WM SCN Maternity Bereavement Audit | NHS Networks

West Midlands Maternity and Children’s Strategic Clinical Network Maternity Bereavement Services Audit

Alison Davies, Quality Improvement Lead March 2015

Classification: Official

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Contents

Page

Background 3

Aim 3

Approach 3

Audit Results 4

Introduction and overview 4

Section 1: Training and staff support 5

Section 2: Labour and after birth 8

Section 3: Communications & Arrangements 9

Section 4: Postnatal and onwards, including process and review 13

Additional areas of discussion 15

Conclusion 15

Further Actions 16

List of Figures

Fig1: CTG audit submissions received 3 3

Fig 2: Bereavement Lead meeting attendance 4 4

Fig 3: SANDS audit tool completion 5 5

Fig 4: Areas of good practice and improvement as highlighted by the SANDS tool 5 5

Fig 5: SANDS bereavement standard 1.2 p6 6

Fig 6: Training identified and comments received 7

Fig 7: How ‘care of the caregiver’ is managed within West Midlands maternity units 7 7

Fig 8: SANDS Bereavement Standards 6.1 – 7.2 p9 9

Fig 9: SANDS bereavement standards 4.1 – 5.1 p10 10



Fig 12: Locations of post mortem results meetings p13 13


Fig 14: Additional discussion information p15 15

List of Appendices

Full audit results 18

Stakeholder event attendees 24th February 2015 44

HEFT Presentation 24th February 2015 45

UHCW Presentation 24th February 2015 54


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Background The West Midlands Strategic Clinical Network highlighted a number of areas for attention in maternity and newborn services, driven from both the work towards a stillbirth national care bundle; and also from the outputs of an SCN Maternity Gap Analysis project during 2014. During the Maternity Gap Analysis, the SCN interviewed a number of bereaved parents, who had suffered a loss within the last 5 years, either through stillbirth or early neonatal death; and whose care was managed within a West Midlands unit. This involvement of parents highlighted an apparent variation in the provision of dedicated bereavement services across the various units. As such, one of the recommendations of the gap analysis was for the SCN to complete a short and concise scoping exercise of bereavement care, by April 2015.

Aim The aim of this work was to explore the provision of bereavement services across the West Midlands; exploring variation and exposing both areas of good practice and opportunities for development.

The purpose of this report is to provide intelligence to Bereavement Leads, Heads of Midwifery and Operational Delivery Networks to enable them to identify gaps in service provision and best practice which may be appropriate for spread.

Approach Utilising standards taken from the SANDS bereavement audit tool 2011, a regional audit was designed and distributed to all Bereavement Leads for completion. Audit submissions were received from the following organisations listed within Figure 1, by Operational Delivery network geography. These organisations are abbreviated, as indicated, later in this report. The full audit results are available within Appendix 1. Fig1: CTG audit submissions received

Southern West Midlands Maternity & Newborn Network (SWMMNN)

Heart of England Foundation Trust (HEFT)

Wye Valley Hospital (WV)

Worcestershire Acute (WA)

Sandwell and West Birmingham (SWBH)

Birmingham Women's Hospital (BWH)

Staffordshire, Shropshire & Black Country Maternity & Newborn Network (SSBCMNN)

Royal Wolverhampton Hospital (RWH)

Dudley Group of Hospitals (DGOH)

Shrewsbury & Telford Hospitals (SATH)

University Hospital of North Midlands (UHNM)

Central Newborn Network (CNN)

University Hospital of Coventry & Warwick (UHCW)


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George Eliot Hospital (GEH)

Queens Hospital, Burton (QHB)

South Warwickshire Hospital (SWar)

A total of 13 full submissions were received, with 1 omission within the timescale (Walsall Healthcare Trust). Results from the audit were presented and discussed at a Bereavement Leads meeting on 24th February 2015. The meeting was attended by 11 of the 14 West Midlands Trusts (see Figure 2), along with a SANDS representative, 4 bereaved parents and representatives from the SCN and all 3 operational delivery networks. A full attendance list can be found in Appendix 2. Fig 2: Bereavement Lead meeting attendance

SWMMNN 5/5

Heart of England Foundation Trust

Wye Valley Hospital

Worcestershire Acute

Sandwell and West Birmingham

Birmingham Women's Hospital

SSBCMNN 3/5

Royal Wolverhampton Hospital

Dudley Group of Hospitals

Shrewsbury & Telford Hospitals

University Hospital of North Midlands

Walsall Healthcare Trust

CNN 3/4

University Hospital of Coventry & Warwick

George Eliot Hospital

Burton Hospital

South Warwickshire Hospital

The meeting gave opportunity for further detail to be gained in relation to the areas investigated under the audit, for areas of best practice to be shared and for an action plan to be created for continuing improvement as a group. Further details on this can be found on page 16 of this report.

Audit Results Results for the high level audit are detailed below: Introduction and overview: The SCN sought to understand how many units had already completed the SANDS bereavement audit tool, and if they had how recently this had been completed and what had been learnt from it. As can be seen in Figure 3, 38% of the units have


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completed the full SANDS audit, one further unit who selected ‘no’ commented that they were currently in the process of completing; and 2 further units had completed sections of it but on an informal basis. Fig 3: SANDS audit tool completion

The 5 units that had completed the SANDS tool informed the audit of areas that had been highlighted as good practice within their own unit; and areas for improvement. Figure 4 depicts some of the areas listed. It is evident that both best practice and service gaps are varied across these units, with ‘training and education’, ‘support for staff’ and ‘post mortems’ appearing on both end of the lists; indicating there exists real scope for sharing and learning across the region. Fig 4: Areas of good practice and improvement as highlighted by the SANDS tool

Section 1: Training and staff support Section 1 of the SCN audit focused on staff establishment, staff support and training and education.


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Results inform us that 11 of the 13 units have dedicated bereavement midwives in post, with no dedicated hours for bereavement at Wye Valley or George Eliot Hospitals. Dedicated hours at the 11 units are widely varied, largely covering only core hours with a variety of ways of adopting bereavement cover out of hours, including training bereavement link workers, utilising chaplaincy support and also providing additional training to senior midwives. Figure 5 outlines the responses to SANDS bereavement standard 1.2: All staff have had training and support to enable them to care sensitively and confidently for parents whose baby is dying or has died. Fig 5: SANDS bereavement standard 1.2

SWMMNN 1/5

Heart of England Foundation Trust

Wye Valley Hospital

Worcestershire Acute

Sandwell and West Birmingham

Birmingham Women's Hospital

SSBCMNN 1/4

Royal Wolverhampton Hospital

Dudley Group of Hospitals

Shrewsbury & Telford Hospitals

University Hospital of North Midlands

CNN 2/4

University Hospital of Coventry & Warwick

George Eliot Hospital

Burton Hospital

South Warwickshire Hospital

A presentation on 24th February by Heart of England Foundation Trust’s Bereavement Lead provided details of a 24/7 ‘link bereavement midwife’ service they have established within Heartlands Hospital, in order to maximise on bereavement support outside of core hours. The presentation can be found at Appendix 3 and sees to provide a baseline for best practice within this area – improving access to specialised services within the given envelope of staff resource, whilst developing staff skills and capabilities. The audit went on to establish what training is provided around bereavement; and for which professionals. Figure 6 depicts the spread of training which is accessed across the region. Many of the comments suggested that in the main, training is designed and delivered by the bereavement leads, using a hybrid of various training they have attended. In addition to these training options, additional training has been received in bereavement photography, which has been received well by midwives and families.


