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Maternity and Neonatal Safety Improvement Programme Newsletter

Winter 2023

Dear colleague,

Welcome to the Maternity and Neonatal Safety Improvement Programme (MatNeo SIP) winter newsletter, which highlights developments within MatNeo SIP across the North West Coast and offers useful resources and events.

Since our last newsletter the Innovation Agency has been renamed Health Innovation North West Coast, but we will continue to work in the same way and this won’t change the way we support local teams.

Please encourage colleagues to subscribe to this newsletter via this link; to our FutureNHS workspace and to check out our page on the Health Innovation North West Coast website.

I would like to thank all the contributors for sharing their learning for this and previous newsletters and those who have contributed to our SIGs and face-to-face learning event this year. We consistently get good feedback and attendance at all our events and teams really appreciate networking and sharing local learning and we couldn’t do this without the support of local clinicians across the network.

Thank you for being part of our MatNeo community.

Best wishes,
Amanda Andrews
Senior Programme Manager

 

National Maternity and Neonatal Safety Improvement update

Please find the MatNeo SIP driver diagram for 2023/24 here.

The national MatNeo SIP team have sent a request out to update Badgernet permissions. The letter has been sent to all digital leads/DOMS/HOMS. If you are happy with the changes no action needs to be taken, otherwise follow the instructions within the letter.

As the planning work for digitalisation of the national MEWS/NEWTT2 tool progresses we have contacted all trusts’ digital teams/midwives to provide further information on current systems used to record maternal and neonatal observations. This will help gain an understanding of the current landscape to enable robust planning, testing and subsequent implementation of the digital versions. Please encourage your digital teams to return the relevant information and contact Amanda with any further questions.

See how the NEWTT2 and MEWS tools align to the Three year delivery plan for maternity and neonatal services (NHSE 2023) in Theme 4, Objective 10: Standards to ensure best practice.

Saving babies’ lives version 3 Optimisation care bundle is now included within element 5. Providers will be required to demonstrate implementation of at least 50 per cent of interventions within each element. Let us know if you require any support with your data.

 

Optimisation of the preterm infant

We have recently held two events for optimisation of the preterm infant.

The virtual optimisation SIG in September had a focus on saving babies’ lives vs 3 (SBLvs3) and the two new optimisation measures. The recording can be found here and presentations here.

Dr Nigel Simpson, author of Element 5 in SBLvs3 and Leeds preterm birth team presented and discussed some of the underpinning evidence for element 5 and the role of the specialist preterm birth midwife service in Leeds. Check out the recording to hear more (recording at 2.54). Catherine Nash presented some changes to the optimisation tool and the results from the North West ventilation survey (recording at 44.39). We heard about local experiences of implementing Volume-target ventilation from Dr Delyth Webb from an LNU perspective (recording 1:26:15) and Dr Amitava Sur from an NICU perspective (recording 1:04:53). We also heard about the important role of caffeine with the preterm infant from Dr Archana Misra and the neonatal team at Bolton and how they made local improvements (recording 1:39:55). All the presentations were extremely interesting and generated lots of discussion around local improvement.

In November we collaborated with Liverpool Women’s Hospital, NWNODN and HiNM to have an optimisation promotion week to support teams with implementation and raise awareness of the care bundle. We included a social media campaign with blogs and held our first face-to-face event post pandemic at Liverpool Women’s Hospital. You can see our X/Twitter thread here. The aim of the day was to provide local optimisation teams the opportunity to network, share learning and participate in some workshops to support knowledge and skill development in the various elements of the optimisation care bundle.

During the event we heard about a preterm birth journey presented jointly by Dr Sarah Thompson, Neonatologist at Arrowe Park, and from a patient who provided valuable insight into how it feels to experience preterm birth, what went well and how we can improve.

