Current initiatives for improving safety for newborns · Seen as a signal of sub-optimal care...

Current initiatives for improving safety for newborns Michele Upton Head of Maternity and Neonatal Transformation Programmes NHS Improvement

13th February 2018

The journey to a national maternity safety ambition

2010

2010 - NHS Mandate & Outcomes Framework

2013 – NAO

Report on maternity services

2015 – Kirkup Report

2015 – National Ambition

2016 – Better Births

2016 – Safer Maternity Care

Action Plan

National Maternity Ambition

To reduce the rate of

stillbirths, neonatal and maternal deaths, and brain injuries occurring during or soon after birth by 50% by

2030; and 20% by 2020

Maternity Transformation Programme

A cross-system programme

set up to implement the vision set out in the National

Maternity Review. From April, NHSI is leading

workstream 2 ‘Promoting good practice for safer care’.

Maternity Transformation Programme

4

Work streams

Overarching

communications

strategy which

supports all activity

1. Supporting local transformation

2. Promoting good practice for safer care

3. Increasing choice and personalisation

4. Improving access to perinatal mental health services

5. Transforming the workforce

6. Sharing data and information sharing

7. Harnessing technology

8. Reforming the payment system

9. Improving prevention

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Avoiding Term Admissions Into Neonatal Units

Current initiatives for improving safety for newborns

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2010 - NHS Mandate & Outcomes

Framework

National perspective Seen as a signal of sub-optimal care during antenatal, intrapartum or post natal period – few fully grown babies should need neonatal services Signal that avoidable harm might have been caused Significant but avoidable cost to NHS and families

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• National perspective: Seen as a signal of sub-optimal care during antenatal, intrapartum or post natal period – few fully grown babies should need neonatal services Signal that avoidable harm might have been caused Significant but avoidable cost to NHS and families Maternity and neonatal teams recognise as an issue - will to resolve - but complicated

Why is this important?


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• Mothers and babies have a physiological and emotional need to be together: hours and days following birth.

• The first hour of life outside the womb is the time when a

family is formed. A once-in-a-lifetime experience to be cherished and protected.

• Important for physiological stability of baby and beginning of

maternal infant interaction

• The benefits of skin-to-skin care extend beyond birth. The mother learns about her baby’s needs and how to care for, comfort and soothe her newborn.

Why is this important


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Why is this important

There is overwhelming evidence that separation of mother and baby so soon after birth interrupts the normal bonding process, which can have a profound and lasting effect on maternal mental health, breastfeeding, long-term morbidity for mother and child. This makes preventing separation, except for compelling medical reason, an essential practice in maternity services and an ethical responsibility for healthcare professionals.


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Term live births in England (2011-2014) 3.6%


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Care days for term admissions ( 31%) (>60%)


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136 036 babies care analysed: 2013 – 2015:

• >8% of all live births resulted in a L1,2 or 3 NNU

admission

• Additional 10,000 care days delivered for term babies in

2015 compared to 2011

• Increase predominantly in Special Care category

• ~20% - 30% of admissions were avoidable - intervention

received did not warrant admission

• 20% = 27 207

• 30% = 40 810

What we know


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• Unnecessary intervention

• Risk factors not identified

• Evidence based guidance not followed

• Babies born at 37-38 weeks twice as likely to be admitted to neonatal services as those born at 39-42 weeks gestation

• Examples from acute and community

What we know


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• 39% low risk infants (Mat/Obstet problems; BW and

Apgar)

• 30% admitted <4 hours of age (normal period of transient

hypoglycaemia)

• of which half were <1hour of age (LW/OT)

• 86% of infants of diabetic mothers admitted before 4 hours of age – of which

• 41% had admission blood glucose above the operational threshold

• Suggests prophylactic admissions

Hypoglycaemia


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• 6% of term infants admitted for jaundice (3000/annum)

• Most common reason for admission from home (approximately 20% each year )

• infants admitted from home statistically significantly later – median age is 1.7 vs 3.9

• Majority received phototherapy only

• Admission more likely in babies born at 37 weeks, male babies, those of Asian ethnicity or who were one of a multiple birth

Jaundice


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20% – 30% of all babies admitted to L1, 2 or 3 care

received no intervention which could not have been

delivered by keeping them with their mothers n = 34 000

31% of babies were admitted for <48 hours and

received no high dependency or intensive care

intervention

Role for Transitional Care facilities

Babies born at 37-38 weeks were twice more likely to be

admitted to Neonatal services compared to those born at 39-42 weeks gestation = increased vulnerability

Overall data findings


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National Drivers


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National Drivers


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Share knowledge widely - NHS Improvement webpage – resources for

sharing - Open Access arrangements for all academic publications

IV scheme with NHSE (commissioners) agreed - £m savings

Influence improvements in postnatal care – M&B, Sk2Sk; avoid

unnecessary intervention

NHSI & HEE - transforming the workforce – Atain and TC

Three programmes with RCM&RCOG targeted at reducing HIE

eLfh Atain programme – pre and post reg MDT – launch 2-3 weeks

MNHS Collaborative programme - >50% Atain

Transitional care – resources

Political interest invaluable – influence strategy and policy

Opportunities for transformation


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• Undertake the Atain e-Learning programme – and go on to reflect on

your current practice and where you might do things differently

• Familiarise yourself with and identify local implementing of the BAPM

hypoglycaemia FfP

• Review the Atain resource pack and discuss with your Atain lead

where your unit is with progress

• Work with clinical colleagues to address requirements identified from

reviews of term admissions

• Support the call for keeping mother and baby together – but not to

jeopardise safety

• Maintain a questioning mind set – you bring fresh eyes and insights

from other unis

Your role in reducing term admissions


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Your role in reducing term admissions


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Join the Journey!


@atain7 [email protected]

Current initiatives for improving safety for newborns · Seen as a signal of sub-optimal care...

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