[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

Audit of Bereavement Care Provision in UK Neonatal

Sands & Bliss | December 2018 | Audit of Bereavement Care Provision in UK Neonatal

The Sands  (Stillborn and neonatal death) charity has produced Audit of Bereavement Care Provision in UK Neonatal care.  The report finds that despite instances of good practice by individual nurses and doctors across the country, many services are not set up to deliver consistent high quality bereavement care and health professionals are not getting the training and support they need to perform this vital role.

Image source sands
Image source: Sands.org

Read the full report from Sands 

Positive first year for collaborative maternity incentive scheme

NHS England | November 2018| Positive first year for collaborative maternity incentive scheme

A scheme designed to support maternity services deliver better care has reported positive results in its first year. The scheme from NHS Resolution rewards rewards trusts meeting ten safety actions designed to improve the delivery of best practice in maternity and neonatal services. 

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In year one:

  • 75 trusts met all ten actions and have received their 10% rebate and have been awarded a proportionate share of the remaining funds;
  • NHS Resolution received 100% participation by the 132 eligible trusts; and
  • 57 trusts did not meet all ten actions and have received some funding linked to robust action plans to enable them to meet the outstanding safety actions. NHS Resolution and its partners will be supporting trusts to make progress against the actions in year two.

The scheme saw demonstrable impact in terms of delivering safety improvements, including:

  • 100% registration with Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK to access National Perinatal Mortality Review Tool;
  • Significant improvement in quality of reporting to NHS Digital for March 2018; and
  • 100% reporting to NHS Resolution’s Early Notification scheme (source: NHS Resolution)

Full details available from NHS Resolution

NHS Resolution  Maternity incentive scheme year one results: Overview

National Neonatal Audit Programme – 2018 Annual Report on 2017 data

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).

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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 

 

 

Sick babies at risk due to lack of monitoring of breathing tubes

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.

 

Summary

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

Multiple birth babies requiring neonatal care

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 2016

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