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Fig 6: Training identified and comments received

Thirdly, this section of the audit went on to explore how ‘Care of the Caregiver’ is managed within the organisation, asking units to outline what support is in place for staff dealing with emotional strain of handling bereavement, including handling of clinical governance investigations. Results show that there are large and varied options being used (see Figure 7). Workshop sessions at the Bereavement Lead meeting suggested that much of this support falls to the Bereavement Leads themselves, with little formal training available for them in how to support their colleagues in this way. Fig 7: How ‘care of the caregiver’ is managed within West Midlands maternity units


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During the stakeholder meeting, a number of recommendations, suggestions and requirements were made by the group around 24/7 cover, training, education and staff support, with a few key themes as outlined below:

1. A consistent approach is required to training, with standard methods of e-learning and a West Midlands wide recommendation on what training and education should be followed; to cover all roles who come into contact with bereaved families

2. Shared training is required for all Bereavement Leads in how to effectively support staff who are dealing with bereavement

3. Training could be improved by asking bereaved parents to be involved and share their stories with professionals

4. All units could benefit from assessing the 24/7 cover they provide and how they can utilise and develop existing staff/ roles to provide out of hours specialised bereavement support

Section 2: Labour and after birth The results of the 2014 SCN Maternity Gap Analysis highlighted that location of care was one of the factors greatly affecting the experience of parents during labour and after birth. The bereavement audit asked units to outline where families are placed during this time and whether the facilities available were sufficient. Additionally, a number of other relevant standards were assessed in relation to the period of labour and after birth. Figure 8 shows the units responses to the following SANDS standards:

6.1 When there is time, parents are always offered opportunities to plan the birth and how they would like it to be handled.

6.2 Once she is in established labour, every woman has an experienced midwife who looks after her throughout her labour and birth.

6.3 Less experienced midwives are given opportunities to care for women alongside experienced midwives in order to develop their skills and confidence.

6.6 There are one or more dedicated rooms on the labour ward with en suite toilets and showers for mothers whose baby has died or will die, where they cannot hear other mothers and babies.

6.8 There are enough of these dedicated rooms for the number of late miscarriages, stillbirths and neonatal deaths in this unit.

6.10 All staff are able to offer parents opportunities to see and hold their baby and to create memories.

6.18 Partners and other family members are always able to get food and hot drinks (even if only from a machine) 24 hours a day.

6.19 There are toilets and washing facilities for both male and female partners and other family members near the labour ward.

7.2 Each dedicated room has a double bed (or an extra single bed) so that the mother’s partner or companion can stay overnight.


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Fig 8: SANDS bereavement standards 6.1 – 7.2

6.1 6.2 6.3 6.6 6.8 6.10 6.18 6.19 7.2

SWMMNN 4/5 1/5 2/5 1/5 0/5 4/4 5/5 4/5 5/5

HEFT

WV

WA

SWBH

BWH

SSBCMNN 4/4 2/3 3/3 3/4 1/4 4/4 4/4 3/3 3/4

RWH

DGOH

SATH

UHNM

CNN 4/4 3/4 3/4 2/4 2/4 4/4 3/4 4/4 3/4

UHCW

GEH

QHB

SWar

There were many comments received both within the audit and the meeting in relation to some of the areas highlighted above, in particular around the challenges of offering location of care where other labours or babies cannot be heard – balancing this emotional trauma with clinical need to keep families close to the required professionals. All comments can be found within the full audit in Appendix 1. Stakeholder discussions on this topic involved sharing how and where they care for bereaved families and how they look to overcome these challenges. Units discussed the benefits in continuing to network together; and to visit and view each other’s bereavement rooms/ layout in order to share and learn. Section 3: Communications & Arrangements A further area of concern received by the families within the Maternity Gap Analysis was lack, or miscommunication, of information between healthcare professionals following a loss. Section 3 of the audit investigates the process units have established to ensure information is cascaded timely and efficiently to all who may come into contact with the family. The section tests against SANDS standards, as follows, with results illustrated in

Figure 9:

5.1 The unit has a designated person who always ensures that the mother’s GP

and community midwife are accurately informed of what has happened within

one working day:

a) following the discovery of a serious problem or a fetal abnormality during

pregnancy;

b) following a late miscarriage

c) following the diagnosis of an IUFD


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d) following a stillbirth

e) following a neonatal death in the maternity unit.

4.1 The antenatal clinic staff are always informed of the baby’s death.

4.2 Any remaining antenatal appointments are always cancelled.

4.3 The maternity unit has a comprehensive list of other likely departments that

may need to be informed that the baby has died.

4.4 All the relevant departments are always informed. Fig 9: SANDS bereavement standards 4.1 – 5.1

5.1a 5.1b 5.1c 5.1d 5.1e 4.1 4.2 4.3 4.4

SWMMNN 3/5 4/5 4/5 4/5 4/5 5/5 5/5 5/5 5/5

HEFT

WV

WA

SWBH

BWH

SSBCMNN 2/3 2/4 2/4 2/4 2/4 4/4 4/4 3/3 4/4

RWH

DGOH

SATH

UHNM

CNN 2/4 1/4 1/4 1/4 2/4 4/4 4/4 4/4 3/4

UHCW

GEH

QHB

SWar

In relation to standard 5.1, discussions at the Bereavement Lead meeting confirmed that the reason many leads had answered ‘no’ or ‘sometimes’ to these standards was not because there were no systems in place to ensure this information was cascaded, but because it was not the responsibility of one designated member of staff, as requested within the standard. For example, Wye Valley have a robust bereavement checklist, which covers all of these areas. The individual completing the checklist will alter - but whoever is completing will be responsible and accountable for these actions being followed. Not all units have a bereavement communications checklist and as such this is one area of shared improvement worth pursuing. One area for inclusion within the checklist should be health visitors for families with other children, as Queens Hospital, Burton highlighted that these professionals are not always informed. Section 3 of the audit continued by requesting information pertaining to the arrangements of registrations of deaths and funerals, including 4 SANDS bereavement standards, as outlined in Figure 10.


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10.1 All parents whose baby is stillborn, or was born alive and then died, are given verbal information about how, when and where to register the stillbirth or the birth and death of their baby.

10.2 All parents whose baby is stillborn, or was born alive and then died, are given written information about how, when and where to register the stillbirth or the birth and death of their baby.

11.1 All staff are able to give the parents verbal information about the funeral arrangements that the hospital offers.

11.12 A well-informed member of staff monitors the quality of contract funerals at least once a year.


10.1 10.2 11.1 11.12

SWMMNN 5/5 5/5 4/5 5/5

HEFT

WV

WA

SWBH

BWH

SSBCMNN 4/4 4/4 3/4 2/4

RWH

DGOH

SATH

UHNM

CNN 4/4 4/4 2/4 3/4

UHCW

GEH

QHB

SWar

University Hospital of Coventry and Warwick presented during the 24th February stakeholder meeting, informing the group of 3 areas of improvement which had been made within the Trust’s maternity bereavement services:

1. On-site registration of deaths 2. Placental histology 3. Postnatal counselling service

The introduction of the registrar for deaths on site at the hospital, one day a week, has provided some additional choices for bereaved parents. The presentation is available in Appendix 4. One parent in particular who presented her baby’s story at the meeting, spoke passionately about the importance of providing the support to families around these arrangements – a voice that echoes the message heard by many families during the Gap Analysis work.


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Figure 10 would indicate that 9/13 units are confident that all staff can discuss funeral arrangements; and 11/13 are assessing the quality of the funerals offered annually. Full details of what is provided in terms of funerals by Trusts can be found within the full audit responses at Appendix 11. The offering of post mortems and follow up information and meetings were explored within the audit and the follow on meeting. The audit assessed SANDS bereavement standards 9.1-3 and 9.7, with the results shown within Figure 11.

9.1 All parents whose baby dies are offered a post mortem. 9.2 All staff who seek consent/ authorisation for a post mortem are trained to

do so, understand what a post mortem entails, understand the benefits of a post mortem, and are able to answer parents’ questions.

9.3 All parents are offered written back-up information about post mortems that is specifically suitable for a perinatal death.

9.7 All parents who have consented to a post mortem are able to discuss the results with a senior member of staff within twelve weeks of the birth.


