Case study (Resident Doctor Showcase): A Digital Shift in Post-Caesarean Medication Self-Administration

23 Sep 2026

Resident Doctor Showcase competition winner, as part of Clinical Audit Awareness Week 2026

Creating Tabtracker: A Digital Shift in Post-Caesarean Medication Self-Administration is a quality improvement project led by South Warwickshire University NHS Foundation Trust (SWFT) to support women recovering from caesarean birth. Recognising the challenges that new mothers can face when managing post-operative medication, a multidisciplinary team worked together to develop a digital solution designed around patient needs.

The multidisciplinary team included anaesthetists, midwives and a human factors software expert. Key contributors included Dr Alex Tebbett, Anaesthetic Registrar, and Rory Manning, Software Designer, who led the design and development of the Tabtracker application. They were supported by Dr Smita Gohil, Clinical Director for Anaesthetics, and Kirsty Hartwell, Quality Improvement Midwife, who played a key role in implementing and auditing the project.

Who is the project designed to support?

The project was primarily designed to support women recovering from caesarean birth who are self-administering their post-operative medication while caring for a newborn. In particular, it aims to help new mothers navigating a post-operative environment who need to safely self-manage their medications.

The project also supports healthcare staff by reducing midwifery workload and improving ward efficiency. While initially developed for post-caesarean care, the approach has wider potential to support any patient group that would benefit from guidance and support with medication self-administration.

What did it set out to achieve?

The project initially set out to evaluate the effectiveness of the existing paper-based medication self-administration system. Following this review, the team aimed to address a significant clinical problem, where only 63% of patients were keeping records of their medication, leading to varied dosing, overreliance on opioids and adverse incidents.

The digital intervention was developed to help patients accurately plan doses, record administrations and track pain scores, while the re-audit looked at the impact of the digital intervention. Ultimately, the project aimed to empower new mothers, streamline the hospital discharge process and support safe self-management of post-operative medication.

When did the project start?

The project began in 2023 with a week long audit of the existing paper-based system. In response to these findings, the Tabtracker app was developed during 2024 and introduced into practice. The impact of the digital intervention was then assessed through surveys conducted between November 2024 and April 2025, alongside a five-month re-audit period that collected app usage data.

How did the project work?

A root-cause analysis found that poor compliance with the existing paper-based system was due to practical and human factor barriers, such as patients not having a pen available, charts being out of reach and a preference for using smartphones.

Recognising that more than half of patients already relied on their phones, the team developed Tabtracker, a bespoke mobile application that replaced paper charts with digital scheduling and record keeping.

The app supports patients by helping them plan and record medication doses, providing safety alerts for dose limits, sending reminder alerts and enabling pain and symptom tracking, making it easier to safely self-manage medication during postnatal recovery.

Did the project involve changes to processes in order to implement?

Implementing the project involved digitally transforming the department’s existing drug policy. The traditional method of recording medication use on paper charts was replaced with a personalised digital record accessible through the patient’s own mobile phone. This shift enabled medication scheduling, dose recording and symptom tracking to be managed electronically, helping to create a more accessible and user-friendly process for both patients and staff.

Did the project succeed and, if so, what is the evidence?

The project was highly successful, with 4,329 medication doses recorded across 228 unique users during the initial five month period.

Evidence from patient surveys showed that 87% of patients used the app and rated it 4.5 out of 5, while the proportion of patients able to take their medication on time increased from 73.6% to 95%. Patient satisfaction with pain management and the information provided also improved significantly, rising from 73.5% to 95%.

Staff reported positive benefits too, with 92% of staff reporting that the app improved medication tracking accuracy, and the proportion of midwives spending less than five minutes explaining medication protocols increasing from 41.7% to 76.9%.

Safety outcomes also improved, with 69.2% of staff reporting that medication errors were rare when using the app, compared with 25% under the previous paper-based system.

“The implementation of Tabtracker has significantly improved the staff experience on the postnatal ward by reducing explanation time, enhancing medication tracking accuracy and alleviating workload pressures. Midwives appreciate its user-friendly design and positive impact on patient interactions, particularly in addressing logistical issues inherent in the paper-based system.” QI midwife lead

Other insights or learning points

The project has produced a number of valuable outputs, most notably the Tabtracker mobile application itself, which was developed to support medication self-administration following caesarean birth. Alongside the app, the team collected survey feedback and app usage data to compare the effectiveness of the new digital approach with the previous paper-based system.

To support wider learning and knowledge sharing, a presentation slide deck was also developed and presented during Clinical Audit Awareness Week 2026 (CAAW26). The presentation outlines the project’s background, app development cost considerations, including hosting and security requirements, and the results achieved following implementation.

Other supporting materials: