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Maternity and Neonatal Safety Improvement Programme

Posted: 17 December 2019

Picture of a group of nurses

What did the team achieve?

- 80 % reduction in babies with hypoglycaemia admitted to the neonatal unit over the last two years. (120 fewer admissions/year)

- Babies with necrotizing enterocolitis (NEC) down by 70% in 2018 compared to 2017.

- Timely administration of magnesium sulphate - from 15% to 83% compliance in last three years - preventing cerebral palsy in babies.

SUCCESSFUL, simple clinical interventions in WHHT’s Maternity and Neonatal units are reducing mother infant separation and dramatically reducing numbers of babies with neonatal hypoglycaemia, necrotizing enterocolitis (NEC) and cerebral palsy.

The multi-disciplinary intervention and improvement programme has been led by Paediatric Consultant Dr Sankara Narayanan and started in 2016.

He said: “When a baby is born full term the best place for the baby is to be with his/her mother where they can bond and benefit from skin to skin and breast feeding.

“There are five areas of clinical practice where the teams’ work is continuing to make a difference; neonatal hypoglycaemia, jaundice, necrotizing enterocolitis, neonatal intubation safety and reduction of cerebral palsy.

“The intention is to avoid admissions to the neonatal unit where possible and ensure that mother infant separation isn’t necessary unless absolutely required for safety reasons”

Preventing neonatal hypoglycaemia
In line with national guidelines, ensuring an oral glucose gel is given to babies showing signs of hypoglycaemia has reduced admissions to the neonatal unit by 80% since 2017.

This was achieved by fostering a culture of shared responsibility for mother/infant care across the whole team and empowering staff with the confidence and education to administer the glucose gel in a timely manner without waiting for the consultants’ go ahead.

A focused education programme and a robust communication strategy including a step by step photographic guide to the administration of the gel, mocked up in the hospital’s simulation suite, made a big difference. The team also involved families in the change and feedback was gathered from mothers who had experienced the successful intervention. The introduction of ‘At- risk’ infant cards and ‘hats,’ daily patient safety meetings and perinatal service board rounds was also a game changer.

WHHT has gone on to support seven other neonatal units across the country and the piece work was presented to 44 fellow hospitals who participated in a national learning event in March 2019.

Most of the treatment for jaundice in the baby is now given at the mother’s beside in the post-natal ward or transitional care rather than separating the child and sending them to the neonatal unit.
The Midwifery team identify babies at risk of jaundice and provide intense support to mothers to establish breastfeeding and monitor jaundice using a simple tool that checks jaundice levels bedside (transcutaneous bilirubin meter).

Significant reduction in Necrotizing Enterocolitis (NEC)
Necrotizing enterocolitis (NEC) is a medical condition where a portion of the bowel dies. It typically occurs in new-borns who are either premature or otherwise unwell.

If preterm infants are fed with donor breast milk (when a mother's own breast milk is insufficient or unavailable), rather than an artificial formula, this can reduce the risk of these problems. The team received education and training and now has donor breast milk delivered into the unit within two hours of a request. NEC Occurrence has dropped by 70% over the last year.

Neonatal Intubation
This high-risk procedure involves placing a tube down the windpipe of the baby to enable the child to breathe with a ventilator. It requires a great deal of skill and is open to risk.

The multi-disciplinary team got together for a brainstorming session designed to expose the specific challenges. This resulted in the introduction of a read aloud intubation check list in April this year. The list includes an equipment check, team member check, and team roles risk assessment.

Cerebral Palsy
Research shows that magnesium sulphate given to the mother in threatened preterm labour is neuroprotective and reduces cerebral palsy by up to 30%.

Frontline champions were appointed, live run charts implemented, and safety huddles introduced. The team ran engagement sessions with stakeholders, developed and implemented a new simple guideline, encouraged 1:1 midwifery care in labour, introduced daily board rounds to identify all eligible women. They involved mothers by providing them with information in a antenatal counselling pack with counselling conversations and a golden hour checklist.

A steady improvement from 15% to 86% administration has occurred since 2016, having a direct impact on the long-term neurodevelopment and quality of life of preterm babies born at fewer than 30 weeks.

The work was presented at the National Clinical Audit Summit in London and the work will be submitted for NICE Shared Learning Awards. It has also been commended by Health care Quality Improvement Partnership.

Dr Sankara Narayanan added: “We are on a continuous journey of improvement and I’m passionate about providing the best quality of care for mothers who come to deliver their babies in this hospital”
“I have two jobs, firstly my day job as a hands-on consultant and secondly by continuously improving what we do as a department.”

Doctors, nurses and midwives are continuing to work collaboratively to improve the quality of care and family experience for mothers who deliver at Watford Hospital.


Notes to editors

  1. For more information, please contact the communications team on: 01923 436280 or email: Out of hours, please call 07900 228031.
  2. WeWest Hertfordshire Hospitals NHS Trust serves people from across Hertfordshire, north London and further afield. It operates from three hospitals; Watford General, St Albans City and Hemel Hempstead. The trust has a catchment area of over 500,000 people and is one of the largest employers locally, with around 5,000 staff and volunteers.
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