9.1 9.2 9.3 9.7

SWMMNN 5/5 4/5 5/5 4/5

HEFT

WV

WA

SWBH

BWH

SSBCMNN 4/4 4/4 4/4 3/4

RWH

DGOH

SATH

UHNM

CNN 4/4 3/4 4/4 1/4

UHCW

GEH

QHB

SWar

Table discussions at the 24th February stakeholder meeting challenged the above results, questioning whether the offer of post mortems is always performed by the most suitable person and at the right time. It was evident that some units are not allowing as much time to parents to make the decision, with others allowing families to return home and with bereavement leads visiting or telephoning to discuss decisions. In addition, it was highlighted by the parents within the meeting how significant it is that the post mortem is offered by a professional who already has a relationship with the parents. Figure 12 details the variety of locations that units are using for post mortem result meetings. The Gap Analysis highlighted the discomfort for many families in carrying out these meetings in environments that are not fit for purpose. It is clear that across


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the region, some dedicated rooms are available; and where they are not available, or at the request of consultants, other locations are being utilised. Fig 12: Locations of post mortem results meetings

Section 4: Postnatal and onwards, including process and review The third area of improvement described by UHCW was around postnatal care and the offering of counselling services. Many units expressed the inability to secure or provide counselling; and the varying levels of engagement with supporting charities (including SANDS, Tommy’s and Bliss); plus the challenges for areas that do not have a local SANDS group. In addition, the process of review, feedback and improvement were discussed, with 10/13 units confirming that stillbirths are reviewed within a multi-discipinary team; and all 13 units stating that neonatal deaths are included in regular audit or case review. Figure 13 highlights the responses to the SANDS bereavement standards relating to these areas of the pathway, as listed below:

12.4 All parents whose baby dies are given written details of national and local sources of support and organisations such as Sands, BLISS, the Miscarriage Association, ARC (Antenatal Results and Choices), and the CBC (the Child Bereavement Charity).

13.2 All bereaved mothers attending the unit for a postnatal check-up are invited to wait in a separate waiting area, away from other mothers and babies.


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13.3 There is a fail-safe system for making sure that all staff who see a bereaved mother at her postnatal check-up know that her baby has died.

14.1 A mother whose baby has died, and her partner, are always offered extra support and monitoring in each subsequent pregnancy.

15.1/2 Staff can always call on a professional interpreter when a problem is identified in the antenatal clinic or ultrasound department/ and within the labour ward

17.1 There is a designated member of staff who is responsible for overseeing and co-ordinating the whole experience of care for parents whose baby dies – from the moment the death is suspected or confirmed until the parents leave the unit.

17.2 There is a designated member of staff who is responsible for monitoring maternity unit systems, policies and protocols to ensure that they are consistent and ensure the best possible care for all parents.

17.3 The unit has formal and informal ways of getting feedback on the care that bereaved parents have received through, for example, local support groups and interviews with individual parents.

18.1 All stillbirths are reviewed in a multi-professional meeting using a standardised approach to analysis for sub-standard care and means of future prevention. The results of the discussion are recorded in the mother’s medical notes and discussed

18.2 All neonatal deaths are included in regular audit/ case reviews. Fig 13: SANDS bereavement standards 12.4 – 18.2

12.4 13.2 13.3 14.1 15.1/2 17.1 17.2 17.3 18.1 18.2

SWMMNN 5/5 2/3 3/5 4/5 5/5 4/5 4/5 5/5 4/5 5/5

HEFT

Wye Valley

Worcs Acute NR

SWBH

BWH NR

SSBCMNN 4/4 1/2 2/3 4/4 4/4 3/4 3/3 1/3 2/4 4/4

RWH NR

DGOH

SATH

UHNM

CNN 4/4 3/3 3/3 3/3 3/3 1/3 4/4 2/4 4/4 4/4

UHCW NR

George Eliot

Burton

South Warwick

NR = Never return – Mothers are not invited back for postnatal checks within the hospital – they are done at home or at the GP surgery


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Additional areas of discussion During the stakeholder meeting, 3 further areas of discussion were raised and information gathered accordingly, as presented in Figure 14. The units for whom responses are recorded are those who were present in the discussions at the time and as such omissions are no reflection on the units concerned. Additional areas of discussion were:

1. Variation in gestation accepted within the midwifery bereavement service. As can be seen by Figure 14, this ranges from 12/40 at the lowest to 22/40 at the highest within UHCW, with an average gestation acceptance of 16 weeks.

2. Secondly, discussions around the variation in acceptance for the bereavement leads to do home visits – with 4 of the units asked still continuing this area of good practice, and 4 others unable to do so.

3. Lastly, discussions around SANDS involvement continued from section 4, with the majority of units discussing the benefits they receive of strong links with their local group.

Fig 14: Additional discussion information

Gestation criteria for service

Home visits service available

SANDS group attendance

Worcestershire Acute 12/40 Yes No SANDS group in

Worcestershire

Sandwell and West Birmingham 16/40 No Links with Birmingham

SANDS

Birmingham Women's Hospital 16/40 No Excellent links with

Birmingham SANDS

Royal Wolverhampton Hospital 16/40 Yes Yes

Dudley Group of Hospitals 20/40 No No

University Hospital of North Midlands 12/40 if TTOP No Yes

University Hospital of Coventry & Warwick 22/40

Yes Excellent links with Coventry SANDS

South Warwickshire Hospital 20/40 Yes No attendance but

strong links

Conclusion The West Midlands SCN bereavement audit provided a sound base on which to begin discussions around the variation in practice of bereavement care across the region. Almost all areas of this care pathway have pockets of good practice and equally gaps in provision, in differing units. The networking and stakeholder event provided a launch forum for discussions around the findings of the audit and the beginnings of sharing, learning and peer development and support.


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Fundamentally, all stakeholders were keen to engage on a journey of improvement, eager to further investigate bereavement care and work towards a standardised, fair and consistent service for our families.

Further actions Southern West Midlands and Staffordshire, Shropshire and Black Country Operational Delivery Networks (ODNs) have both agreed to host and support an ongoing bereavement lead subgroup, to continue to interrogate the audit and other areas of improvement within this speciality. Central Newborn Network, although not a maternity network, have also agreed to support their bereavement leads in working together to improve services. Each of these subgroups will meet and create its own objectives for the future. Listed below are some recommendations for inclusion in these objectives, as highlighted within this report. These areas for further work are not exhaustive; and all improvement planning should be done with the full audit information, as available in Appendix 1.

A consistent approach to training, with standard methods of e-learning and a West Midlands wide recommendation on what training and education should be followed; to cover all roles who come into contact with bereaved families

Shared training for all Bereavement Leads in how to effectively support staff who are dealing with bereavement

Inclusion of bereaved parents within training programmes

All units to assess the 24/7 cover they provide and how they can utilise and develop existing staff/ roles to provide out of hours specialised bereavement support

Units to continue to network together; and to visit and view each other’s bereavement rooms/ layout in order to share and learn.

Sharing and agreement of a standard bereavement communications checklist and process

Consideration of location of post mortem meetings

Consistent West Midlands wide approach to gestation acceptance criteria for maternity bereavement services

Review the ability of units to home visits, with the view to offer all patient equitable services

The Strategic Clinical Network is satisfied with its assessment of bereavement services and that continued improvements will rest within the ODNs. Any recommendations for future work from the SCN are listed below:

Collate together future improvements and work completed by ODNs with a goal for consistent care across the 3 ODN geographies

Host annual bereavement event, bringing together bereavement leads, charities and parents for sharing of good practice


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Produce recommendation document for Trusts around what a gold standard bereavement service would look like within their units; enabling the ODNs to report on any unacceptable levels of provision

Please note there is no schedule or requirement for this work to be carried out by the SCN at this stage and communications will continue between the SCN and the ODNs around bereavement care as part of collaborative working, whilst subgroups and improvement plans are established.


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RespondentID Trust Site/s Completed by

Has your Trust completed the SANDS bereavement audit tool?

Please give the approximate date of most recent completion:

What areas did the tool identify as areas of best practice within your organisation?

What areas for improvement or gaps were highlighted?

Do you have an electronic version of the audit - or a presentation/ summary of the results?

