current initiatives for improving safety for newborns · seen as a signal of sub-optimal care...
TRANSCRIPT
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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Current initiatives for improving safety for newborns
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?
Current initiatives for improving safety for newborns
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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
Current initiatives for improving safety for newborns
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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.
Current initiatives for improving safety for newborns
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Term live births in England (2011-2014) 3.6%
Current initiatives for improving safety for newborns
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Care days for term admissions ( 31%) (>60%)
Current initiatives for improving safety for newborns
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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
Current initiatives for improving safety for newborns
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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
Current initiatives for improving safety for newborns
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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
Current initiatives for improving safety for newborns
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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
Current initiatives for improving safety for newborns
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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
Current initiatives for improving safety for newborns
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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
Current initiatives for improving safety for newborns
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Your role in reducing term admissions
Current initiatives for improving safety for newborns
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Join the Journey!
Current initiatives for improving safety for newborns
@atain7 [email protected]