Healthcare Quality Improvement Programme | September 2018 | National Neonatal Audit Programme – 2018 Annual Report on 2017 data
The National Neonatal Audit 2018 Annual Report on 2017 data published by the Royal College of Paediatrics and Child Health (RCPCH) shows key achievements made in neonatal care for preterm babies in England, Scotland and Wales. The report contains key findings and selected recommendations for quality improvement of neonatal care going forward (Source:HQIP).
The audit finds progress in the following areas:
- more very preterm babies being admitted to neonatal units with a normal temperature;
- rates of magnesium sulphate administration to mothers at risk of very preterm birth significantly increasing.
Included in this year’s report are new meaures which focussed on
parental partnership in care; looking at minimising separation of mother and baby, and the presence of parents on consultant ward rounds. The National Neonatal Aduit Programme hopes that these measures will support neonatal units to achieve a partnership with parents in providing care. This year they also describe how many of the least mature babies are delivered in units best suited to care for them. Their final new measure describes, for the first time, how many babies develop necrotising enterocolitis.
Full details from HQIP’s executive summary
Download the full report
Your baby’s care
Foy, K. E. et al. | 2018| Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC‐NIC survey| Anaesthesia| doi:10.1111/anae.14359
A new article that appears in the current issue of Anaesthesia finds that some special care baby unit may be putting babies health at risk due to breathing tubes not being monitored.
The study reports major gaps in optimal airway management provision in both pediatric intensive care, but particularly in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new ‘Never Event’ and has the potential to improve airway management.
The researchers used telephone surveys from paediatric and neonatal intensive care units across England, finding that less than half of specialist baby units had the equipment to measure carbon dioxide (capnography) coming from the lungs.
In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a ‘Never Event’ in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre‐intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was ‘available’ in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and ‘always available’ in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new ‘Never Event’ and has the potential to improve airway management.
The full article can be read at Anaesthesia
In the news:
BBC News Sick babies at risk from lack of breathing tube monitoring
Twin pregnancy and neonatal care in England: a Tamba report | The Twins and Multiple Births Associations (TAMBA)
This report includes information from neonatal networks for stillbirth rates, neonatal death rates, NICE compliance and neonatal admissions for twins.
Findings revealed that twins were 2.5 times more likely to result in a stillbirth and more than five times more likely to result in a neonatal death, in comparison to singleton pregnancies. The report is being submitted to the national review into neonatal services with a call to highlight where and how care should be delivered to multiple birth babies.
Full document available here
Additional link: Royal College of Midwives press release
National Neonatal Audit Programme (NNAP) 2017 annual report on 2016 data | The Royal College of Paediatrics and Child Health (RCPCH)
This report highlights key findings and recommendations form the NNAP analysis of neonatal care data for over 95,000 babies during 2016. The report is accompanied by case studies and a guide to the audit for parents and carers.
See also: Your Baby’s Care’ – A guide for parents and carers to the NNAP 2017 Annual Report on 2016 data
Additional link: RCPCH press release
Kilcullen, M. & Ireland, S. Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery. BMC Palliative Care | Published online: 11 May 2017
Background: Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit.
Conclusions: This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.
Read the full article here
Adams, M. et al. BMC Pediatrics | Published online: 17 April 2017
Background: Quality improvement in health care requires identification of areas in need of improvement by comparing processes and patient outcomes within and between health care providers. It is critical to adjust for different case-mix and outcome risks of patient populations but it is currently unclear which approach has higher validity and how limitations need to be dealt with. Our aim was to compare 3 approaches towards risk adjustment for 7 different major quality indicators in neonatal intensive care (21 models).
Conclusions: All three approaches to risk adjustment revealed comparable results. The limited effect of risk adjustment on clinic comparisons indicates a small case-mix influence on observed outcomes, but also a limited ability to isolate quality improvement potential based on risk-adjustment models. Rather than relying on methodological approaches, we instead recommend that clinics build small collaboratives and compare their indicators both in risk-adjusted and unadjusted form together. This allows qualitatively investigating and discussing the residual risk-differences within networks. The predictive validity should be quantified and reported and stratification into risk groups should be more widely used to correct for confounding.
Read the full article here
Riviere, D. et al. Anaesthesia and Intensive Care Medicine. Published online: January 5 2017
Life as a fetus is very different from life after birth. The neonatal period (first 28 days of life or 44 weeks postconception age) is a period of dramatic and rapid physiological changes. These vary from the immediate adaptations to extrauterine life to a consequent gradual maturation of organ function. Questions still exist around this transition concerning the optimal oxygen concentration during resuscitation, methods of respiratory support, facilitation of cardiovascular changes, identification of at-risk infants for problems such as hypoglycaemia and hypothermia, and the role of therapeutic hypothermia. This article combines well established and contemporary information to summarize a systems-based approach to traditional neonatal physiology.
Read the full abstract here