3771562883 heart of england foundation trust

Good hope, Heartlands, Solihull clare beesley Yes 2012/13

continity of care, bereavement team work, training and education, working closely with local charities and support groups.

support for staff Bereavement key workers cross sites environment Yes

3763153265 worcestershire Acute hospitals NHS Trust

Worcestershire Royal Hospital, Alexandra Hospital, Redditch Trudy Berlet No

Not yet formally completed it within the trust

3758570131 University Hospital of North Midlands Royal Stoke Sarah Lake No

Currently in the process

3755019037 UHCW Coventry S CARTER No

3738907751 UHCW Women and Childrens sam collinge No

I have downloaded it and looked at what we should be doing but havent yet formally completed it

3754957067

SANDWELL AND WEST BIRMINGHAM HOSPITALS CITY HOSPITAL

ANN MINTO/MARY MOLLOY No

3749275657 South Warwickshire Foundation Trust Maternity Yvonne Hood No

3748003287 Wye valley NHS Trust hereford County Hospital

Andrea Walker Yes 12/01/2014 Information for parents Policy

Bereavement lead Training Environment-no dedicated areas post mortem PN support for parents No

3747387933 george eliot hospital maternity emma bennett No

3743931977 Dudley Group of Hospitals

Russells Hall Hospital

Beverley Paterson Yes 21.12.14

All staff trained to care for bereaved families. Support for staff and families.

Dedicated bereavement room Yes

Appendix 1: Full audit results


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3741148948 Birmingham Womens Edgbaston Karen Henson Yes 2012

Care after birth/post mortem examinations/registration/funerals Written back up information/ a seamless process of care

Care for parents with hearing or visual imparements. parents whose first language is not english No

3740988524 Queens Hospital Foundation Trust Burton on Trent

Samantha Evans Yes 2013 2013 Section 3, 4, 5, 6, 7, 9, 10, 18

Section 8,11, 12, 14, 15, 16, No

3738568575

Royal Wolverhampton Hospitals

New Cross Hospital Wolverhampton Carole Sadler No

3738468333

Shrewsbury and Telford Hospital NHS Trust

Princess Royal Hospital

Jan Latham Bereavement Midwife No

RespondentID What staff (roles and WTE) are designated specifically to bereavement care within your Trust?

How do these roles interact with bereaved families on neonatal unit?

Is there 24/7 designated bereavement care? (If not, please indicate what is available)


1 x band 7 wte bereavement midwife, 1 x band 6 wte and nominated key workers who cover the bereavement unit.

If care is withdrawn on a baby care is offered on our bereavement unit, interaction is led by the neonatal unit but is something that we would like to imporve. yes


Bereavement Support Midwife 37.5 WTE Bereavement Officer 37.5 WTE on each site Provide support to families and liase with staff

No, bereavement support midwife and officer monday- friday but information and packs available in each area and also bereavement links in each area with knowlwdge. Also guidelines and policies in place. There is 24hr Chaplincy support which have an excellent knowledge base about choices.

3758570131 University Hospital of North Midlands Bereavement Specialist Midwives 1WTE Minimal interaction with families on NNU.

Bereavement Midwives 1 WTE(Mon-Fri 08:30 - 16:30). Both work clinically on Delivery Suite as well so are available at other times. Bereavement care and support provided by delivery suite midwives and details passed to bereavement midwife if required.

3738907751 UHCW

My role as bereavement support specialist midwife - 22hrs and my colleague who is supporting the role - 16 hrs

Our role is to support families following stillbirt, late fetal loss and neonatal death

Not care from the specialist midwife (please see response to Qu 5)midwives/nursing/medical staff support women and their families clinically 24/7

3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS

2 X Bereavement support midwives. 1xband 7, 30hrs per week 1xband 6, 22.5hrs per week.

To offer support to parents who are/ or may be become Bereaved.

The Bereavement support midwives cover 5 days per week, this can include weekends and Bank holidays. Designated Bereavement links x 7 on delivery suite.

3749275657 South Warwickshire Foundation Trust

Bereavement Midwife Clinical lead SCBU Perinatal psychology

Clinical lead from SCBU and bereavement midwife would visit at home

No, all midwives are updated on bereavement care and bereavement midwife employed 1to 2 days per


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week

3748003287 Wye valley NHS Trust One senior midwife is identified as lead but has o dedicated hours not at all

the Senior mdwives are responsible and have had extra infoirmation and support

3747387933 george eliot hospital none designated not midwifery only hospital bereavement centre


Lead Midwife for Bereavement and two Band 6 midwives are on Bereavement team but no staff member is exclusively for bereavement.

Neonatal Staff interact with bereaved families on Neonatal Unit with midwifery input when required or requested.

No. Bereaved families provided one to one midwifery care whilst in hospital. Bereavement support provided by Chaplains when discharged from hospital.

3741148948 Birmingham Womens

3 wte Bereavement/spiritual care manager, bereavement specialist midwife and pa to bereavement services

There is little difference in what the staff provide, but in terms of bereavement care, families , generally do not stay at the hospital, therefore we do not get to spend as much time with them.

No. Our service is Mon- Fri 8- 4.30, occasional bank holidays so the service is covered.

3740988524 Queens Hospital Foundation Trust

Joanne Shillito (Bereavement Midwife) Samantha Evans (Bereavement Midwife)

This is dependant upon referral. If the bereavement team are awre, we will given input and support.

The bereavement team cover 30 hours per week over four office days. The bereavement team also work as clinical Midwives to completes full time hours so are usually around on the unit at some point.

3738568575 Royal Wolverhampton Hospitals Specialist \midwife for Bereavement Services (SMBS) Visit families within the unit/at home

SMBS is a full time post. All women are cared for on delivery suite 24/7

3738468333 Shrewsbury and Telford Hospital NHS Trust 1 WTE Midwife

Both Consultants and Nurses on NNU inform Bereavement Midwife when Neonatal Death occurs and will go and meet family No. Bereavement support Mon-friday 9-5

All staff have had training and support to

enable them to care sensitively and

confidently for parents whose baby is dying or

has died.

What bereavement training is used and for which professionals?

Response Comments

SANDS guidelines for professionals - Midwives

SANDS guidelines for professionals - Senior Midwives

SANDS guidelines for professionals - Bereavement Leads

SANDS guidelines for professionals - Doctors

SANDS guidelines for professionals - Sonographers

SANDS guidelines for professionals - Health Care Assistants

ODN's Advanced Communications Training - Midwives

ODN's Advanced Communications Training - Senior Midwives

ODN's Advanced Communications Training - Bereavement Leads

ODN's Advanced Communications Training - Doctors

ODN's Advanced Communications Training - Sonographers

ODN's Advanced Communications Training - Health Care Assistants

3771562883

heart of england foundation No

we are continuing to ensure Midwives

Senior Midwives

Bereavement Leads Doctors

Health Care Assistant



21

trust this takes place by offering a roling programme of training in bereavement

s

3763153265

worcestershire Acute hospitals NHS Trust No

Area that needs to be developed Midwives

Senior Midwives

Bereavement Leads

3758570131

University Hospital of North Midlands No

On going training sessions on a monthly basis for staff. Also bereavement now included on mandatory training days. Midwives

Senior Midwives

Bereavement Leads

3738907751 UHCW Yes

All new staff/juniour doctors/student midwives/neonatal students have a session from me regarging their role in the care of parents and their baby midwives get an hour and a half mandatory update per year Midwives

Senior Midwives


Sonographers

Health Care Assistants

3754957067

SANDWELL AND WEST Yes On going Midwives

Senior Midwive

Bereavement Doctors

Sonographers

Health Care


22

BIRMINGHAM HOSPITALS

s Leads Assistants

3749275657

South Warwickshire Foundation Trust Yes Midwives

Senior Midwives

3748003287

Wye valley NHS Trust No

Now included in professional update day-lead by senior midwife

3747387933

george eliot hospital No

no specific training provided Midwives

Senior Midwives

3743931977

Dudley Group of Hospitals No

Training commencing in February for midwives, HCA and student midwives. Midwives

Senior Midwives

Bereavement Leads


3741148948

Birmingham Womens No Midwives


3740988524

Queens Hospital Foundation Trust No

Bereavement support electronic training is mandatory for all Midwives new to the Trust but most midwives were in post before this was mandatory and, therefore Midwives

Senior Midwives


Sonographers



23

have not completed.

