant issues at this time. Times when the telephone interpreting services should be used: Routine antenatal visits When obtaining consent for elective surgery When less complicated messages need to be delivered to the woman When there are known issues around domestic abuse Times when leaflets in other languages can be used: Prior to appointments to give information In conjunction with any of the above situations It is important to establish that the woman can read if this means of communication is used In normal circumstances a relative should not be used to interpret if they are emotionally involved in a situation. In Urgent Situations: There may be situations when a decision has to be made urgently and consent obtained, for example, when problems are encountered in labour. The principle that consent should not be taken using a family member or friend to interpret still stands, but the need to communicate with the woman over-rides this in the urgent situation: A member of staff who is able to speak the required language may be used to interpret on behalf of the woman The telephone interpreting services should be utilised whenever possible and if time allows A family member may be used, if present, and can interpret when this is the only means of communicating with the woman 6
A friend who is acting as birth partner could be asked to interpret There may be situations where there will be a need to proceed without anyone being able to interpret - all efforts should be made to ensure the woman s understanding - any care given in these circumstances would be done so under the best interests of the patient - full explanation, using interpreting services, must be performed afterwards. It is acceptable (and usually preferable) for family and friends support and interpret during the course of normal labour or during procedures where consent has been obtained. Taking consent If a face-to-face interpreter is used in gaining written consent they must be asked to sign the appropriate statement on consent forms 1, 2 and 3 (Trust consent policy). If consent has been obtained over the phone then their interpreter identifying number should be obtained. If a telephone interpreter is used to take written consent, their code should be recorded on the consent form Relatives should only be used when there is no alternative Costs Using interpreting services is a resource and should be used wisely. Face-to face: The minimum time frame is an hour, with increments of 15 minutes after that initial hour. 30 - Polish 33 - Punjabi, Urdu, simple Arabic 37 for everything else Telephone charges only for the time used. They try to connect in 30 seconds. 47p/min-Polish 49p/min-Czech and Slovac 7
54p/min for everything else (October 2014) BSL rate - 47.50 but for a minimum of 1 hour with subsequent hours at 40 8