Local teams were invited to share excellence in implementation of the optimisation care bundle. These presentations created lots of discussion and debate and some of that was around the complexities on antenatal corticosteroid timing. Some of this was discussed in the recording with Dr Nigel Simpson, however I thought it would be useful to share some further resources that discuss some of these complexities.

Useful resources


This interesting and useful blog describes the realities of practice for optimal steroid administration by obstetrician Dr Shireen Hickey.

The national MatNeo SIP Action Learning Set from Nov 22 provides some useful insight and discussion around steroid optimisation (Recording 14:00)

This is another great resource by Dr Andrew Shennan The Use and Misuse of Antenatal Corticosteroids - Hologic Education

We have created an interactive Jam Board underpinned by appreciative enquiry  to help teams think about what is currently working well and identify any opportunities for improvement related to local steroid data – see here. You cannot edit this board but please contact Amanda if you would like an editable board that can be used by your team or any support using the Jam Board.
Overall, we received really great feedback from the day and all resources will be uploaded to our FutureNHS workspace
 
One of the aims of this newsletter is to share some of the good practice across the region.

Maintaining normothermia can be challenging for the preterm infant – see how some of our local teams have made significant and sustainable improvements which is reflected in local improvement data consistently >80%.

East Lancashire Hospital NHS Trust. Neonatologist Dr Amitava Sur


Our focus on normothermia drive had 3 phases of PDSA and project aims:

Phase 1: Delivery area temperature optimisation - which was done via repeated cycles of education, visual aide memoirs in all delivery areas and staff awareness. We aimed for optimal DR temperature of 26, our mean improved from 21.6 pre project to 25 post implementation. 

Point 1: Top tip: Survey of delivery areas and increase staff awareness by educational materials and visual aide memoirs at regular intervals. 

Phase 2: Delivery room thermoregulation SOP 
Top tips: 
  1. Designate a temperature champion before resus who will remind about checking temperature every 5 mins
  2. Deliver in NeoHelp bag and in infants <27 weeks we use Transwarmer over our Lifestart trolley
  3. We aim not to leave delivery room until 2 consecutive temperatures measured are >36.5
 
Phase 3: Prevention of hyperthermia (fine tuning)
Top tips:
  1. We use servo-control via skin probes for preterm deliveries and set resucitaire  “baby mode” with set temperature of 37 oC
 
Before phase 1 (2018) our data showed 67.9% babies in optimal range, currently we are consistently >80%

 For further reading please see
“Using servo-control as part of normothermia bundle during delivery room resuscitation of preterm infants – a QI project “ Netherton, Sur et al
https://www.infantjournal.co.uk/journal_article.html?id=7294

Liverpool Women’s Hospital. Neonatologist Dr Alex Cleator

 
Utilising the perinatal MDT is essential to drive change, particularly in large complex organisations. 

Top Tips
  1. It is possible to almost eliminate admission hypothermia in preterm babies, whilst still providing deferred cord clamping (DCC) and delivery room cuddles (DRC).
  2. A case by case review of any hypothermic babies helped us to identify potential reasons and develop solutions
  3. A plan, do, study, act (PDSA) cycle was used to implement changes. These changes were then communicated to staff through newsletters, posters, social media, teaching and guideline updates. 
  4. The solutions that we have developed in our quality improvement project may not be the best solutions in another environment and we recommend that other units adopt a similar approach to develop their own best solution.
For further reading please see Maintaining Normothermia in Preterm Babies during Stabilisation with an Intact Umbilical Cord. Cleator, Coombe et al.
Children | Free Full-Text | Maintaining Normothermia in Preterm Babies during Stabilisation with an Intact Umbilical Cord (mdpi.com)
For any further information or if you cannot access the articles, please contact Amanda. Let us know if your team have made any local improvements that we can feature in our next newsletter.

We continue to regularly meet all optimisation teams to discuss progress for implementation, share good practice and identify any risks/issues. Data remains an issue for most units however this is an improving picture with teams identifying and implementing change ideas to improve.