3738568575

Royal Wolverhampton Hospitals Yes Midwives

Senior Midwives


Sonographers


3738468333

Shrewsbury and Telford Hospital NHS Trust No

In-house Training - Midwives

In-house Training - Senior Midwives

In-house Training - Bereavement Leads

In-house Training - Doctors

In-house Training - Sonographers

In-house Training - Health Care Assistants

None - Midwives

None - Senior Midwives

3771562883 heart of england foundation trust Midwives

Senior Midwives

Bereavement Leads Doctors Sonographers


3763153265 worcestershire Acute hospitals NHS Trust Midwives

Senior Midwives


3758570131 University Hospital of North Midlands Midwives

Senior Midwives

Bereavement Leads


3738907751 UHCW Midwives Senior Midwives



3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS Midwives

Senior Midwives




24

3749275657 South Warwickshire Foundation Trust Midwives

Senior Midwives

3748003287 Wye valley NHS Trust Midwives Senior Midwives


3747387933 george eliot hospital

3743931977 Dudley Group of Hospitals Midwives Senior Midwives

Bereavement Leads


3741148948 Birmingham Womens Midwives Doctors

3740988524 Queens Hospital Foundation Trust Midwives

Senior Midwives



3738568575 Royal Wolverhampton Hospitals Midwives

Senior Midwives



3738468333 Shrewsbury and Telford Hospital NHS Trust Midwives Sonographers

If other please expand

None - Bereavement Leads

None - Doctors

None - Sonographers

None - Health Care Assistants

Other (please state) - Midwives

Other (please state) - Senior Midwives

Other (please state) - Bereavement Leads

Other (please state) - Doctors

Other (please state) - Sonographers

Other (please state) - Health Care Assistants Open-Ended Response


rachel haydon photography training.

3763153265

worcestershire Acute hospitals NHS Trust

Health Care Assistants Training isnt formalised or specific

3758570131 University Hospital of North Midlands

3738907751 UHCW Midwives Senior Midwives



I use a combination of guidelines for good practice inc SANDS, Child bereavement UK and training packages I have developed over the years that include local information and guidance


25

3754957067

SANDWELL AND WEST BIRMINGHAM HOSPITALS


3748003287 Wye valley NHS Trust


3747387933 george eliot hospital

3743931977 Dudley Group of Hospitals Doctors Sonographers

3741148948 Birmingham Womens Neonatal nurses


3738568575

Royal Wolverhampton Hospitals

3738468333

Shrewsbury and Telford Hospital NHS Trust


26

Trust

How is "Care of the Caregiver" managed within your organisation? What support is in place for staff dealing with emotional strain of handling bereavement, including handling of clinical governance investigations?

When there is time, parents are always offered opportunities to plan the birth and

how they would like it to be handled.

Once she is in established labour, every woman has an experienced

midwife who looks after her throughout her labour and birth.

Less experienced midwives are given opportunities to care for women alongside

experienced midwives in order to develop their skills and confidence.


peer support but really needs developing Yes Sometimes

This is the ideal but realistically on a very busy high risk labour ward this doesnt always happen which is why we are keen to develop and support junior midwives Sometimes

Again this is something we aim for but can be difficult on busy labour ward. we encourage students to work on our bereavement unit and junior midwives.


Supervision, debriefs, round table, senior midwife support and disscussion with bereavement support midwife. Bereavement support midwife has clinical supervision independantly outside of trust Yes Yes Yes

Bereavement support midwife and senior midwives provide support.

3758570131 University Hospital of North Midlands

Bereavement midwives offer support to staff involved. Yes Sometimes

Ideally if an inexperienced midwife is allocated to care for the family, an experienced midwife would be allocated as support. Yes

3738907751 UHCW

Supervision of midwives, occupational health, one to one support from myself and the hospital chaplain, drop in staff support sessions debreifing sessions organised by the neonatal unit and table top/root cause analysis meetings every death is reviewed by the risk team and Yes

it is offered by myself and I will visit the family at home if desired- a robust managemant plan is made and neonatal team are involved and will offer counselling as appropriate Yes

when delivering training i actively encourage the midwives to involve junior staff/students and I encourage the students/juniors to speak up when there has been a loss and ask senior midwives if they Yes

please see response to question above - in addition to the session they get from me at Uni - i encourage the student midwives to spend a morning with me towards the end of their training in order to familiarise themselves with the bereavement documentation, creating memories, - in order to


27

discussed at the weekly clinical adverse event meeting

can be involved in the care

build their confidence - I also take them to the mortuary

3754957067

SANDWELL AND WEST BIRMINGHAM HOSPITALS

Bereavement support Midwives SOMs Trust Bereavement officer Risk lead Chaplains HOM Yes Most of the time. Sometimes

Depends on work load and Delivery suite skill mix.


supervisor of midwives clinical psychology governance midwife Yes Sometimes Sometimes

3748003287 Wye valley NHS Trust

Unfortunately we have no dedicated person although the senior midwife tries to suppotr. The lead for bereavement will go through cases and support staff Sometimes Sometimes

Not always an experienced midwife but if the midwife is junior he/she will be well supported by senuor midwife Yes

3747387933 george eliot hospital quality o fcare reviews / debriefis Yes Yes Yes


Support is provided by Lead Midwives, Supervisors of midwives and Lead midwife for bereavement. Chaplaincy support. Counselling can be arranged if required. Yes Yes Yes

3741148948 Birmingham Womens

Support is offered by managers/ supervisors of Midwives/ other midwives/ nurses and Bereavement team will offer debriefing sessions Yes Sometimes Sometimes


Supervision and support from Bereavement Midwives, (although we have had no training on supporting staff). Yes Yes Yes


28

3738568575 Royal Wolverhampton Hospitals

Support from SMBS for staff. SMBS has access to counselling services in the community setting Yes Yes Yes

SMBS works with newly qualified midwives where possible

3738468333 Shrewsbury and Telford Hospital NHS Trust Yes

Trust

There are one or more dedicated rooms on the labour ward with en suite toilets

and showers for mothers whose baby has died or will die, where they cannot hear

other mothers and babies.

Tell us about where you care for these mothers during labour

Tell us what rooms you have available for these families for after birth?

Each dedicated room has a double bed (or an extra

single bed) so that the mother’s partner or companion can stay

overnight

There are enough of these dedicated rooms for the number of late

miscarriages, stillbirths and neonatal deaths in this unit

3771562883 heart of england foundation trust No

We have this on our bereavement unit but high risk ladies or over 24/40 will be cared for on delivery suite, were are unable to have a dedicated room due to capacity issues although we have a room we try and keep free. As a trust we knoew this is totally unacceltable but we are working hard to ensure that with the new reconfiguration of heartlands that we have the ideal facilities this is going to be a 4 bedded all ensuite bereavement unit with its own access.

below 24 weeks bereavement units over 24 weeks delivery suite

bereavement unit, 2 beds on each site with ensuite and a quiet room. Yes Sometimes

with reconguration at heartlands this issue will be addressed

3763153265 worcestershire Acute hospitals NHS Trust Sometimes

the room in which labour happens, babies can be heard and the room in which they go afterwards is quiet. There has been minimal occasions when room is not available

Designated room on delivery suite at the end of the corridor with an alternate access and close to the bereavement suite

1 labour ward bereavement suite 1 bereavement suite opposite neonatal unit 1 bereavement room on gynaecology ward Yes

labour ward and neonatal unit does Sometimes


29

3758570131 University Hospital of North Midlands Yes

In most applicable environment for the mothers physically condition - ie mother with a massive haemorrhage would be cared for in HDU on Delivery Suite. However the majority of families are cared for in the designated rooms.

Families stay in the designated bereavement suite until discharge. Yes Sofa bed Sometimes

Occasionally a quiet room on delivery suite may need to be used.

3738907751 UHCW No

No sadly not - we have 4 bereavement rooms on the post natal ward but baies can still be heard - there is no dedicated room on labour ward

on gynae ward up to 21 wks and labour ward from 22 wks

please see response to Qu 15 Yes Yes

It is unusual to have all 4 rooms full but this is because a large number of women are cared for on Gynae ward

3754957067

SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes

Designated 1 room on delivery suite, Jasmin Suite,

Once delivered the family stay in the Jasmin suite. Yes No

3749275657 South Warwickshire Foundation Trust Yes

early labour in bereavement suite on labour ward on en suite room once established bereavement suite Yes Yes

3748003287 Wye valley NHS Trust No All our delivery rooms do have en suite facilities On the main delivery suite.

The main delivery suite rooms Yes

A fold away bed is always supplied for the birth partner to stay No

3747387933 george eliot hospital Sometimes

we have one room on labour suite but if unit is busy then there is the risk that other mothers can be heard Yes Sometimes

3743931977 Dudley Group of Hospitals No Only LDRP rooms available.

A room has been designated for bereaved families on Delivery suite and decorated to be less clinical. Private shower and toilet. Screens to seperate delivery bed from private seating area.

