MatNeo Wave 3 Imperial College Healthcare NHS Trust Jenny Ziprin - - PowerPoint PPT Presentation

MatNeo Wave 3

Imperial College Healthcare NHS Trust

• Jenny Ziprin – consultant

Neonatologist

• Heather Liggins –

midwife

• Shree Koirala – midwife
• Tom Prior – consultant

Obstetrician

Bristol

• We got to know each
• ther a little better
• And got to know the

program a little better

• We travelled to Bristol

a little less prepared than other team

Bristol learning set

• We were

encouraged to think big……..by making small changes

Developing

• ur project

We wanted a project that fitted the framework of the collaborative But, we also wanted a project that involved all areas of the team Many of the change ideas were things already being done well at

• ur units

So we put our heads together and identified a problem…….

Neonatal antibiotics

• We felt that many of the

babies prescribed Antibiotics following delivery, were receiving them unnecessarily.

• We reviewed the NICE

guidelines – 2 risk factors

• r 1 red flag = Abx

Risk factor Red flag Invasive GBS in previous baby Maternal GBS in current pregnancy Prelabour ROM Preterm birth <37 weeks PROM >18 hours Intrapartum pyrexia >38/suspected chorioamnionitis Parenteral Abx given to mother due to suspected invasive sepsis Yes Confirmed infection in co-twin Yes

Neonatal antibiotics

Anecdotally we all felt that these guidelines were not being followed Many babies were being treated leading to

• Longer admission for mother and baby
• Potentially unnecessary and painful

investigations for baby (eg. LP)

• Stress for mothers
• Increased Antibiotic use

Why……Why …….Why……. Why…….Why

Lack of awareness of the guidelines Defensive practice Lack of communication between maternity/obstetric teams and neonatal teams – intra-partum pyrexia being interpreted as sepsis Culture Concern that babies would not be monitored appropriately

So we came up with an aim….

Achieve that 100% of babies receive antibiotics for appropriate indications by June 2020. Improvement would lead to

• Better maternal experience
• Less investigation of baby
• Better awareness of true sepsis
• Shorter admissions for mother and

baby

• Reduced ‘bed blocking’ on postnatal

ward

• Better flow of patients through the

unit

And a plan…….

• Firstly we needed to confirm we had a problem
• We planned an audit of neonatal Antibiotic prescriptions over a 10 day

period.

• 75% of babies received Abx

inappropriately

• Definite scope for improvement

3 9

Appropriate Inappropriate

Next we developed our driver diagram

Achieve that 100% of babies receive antibiotics for appropriate indications by June 2020 Reduce inappropriate prescription to babies Reduce inappropriate prescription to mums Ensure guidelines for maternal Abx prescription are followed and intrapartum pyrexia and puerperal infection distinguished Ensure guidelines for assessment of intra-partum pyrexia are followed with Antibiotic stewardship note Ensure NICE guidelines (Red/white flags) are followed Neonatal SHO to add to ‘Antibiotic stewardship’ note documenting risk factors that necessitate ongoing neonatal treatment Improve communication between Obstetrics and neonatal team Obs SHO to add specific Cerner note titled ‘Antibiotic stewardship’ when commencing Abx with indication documented Optimise neonatal monitoring for signs of sepsis NEWS to be used and documented by postnatal ward staff/neonatal team

Aim Primary drivers Secondary drivers

Which needed to be revised following 1st Coaching Call..

Achieve that 100% of babies receive antibiotics for appropriate indications by June 2020

Aim

Engagement in SCORE survey with feedback & debriefing

Monitoring of Friends & Family survey and “NeoTrips” parental questionnaire Monitoring of Datix ‘s relating to antibiotic errors

Lets make a change

• First PDSA cycle planned for week

commencing 3rd June

Act Plan Do Study

• Is communication a problem ?
• Aim to standardise communication and

indications for maternal and neonatal antibiotics.

• Obs SHO to create new Cerner note titled

‘Antibiotic stewardship’ whenever intrapartum Abx are prescribed with indication for Abx.

• Neonatal SHO to add to this note when

reviewing baby post delivery

• Was maternal temp measured and

documented correctly

• Was the Antibiotic Stewardship note

completed on Cerner

• Were maternal antibiotics prescribed in

accordance with local/national guidelines (1 temp >38 or two 1 hour apart >37.5)

• Did the Neonatal SHO add to ‘Antibiotic

Stewardship’ note

• Were Abx prescribed/not prescribed in

accordance with guidelines Results will guide our next PDSA cycle

QCCH

5 3 3

Appropriate Inappropriate Avoided AB

SMH

2 3 1

Appropriate Inappropriate Avoided

5 5 1

Stewardship yes no n/a

3 3

Stewardship yes no

Challenges

• 3 labour wards on 2 sites
• Definition of maternal sepsis not clear cut
• Pulling denominator data from Cerner (EPR)
• The private ward..
• Patient Experience
• Locum staff