We still have copies of the Optimisation Parent leaflet – please let Amanda know if your team would like some copies.

The NWNODN are supporting implementation of Volume Target Ventilation. The first Task & Finish Group to move forward with a Volume Targeted Ventilation (VTV) framework and training packages took place in November. There was excellent attendance from across the region and some good discussion on the best way forward. Subgroups to develop the content of the framework, troubleshooting information and collation of training resources are currently being set up. The MatNeo teams and NWNODN are keen for all units to have representation for this piece of work. The aim is to support LNUs with the roll out of VTV, by offering on-site training for Neonatal Teams over the next few months. An action plan will be shared early December which units can use as SBL evidence.

Early recognition and management of deterioration in women and babies

This workstream aims to ensure the use of Maternity Early Warning Score (MEWS) and Neonatal Early Warning Trigger and Track (NEWTT2) is embedded within an effective PIER (Prevent, Identify, Escalate, Response) pathway managing deterioration.

The national patient safety team have just launched the third MEWS podcast:

The national team are planning the digitalisation of both tools. We will inform teams of any progress over the coming months. We are working with our Coaching Academy to set up some communities of practice to support implementation and will be in touch with deterioration leads shortly.

 
NEWTT 2 - paper based followed by digital
The NEWTT 2 tool has been launched; please follow the link to the BAPM site for all available resources. This tool is paper based and there is no expectation for teams on a digital system to adopt this paper-based tool. In the North West Coast we are currently supporting three teams as early adopters of the NEWTT2 tool.

Digital specification: We understand there is a demand for the national MEWS and NEWTT2 tools and there have been queries about changing digital systems to align with both tools. To ensure standardisation and reduce variation in England, the MatNeo SIP team are currently working through the process for development of a digital specification for both tools, that will include both the physiological components for the tools and the escalation and response requirements. This will then provide the blueprint for digital providers to update their systems and provide standardisation for those organisations on their digital transition journey.

Digital testing: The MatNeo SIP team are currently working with the digital providers to consider testing in already established digital organisations. When we have a formal solution to this, we will be requesting organisations to identify themselves to be included in the process.

Each Baby Counts Escalation Toolkit
We are working with several teams to implement the Each Baby Counts Escalation toolkit and held our first special interest group (SIG) in February. We have developed some resources to support teams and these plus the recording from the SIG meeting can be found on our futures workspace.

The aim is to support teams to develop pathways of escalation of care in preparation for the launch of the national MEWS and NEWTT tools. If you are interested in implementing the EBC toolkit or would like some support, please contact us.

See the new Three year delivery plan for maternity and neonatal services (NHSE 2023) for more details on how these tools align to the national plan (Theme 3).
 

Useful resources

MatNeo SIP Learning event dates for 2024

Exciting news for Liverpool who are hosting the UK Preterm Birth conference in Jan 2024. Tickets have now sold out however you can find all about it here.
  • 1 February: North West Neonatal Conference 2024
    • The Annual NWNODN Study Day is being held on 1 February 2024. As part of a varied agenda, including an international speaker from Japan and a Professor from Imperial College London, one of the afternoon workshops be a joint MatNeo & NWNODN workshop on optimisation and how it links to the new Bronchopulmonary Dysplasia (BPD) framework.
  • 6 February: Optimisation SIG meeting
 

Keep in touch

Sign up to our database so we can keep you updated on our work, by providing your details here.

Follow this link and sign up to the North West Coast MatNeo SIP – Maternity and Neonatal Safety Improvement Programme FutureNHS platform. This platform provides useful information and resources for the MatNeo SIP programme and links to presentations to previous learning events. You can also join the national Maternity and Neonatal Safety Improvement Programme workspace here.
 
Please contact Amanda for any further information on items in this newsletter or on MatNeo SIP by emailing amanda.andrews@healthinnovationnwc.nhs.uk (please note changed email address)   
 

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