Remain in the same room and clinical equipment removed. No

Two couches and 2 chairs. Sometimes


30

3741148948 Birmingham Womens No

We have 2 designated rooms with en-suite facilities, and a family room. the rooms are situated on D/S, and some families have commented thjat they can here other mothers and new babies unfortunately Same as above Yes Sometimes

We are a very large unit and it has been know to have more than 2 families on the department at the same time. a delivery room is then used.

3740988524 Queens Hospital Foundation Trust Yes

One designated room off of delivery suite with en suite facilities. One multi functional room at the end of delivery suite to be used as bereavement room if the first room is in use, also with en suite.

They remain in the same rooms and never go to the postnatal ward. No

We have one extra single bed and one recliner couch Sometimes

3738568575

Royal Wolverhampton Hospitals Yes

We have two bereavement rooms away from main labour ward Bereavement rooms

Our bereavement rooms are en suite and self contained families can staty there for as long as they wish Yes Sometimes

Most of the time the two rooms enough. The neonatal unit also have parent flats that are used by bereaved parents

3738468333

Shrewsbury and Telford Hospital NHS Trust Yes

Dedicated room off the antenatal ward. Yes

2 rooms with a double bed, one on the labour ward the other on antenatal ward Yes


31

RespondentID Trust

All staff are able to offer parents opportunities to see and hold their baby and to create

memories.

Partners and other family members are always able to get food and hot drinks (even if only from

a machine) 24 hours a day.

There are toilets and washing facilities for both male and female partners and other family

members near the labour ward.

Open-Ended Response Response Comments Response Comments Response Comments

3771562883 heart of england foundation trust Yes Yes Yes will use bereavement unit wherever they are

3763153265 worcestershire Acute hospitals NHS Trust Yes Yes Yes

3758570131 University Hospital of North Midlands Yes Yes Yes

3755019037 UHCW

3738907751 UHCW Yes Yes Yes

3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes Yes Yes

3749275657 South Warwickshire Foundation Trust Yes Yes Yes

3748003287 Wye valley NHS Trust Yes Always if its the parents wish Yes No

3747387933 george eliot hospital Yes Yes Yes

3743931977 Dudley Group of Hospitals Yes Yes Yes

Private bathroom in room. Public toilets if family does not wish to use facilities in room. Can use another room for showering if they wish to do so.

3741148948 Birmingham Womens Yes Yes

3740988524 Queens Hospital Foundation Trust Yes No

Hot food is not available over night except for toast. Resteraunt is available 0730 until 1930. Yes

3738568575 Royal Wolverhampton Hospitals Yes Always Yes Yes

3738468333 Shrewsbury and Telford Hospital NHS Trust Yes Yes


32

RespondentID Trust

The unit has a designated person who always ensures that the mother’s GP and community midwife are accurately informed

of what has happened within one working day: following the

discovery of a serious problem or a fetal abnormality during

pregnancy;

The unit has a designated person who always ensures that the mother’s GP and community midwife are accurately informed of what has

happened within one working day: following a late miscarriage

The unit has a designated person who always ensures that the mother’s GP and community midwife are

accurately informed of what has happened within one

working day: following the diagnosis of an IUFD

The unit has a designated person who always ensures that the mother’s GP and community

midwife are accurately informed of what has happened within one working day: following a

stillbirth

Open-Ended Response Response Comment Response Comment Response Comment Response Comment

3771562883 heart of england foundation trust Yes Yes Yes Yes

3763153265 worcestershire Acute hospitals NHS Trust Yes Yes Yes Yes


Fetal medicine department Maybe

written in communication book for next working day. Maybe

this is done by the midwife caring for the family at the time of diagnosis Sometimes

written in communication book for next working day

3755019037 UHCW

3738907751 UHCW Yes Yes

it is the responsibility of the attendingmidwife - the discahrging midwife/ward clerk should check this has been done on the checklist - nb this is the process - if a woman comes via maternity (ie usuallyfrom 22 weeks) - I am not sure what the process is on the gynae ward Yes

per the checklist (as per qu 24) Yes as above

3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS No

The Midwife who transfers the care of the women into the community, will inform the GP and CMW. Yes As above Yes As above

3749275657 South Warwickshire Foundation Trust Yes Maybe Maybe Sometimes

3748003287 Wye valley NHS Trust No

Bereavement check list ensures all relevant persons notified No



Bereavement check list ensures all relevant persons notified

3747387933 george eliot hospital Sometimes Maybe Maybe Sometimes

3743931977 Dudley Group of Hospitals Yes Screening midwife. No Midwife who provides care. No

Midwife who provides care. Yes Ward Clerk.

3741148948 Birmingham Womens Yes Yes Yes Yes


33

3740988524 Queens Hospital Foundation Trust No Maybe

There is no designated person, but this responsability lies with the midwife caring for the mother to ensure that this is done. Maybe

There is no one designated person, this is the responsability of the midwife caring for the mother to do or ensure that it gets done Sometimes

Again, not one designated person, this falls to the midwife caring for the patient to ensure that this is done

3738568575 Royal Wolverhampton Hospitals No Yes This is done by our ward clerks Yes SMBS Sometimes Not always within one working day

3738468333 Shrewsbury and Telford Hospital NHS Trust Yes Yes Yes

RespondentID Trust

The unit has a designated person who always ensures that the mother’s GP and community midwife are

accurately informed of what has happened within one working day: following a

neonatal death in the maternity unit.

The antenatal clinic staff are always informed of the

baby’s death.

Any remaining antenatal appointments are always

cancelled.

The maternity unit has a comprehensive list of other likely departments that may need to be informed that the

baby has died. All the relevant departments

are always informed.

Open-Ended Response Response Comment Response Comment Response Comment Response Comment Response Comment

3771562883 heart of england foundation trust Yes Yes Yes Yes

curently been updated. Needs to be reviewed regualry to make sure up to date. Yes

3763153265 worcestershire Acute hospitals NHS Trust Yes Yes Yes Yes Yes

3758570131 University Hospital of North Midlands No

depends on where nnd occurs Yes Yes Yes Yes

3755019037 UHCW

3738907751 UHCW Yes as per checklist Yes

all scans/ antenatal appointments are cancelled as per checklist Yes

yes please see qu 28 Yes Yes

they shoild be informed as per checklist


34

3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes

CMW informedif appropriate Yes Yes Yes Yes

3749275657 South Warwickshire Foundation Trust Maybe Yes Yes Yes Yes

3748003287 Wye valley NHS Trust No




Bereavement check list ensures all relevant persons notified Yes

Bereavement check list ensures all relevant persons notified

3747387933 george eliot hospital Yes Yes Yes Yes Yes

3743931977 Dudley Group of Hospitals Yes Midwife who provides care. Yes

Midwife who provides care and ward clerk. Yes Yes Yes

3741148948 Birmingham Womens Yes Yes Yes Yes Yes

3740988524 Queens Hospital Foundation Trust Maybe

As above, not one designated person but it is the midwife who cares for the mother to ensure that this is done Yes Yes Yes Sometimes

If the mother has other children, the Health Visitor is not always made aware.

3738568575 Royal Wolverhampton Hospitals Maybe

Ward clerk on NNU not always within 1 working day Yes Yes Yes Yes

3738468333 Shrewsbury and Telford Hospital NHS Trust Yes Yes Yes Yes


35

RespondentID Trust

All parents whose baby dies are offered a post

mortem.

All staff who seek consent/ authorisation for a post mortem are trained to do so, understand

what a post mortem entails, understand the benefits of a post mortem, and are able to answer

parents’ questions.

All parents are offered written back-up

information about post mortems that is

specifically suitable for a perinatal death.

