National Maternity and Perinatal Audit – Intensive Care Report

Health Quality Improvement Programme | January 2019 | National Maternity and Perinatal Audit – Intensive Care Report

This report from the National Maternity and Perinatal Audit (NMPA) focuses on maternal admissions to intensive care in England, Wales and Scotland. The NMPA’s report and the data it holds, provides a unique opportunity to link maternity data, which contain information about the mother, her pregnancy and her baby, to data from national data sets for intensive care admissions.

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The purpose of the report is to describe the feasibility of linking the NMPA’s maternity data to intensive care data and to evaluate the suitability of rates of maternal admission to intensive care as an indicator of care quality. It also describes the demographics of women admitted to intensive care and the reasons for admission.

National Maternity and Perinatal Audit – Intensive Care Report shows that the linkage of maternity data to intensive care data offers the potential to understand the demographic factors underlying admission to intensive care, and the timing of intensive care admission relative to birth (Source: HQIP).

[NICE Consultation] Intrapartum care for healthy women and babies

NICE | January 2019| Intrapartum care for healthy women and babies

A NICE consultation is open on Intrapartum care for healthy women and babies Clinical guideline [CG190]

This guideline covers the care of healthy women and their babies, during labour and immediately after the birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy (‘term’). The guideline helps women to make an informed choice about where to have their baby. It also aims to reduce variation in areas of care such as fetal monitoring during labour and management of the third stage of labour (NICE).

The consultation close on 22 January 2019

Details from NICE 

[Atlas of Shared Learning] Improving the quality of care for neonatal patients

NHS England | January 2019 | Improving the quality of care for neonatal patients

NHS England spotlights a Great Ormond Street Hospital (GOSH) Quality Improvement (QI) project which focused on improving the quality and safety of core care for neonatal patients across the whole Trust, these included: Jaundice care, New Born Bloodspot screening and fluid therapy. 

Due to the specialist care focus at GOSH, neonatal patients can be located across 22 different wards, so their care must be coordinated across wards to deliver the care every newborn baby needs, in addition to the specialist input they receive for their condition.

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The focused work included:

  • Developing, testing and launching neonatal e-learning packages in jaundice and Newborn bloodspots;
  • Streamlining admission processes to ensure staff can access the demographic information required to complete Newborn Bloodspot screening;
  • Helping develop an automated prompt system that alerts the nursing leads when a baby on their ward is eligible for screening, to help reduce the risk of missing patients who need a bloodspot test;
  • Developing a new neonatal care pathway to be used across all wards, prompting staff to deliver neonatal care and screening at the right time;
  • Working with the QI Developers to develop a real-time report to identify where neonates are situated in the hospital using data from the electronic patient information system such as weight and gestation. This improved the Nurse Advisor’s ability to provide specialist care to the most vulnerable neonates;
  • Developing a Trust guideline for the management of neonatal intravenous fluids;
  • Raising awareness of the tenets fundamental neonatal care (British Association of Perinatal Medicine (BAPM) (2010)) (More examples at NHS England)

The project was initiated in response to clinical audit work, which focused on all aspects of neonatal care carried out by the Neonatal Nurse Advisor, Consultant Neonatologist and Clinical Audit Lead.

Due to the specialist care focus, neonatal patients can be located across 22 different wards, so neonatal care must be coordinated across wards to deliver the care every newborn baby needs, in addition to the specialist input they receive for their condition (Source: NHS England).

Full details from NHS England

[European Standards of Care] New standards set benchmark for preterm and sick babies’ care

The Royal College of Midwives | January 2019 |New standards set benchmark for preterm and sick babies’ care

The European Standards of Care have recently published new standards which set the benchmark for the care of preterm and sick babies. These standards  cover 11 key topics including antenatal and perinatal care, transition to home, ethical decision making, palliative care and long-term follow up.

An editorial in The Lancet welcomed the standards, saying that they were much needed because premature birth remained a major cause of under-fives mortality and lifelong morbidities (Source: RCM). 

baby-218149_640.jpgRead the guidance here

European Standards of CARE 

 

RCM press release 

Lancet editorial Putting the family at the centre of newborn health

EFCNI press release 

 

 

One to one antenatal and postnatal support for mental health

NHS England | January 2019 | One to one antenatal and postnatal support for mental health

A one-to-one antenatal and postnatal support service for mental health, which has improved the outcomes and experiences of women throughout their pregnancy and postnatally is shared in a case study on NHS England’s Atlas of Shared Learning.

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Two midwifery support workers in the community midwives team at Northern Lincolnshire and Goole NHS Foundation Trust developed the service in response to women sharing their anxieties around pregnancy or their mental health-often as early as their 8 week booking appointments.

During community visits the midwifery support workers recognised a need for a mental health service alongside parent craft – which was already being delivered on a one-on-one basis. Women also said that they felt rushed during the 15-minute appointment, unable to disclose their own thoughts and anxieties, as they wanted to prioritise the baby’s health.

After approaching their manager and gaining permission they researched perinatal mental health and undertook free distance learning courses from a local college in understanding mental health conditions and counselling skills to enhance their active listening skills.

A ‘Perinatal Mental Health Champions’ course was also undertaken so the midwifery support workers could train colleagues in perinatal mental health awareness. The two midwifery support workers teamed up as ‘buddies’ to provide a one to one antenatal and postnatal support service for mental health.

Midwives refer women to the service- all offered one to one support. The midwifery support workers phone women regularly and offer home visits to listen and signpost to relevant health professionals if needed. If women are identified at the time of booking their first antenatal appointment as possibly needing the service, they are contacted by the midwifery support workers to ask if they would like their input. The support workers  assist women throughout and up to 28 days postnatally.

Regular phone calls and home visits are documented and updates provided to appropriate health professionals. It aims to support women and their families as early as their first antenatal appointment to prevent any negative experiences and anxiety around pregnancy from building up into something more serious such as postnatal depression, postpartum psychosis or post-traumatic stress disorder (Source: NHS England).

Full details are available from NHS England

Antenatal and Postnatal Analgesia (Scientific Impact Paper No. 59)

Royal College of Obstetricians and Gynaecologists | December 2018 | Antenatal and Postnatal Analgesia (Scientific Impact Paper No. 59)

The Royal College of Obstetricians and Gynaecologists  have published this Scientific Impact Paper is to clarify advice regarding pain relief in the antenatal and postnatal periods reviewing evidence from the Medicines and Healthcare products Regulatory Agency and European Medicines Agency.

It reviews existing evidence-based guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) and European Medicines Agency (EMA) on the use of painkillers during and after pregnancy, as well as during breastfeeding.

The findings reflect current NHS guidance on the use of medical pain relief options in pregnancy and during breastfeeding. The paper also recommends that women try non-medical treatments first, such as adequate rest, hot and cold compresses, massage, acupuncture, physiotherapy, relaxation and exercise.

Before taking any medicine when pregnant or breastfeeding, a woman should ask for advice from her obstetrician, midwife or GP. If a pain relief drug is needed, the lowest effective dose should be taken for the shortest possible time. If possible, all drugs should be avoided during the first trimester (up to 12 weeks of pregnancy), but some will need to be continued to prevent harm to the woman (Source: Royal College of Obstetricians and Gynaecologists).

Access the PDF version of this guideline

Full details from Royal College of Obstetricians and Gynaecologists