All parents who have consented to a post mortem are able to discuss the results with a senior member of staff

within twelve weeks of the birth.

Tell us where your post-mortem results meetings take place

All parents whose baby is stillborn, or was born alive and then died, are

given verbal information about

how, when and where to register the stillbirth or the birth and death

of their baby.

Open-Ended Response Response Comments Response Comments Response Comments Response Comments

Open-Ended Response Response Comments

3771562883 heart of england foundation trust Yes Yes Yes

sans pm leaflet Yes

depending on consultant it will either be back on the bereavement unit if that is ok with the family or in gyna outpatients Yes

3763153265

worcestershire Acute hospitals NHS Trust Yes Yes Yes Yes

antenatal clinic, doctors office, maternity seminar room or room in education centre Yes

3758570131

University Hospital of North Midlands Yes Yes Yes Sometimes

Not always this time scale

Counselling room in ANC accessed through a corridor in EPU Yes

3755019037 UHCW


36

3738907751 UHCW Yes Sometimes

this is a training issue - we are reviewing the training that the doctors receive re taking consent - a BWH pathologist is assisting us with the training Yes Yes

usually though some consultants struggle to see patients within the timescale

in a dedicated counselling room which is away from the clinical area with myself and the Obstetrician and also Neonatal Consulatant if appropriate Yes

3754957067

SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes Yes Yes Sometimes

3-4 months, parents are made aware of this on discharge home.

Separate building from maternity, within City Hospital. Yes

3749275657

South Warwickshire Foundation Trust Yes Yes Yes Sometimes

In a private room within the hospital Yes

3748003287 Wye valley NHS Trust Yes Sometimes

medical staff at present gain consent for PM but it maybe not most apporpriate Yes

SANDS PM consent booklet Yes

In the clinic in a spare room the consultant finds Yes

3747387933 george eliot hospital Yes Yes Yes Sometimes usually 16 weeks

private room in maternity Yes

3743931977 Dudley Group of Hospitals Yes Yes Yes Yes

Private room outside of Maternity Unit with Consultant Obstetrician. Yes

3741148948 Birmingham Womens Yes Yes Yes Yes

Quiet room near Bereavement Yes

3740988524 Queens Hospital Foundation Trust Yes Yes Yes Sometimes

Most of the time but this is dependant upon whrn the final report is available

In the "quiet room", a comfortable meeting room, set off of delivery suite. Yes


37

3738568575

Royal Wolverhampton Hospitals Yes Yes Yes Yes

In consultants office in gynae outpatients Yes

3738468333

Shrewsbury and Telford Hospital NHS Trust Yes Yes Yes Yes

Dedicated Quiet room within the hospital Yes

RespondentID Trust

All parents whose baby is stillborn, or was born alive and then died,

are given written information about how, when and where to register the stillbirth or the birth

and death of their baby.

All staff are able to give the parents verbal information about the funeral

arrangements that the hospital offers.

A well-informed member of staff monitors the quality of contract

funerals at least once a year.

Please tell us what your Trusts policy covers in terms of funded funerals and whether there are any plans for this to change imminently

Open-Ended Response Response Comments Response Comments Response Comments Open-Ended Response


under 16 weeks monthly cremation service at local crematorium that all familes can attend if they wish. Over 16 weeks individual funeral service, council owned graves and also hospital owned graves are purchased when we errect headstones on behalf of the families. Or cremation service with choice to collect or scatter ashes. We have a flexible service to meet the needs of the individual family

3763153265 worcestershire Acute hospitals NHS Trust Yes Yes Yes

Each family that has had a loss over 12 weeks are offered individual cremation or burial, choice of whether they wish to attend or not, chaplincy support available. no plans to change at present

3758570131 University Hospital of North Midlands Yes Sometimes

Depends on experience No

unaware that this happens

Burial or cremation at local crematorium - shared grave/ashes scattered or returned to family. Funeral director with casket and transport. Option of upgrading these to facilitate own wishes being responsible for any extra incurred costs.

3755019037 UHCW


38

3738907751 UHCW Yes

we now have a registrar on site once a week in order that parents may register the death at the hospital Sometimes

they are all given the information at mandatory training but we also have a parent information leaflet Yes

all families are offered a burial in a shared grave or a cremation - free of charge if parents wish to purchase their own plot - they pay the current cost of £400 to Coventry city council (rugby plots are free) - they are not charged for the funeral

3754957067

SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes Yes Yes

Via our CARES office and BSMW.

Choice of Cemetries/ Crematoriums within the Birmingham and Sandwell area. Individual plots in the Sandwell area Offer of Muslims plots. Coffin with name plate, Funeral car. Hospital Chaplain/priest/ minister/imaam. Contract is renewed on a regular basis

3749275657 South Warwickshire Foundation Trust Yes Yes Yes

All women over 20/40 are offered contracted funerals either cremation or buiral.All costs are met except cars for families and flowers

3748003287 Wye valley NHS Trust Yes Yes Yes

The funded service offers babies of all gestations (if the parents request under 18 weeks) burial or cremation in local crematorium with a designated area for under 16s-a well maintined garden of remembrance. The coffin, transport and personnel are also provided within the contract


3743931977 Dudley Group of Hospitals Yes Yes

Chaplains tend to deal with this information but all staff have basic information. Yes

The Trust will fund all funerals when parents use the contracted Funeral Directors.

3741148948 Birmingham Womens Yes No Yes Both burial ans cremations

3740988524 Queens Hospital Foundation Trust Yes Sometimes Sometimes

NVF deaths: We fund a monthly cremation and funeral service. Stillborn and NND: We provide funded burial or cremation for all faiths.

3738568575 Royal Wolverhampton Hospitals Yes Yes Yes Bereavement Office

We fund both burials and cremations. No plans to change

3738468333

Shrewsbury and Telford Hospital NHS Trust Yes Yes


39

RespondentID Trust

All parents whose baby dies are given written details of national and local sources of support and

organisations such as Sands, BLISS, the Miscarriage Association, ARC (Antenatal Results and Choices),

and the CBC (the Child Bereavement Charity).

All bereaved mothers attending the unit for a postnatal check-up are invited to wait in a separate waiting area, away from other mothers and babies.

There is a fail-safe system for making sure that all staff who see a bereaved mother at her postnatal

check-up know that her baby has died.

Open-Ended Response Response Comments Response Comments Response Comments


all consultants are emailed about the follow up and most run specific pregnancy loss clinics

3763153265 worcestershire Acute hospitals NHS Trust Yes Yes Never return for post natal checks Yes

3758570131 University Hospital of North Midlands Yes Sometimes

Majority see own GP. Arrangements can be made for follow up of 3rd degree tears etc. No

Attempts are made but not a fail safe system.

3755019037 UHCW

3738907751 UHCW Yes they have their check up at the Gp practice so do not return to hospital see qu 43

3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes Yes Rarely Yes

3749275657 South Warwickshire Foundation Trust Yes Yes

All PN checks done in mothers own home once discharged or in bereavement suite whilst inpatient Yes

3748003287 Wye valley NHS Trust Yes Sometimes Sometimes


3743931977 Dudley Group of Hospitals Yes Yes Yes


40

3741148948 Birmingham Womens Yes

No mothers are invited to return to the hospital , unless requested by mother Sometimes

3740988524 Queens Hospital Foundation Trust Yes Yes Yes

3738568575 Royal Wolverhampton Hospitals Yes

Bereaved mothers requiring a postnatal check are seen at home. We do not bring them back into the unit. Yes

This information is contained within the printout to the community midwife and

3738468333 Shrewsbury and Telford Hospital NHS Trust Yes

RespondentID Trust

A mother whose baby has died, and her partner, are always offered extra support

and monitoring in each subsequent pregnancy.

Staff can always call on a professional interpreter

when a problem is identified in the

antenatal clinic or ultrasound department/

and within the labour ward

Tell us what onward bereavement or counselling services are available to your families once they have left the hospital; and what signposting or aftercare is provided by your team, if any

Open-Ended Response Response Comments Response Comments Open-Ended Response

3771562883 heart of england foundation trust Sometimes

This is something we are keen to develop to ensure we do this for all families not those who actively seek it. Yes

sands support groups, councellor who will se families and they always have support from us unti lthey decide otherwise.

3763153265 worcestershire Acute hospitals NHS Trust Yes Yes

Bereavement support midwife, local voluntary organisations and GP provide counselling services, local support groups

3758570131 University Hospital of North Midlands Yes Yes

Support offered by bereavement midwives - telephone support. CMW visits. Signposted to local bereavement counselling or SANDS if necessary.

3755019037 UHCW


41

3738907751 UHCW Yes

a robust managementplan is documented in the notes and a copy of this is sent to the woman and her Gp Yes

the bereavement support specialist midwife (BSSM)is notified of all losses in maternity and on the neonatal unit -the BSSM contacts families by phone and a home visit is offered - the BSSM remains in contact with the family as appropriate until the 10-12 week follow up appointment - and after that time if the family desire - support in a next pregnancy is a big part of the role In addition to this we have strong links with SANDS - who have a monthly evening meeting - and the BSSM and SANDS hold a tri monthly afternoon support group for parents who cannot acces the evening SANDS meeting In addition to this we have a free counselling service provided at the Trust by the Laura Centre who are an established provider of counselling and psychotherapy in Leicester and Derby

3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes Yes

Individual support Monthly support group Sign post/refer to SANDs /Edwards trust /most appropriate groups

3749275657 South Warwickshire Foundation Trust Yes Yes In house refferal made with consent to our perinatal psychology department

3748003287 Wye valley NHS Trust Yes Yes SANDS and Cruse (self referral). GP and HV

3747387933 george eliot hospital Yes Yes clinical psycholgy dept acorn centre

3743931977 Dudley Group of Hospitals Yes Yes Chaplains keep in touch with parents and chaplains are bereavement counselling trained. Sign posted to SANDS, BLISS, Towards Tomorrow Together etc.

3741148948 Birmingham Womens Yes Yes We offer support sessions to out parents. we can sign post our families to many different organisations

3740988524 Queens Hospital Foundation Trust No

If the patient 'self refers' to bereavement midwife, we will provide extra support. Previous stillbirths and NND are also Consaultant Lead in their care so have extra observation. Sometimes

Very little counselling support is available. bereavement Midwives have no training in counselling support. GP's waiting lists are oftern very long or GP's say that our families do not need counselling as they are just bereaved and time will help.

3738568575 Royal Wolverhampton Hospitals Yes

This is reiterated at postnatal appointment with consultant. Contact details are given of the SMBS Yes

Support is provided by way of home visits from the SMBS. Counselling services are accessed via GP.

3738468333 Shrewsbury and Telford Hospital NHS Trust Yes Yes

On going support by the Bereavement Midwife who can perform home visits, no time restarints,Telephone contact details given, Support from other agengies such as SANDS, local childrens hospice offers counselling.


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RespondentID Trust

There is a designated member of staff who is responsible for overseeing and co-

ordinating the whole experience of care for parents whose baby dies – from the moment the death is suspected or

confirmed until the parents leave the unit.

There is a designated member of staff who is

responsible for monitoring maternity unit systems, policies and protocols to

ensure that they are consistent and ensure the best possible care for all

parents.

The unit has formal and informal ways of getting

feedback on the care that bereaved parents have

received through, for example, local support groups and interviews with individual

parents.

All stillbirths are reviewed in a multi-professional meeting

using a standardised approach to analysis for sub-standard care and means of

future prevention. The results of the discussion are

recorded in the mother’s medical notes and discussed

All neonatal deaths are included in regular audit/ case reviews.

Open-Ended Response Response Comments Response Comments Response Comments Response Comments Response


on sands committee, devised feedback leaflet specifically for bereaved families, Yes Yes

3763153265 worcestershire Acute hospitals NHS Trust Yes

Bereavement support midwife Yes

Bereavement support midwife Yes Sometimes Yes


Bereavement midwives oversee where possible Yes No

No formal ways however bereavements midives attend post natal counselling appts and visit local sands for feedback No

Not recorded in notes Yes

3755019037 UHCW

3738907751 UHCW Yes

Usually the consultant Fetal Medicine /Obstetrician/Neonataologist liases with the BSSM and a plan of care and support is made Yes

the BSSM - this is an ongoing part of the role Yes

all aprents are given the opportunity to meet with the consultant for follow up at 10-12 wks- if there are any isues/concerns that need addressing prior to this - a senior midwife/clinician will see them at home if they Yes

The results are not recorded in the maternal notes - they are kept seperatly Yes


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desire

3754957067 SANDWELL AND WEST BIRMINGHAM HOSPITALS Yes Yes

Joint team work. Yes Yes

This information is not stored in the mothers notes, but recorded on a shared data base.Risk lead also stores this information. Yes

3749275657 South Warwickshire Foundation Trust Sometimes Yes Yes Yes Yes

3748003287 Wye valley NHS Trust No No Yes Womens forum Yes Yes

3747387933 george eliot hospital No Yes Sometimes Yes Yes

3743931977 Dudley Group of Hospitals No

Comprehensive checklist. Bereavement team member can be called on to provide information and help. Yes Sometimes Yes Yes

3741148948 Birmingham Womens Yes Yes Yes Yes Yes

3740988524 Queens Hospital Foundation Trust Sometimes

Bereavement midwife will co-ordinate as far as possible Yes No Yes Yes

3738568575 Royal Wolverhampton Hospitals Yes Yes Yes We work with No

We have a monthly perinatal mortality meeting but the results of the discussions are not recorded in the woman's notes Yes

3738468333 Shrewsbury and Telford Hospital NHS Trust Yes Yes Yes


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Alison Davies Quality Improvement Lead West Midlands Strategic Clinical Network [email protected]

Andrea Read Quality Improvement Lead West Midlands Strategic Clinical Network [email protected]

Andrea Walker Bereavement Midwife Wye Valley NHS Trust [email protected]

Beverley Paterson Bereavement Midwife Dudley Group of Hospitals [email protected]

Carole Sadler Bereavement Midwife Royal Wolverhampton Hospital Trust [email protected]

Clare Beasley Bereavement Midwife Heart of England Foundation Trust [email protected]

Elizabeth Choney Administrator West Midlands Strategic Clinical Network [email protected]

Emma Rapley Bereaved Parent N/A [email protected]

Holly Haden Bereavement Midwife Dudley Group of Hospitals [email protected]

James Kennedy Bereaved Parent N/A [email protected]

Jo Shilito Bereavement Midwife Burton Foundation Trust [email protected]

Joan Lilburn Lead Midwife Southern West Midlands Maternty & Newborn Network [email protected]

Julie Ruff Bereavement Midwife Dudley Group of Hospitals [email protected]

Karen Henson Bereavement Midwife Birmingham Women's Hospital [email protected]

Kate Branchett Patient Voice & Insight Lead West Midlands Strategic Clinical Network [email protected]

Kate Burley Network Manager West Midlands Strategic Clinical Network [email protected]

Liz Jennings Bereavement Midwife University Hospitals of North Midlands [email protected]

Mary Malloy Bereavement Midwife Sandwell & West Birmingham Hospitals Trust [email protected]

Nina Gayden Bereaved Parent N/A [email protected]

Ruth Moore Network Director and Lead Nurse Shropshire, Staffordshire & Black Country Maternity & Newborn Network [email protected]

Sam Collinge Bereavement Midwife University Hosiptals of Coventry and Warwick [email protected]

Sam Evans Bereavement Midwife Burton Foundation Trust [email protected]

Sarah Bond Bereaved Parent N/A [email protected]

Simon Jenkinson Obstetric Lead West Midlands Strategic Clinical Network [email protected]

Sonia Saxon Network Director and Lead Nurse Southern West Midlands Maternity & Newborn Network [email protected]

Tony Dinning Network Director Central Newborn Network [email protected]

Trudy Berlet Bereavement Midwife Worcestershire Acute [email protected]

Yvonne Hood Bereavement Midwife South Warwick Foundation Trust [email protected]

Appendix 2: Bereavement Lead meeting attendees

mailto:[email protected]








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WM SCN Maternity Bereavement Audit | NHS Networks

Documents

Transcript of WM SCN Maternity Bereavement Audit | NHS Networks