MCQIC Re-engagement Webinar Maternity & Neonates 3pm 4.20pm - - PowerPoint PPT Presentation

MCQIC Re-engagement Webinar Maternity & Neonates

3pm – 4.20pm Wednesday 30 September 2020 Thank you for joining us today - the meeting will begin shortly

Improvement Hub Enabling health and social care improvement

Dr Colin Peters

MCQIC Neonatal Clinical Lead Healthcare Improvement Scotland

Meeting participation

During the meeting please have your microphone on mute and video turned off to avoid distraction for you and also to minimise the likelihood of slowing down the technology. To take part in discussions use the chat box or raise your hand and wait to be invited to speak, please then:

• unmute your mic
• after speaking please re-mute

This meeting will not be recorded.

Meet the Team

Angela Cunningham Midwifery Clinical Lead Colin Peters Neonatal Clinical Lead Elaine Mackay Project Officer Damian Boyd Associate Improvement Advisor Alan Cameron Obstetrics Clinical Lead Jo Thomson Improvement Advisor Sula Kirkpatrick Administrative Officer Dagmara Lukowiec Senior Project Officer

Jo Thomson

MCQIC Improvement Advisor Healthcare Improvement Scotland

MCQIC Reactivation

Where we are:

• Re-engaging with stakeholders
• Team capacity
• Recognition of possible further COVID 19 developments

Priorities we will support in the short term:

• Stillbirth (and associated process measures)
• Neonatal Mortality (Preterm Perinatal Wellbeing Package), Term Admissions
• Developing a package of measures around reducing BPD
• Looking at data on Stillbirths during COVID
• Early development work around C Sections

NHS Borders

Kirsteen Guthrie & Gill Lunn

NHS Borders How did COVID-19 affect work?

• At the end of March 2020 there were concerns regarding COVID 19 within the hospital ,the transmission of this via the

vertical ventilation system. This had the potential to compromise patient and staff safety and our antenatal/postnatal ward was re located to another area within the hospital with a smaller foot print.

• With a reduced amount of antenatal beds the obstetric staff reviewed our current induction of labour policy.
• After discussions with other health boards it was decided to use the Cooks Cervical Ripening Balloon as an alternative

form of induction of labour for appropriate women.

• Advantages of the Cook Cervical Ripening Balloon at NHS Borders

– Using the Cook balloon for women wishing a VBAC to help reduce intervention and emphasise patient experience – At the beginning of lockdown there was no visitors or partners allowed to visit, which led to increased anxiety for women having to stay in hospital – Most women were keen to spend as little time as an inpatient as possible at this time – The Cook balloon costs around £80 compared to the cost of an overnight stay on the ward

NHS Borders Lessons learned?

• Communication with all staff concerned regarding change of practice
• Cook Balloon has usually been performed by medical satff
• Induction of labour at term in low risk pregnancy has historically been a midwifery

procedure

• A standard Operating Procedure has been adapted from NHS Lothian to allow midwives

to perform the procedure

• We need to look at outcomes of the new process with data collection to see if there can

be any quality improvements made

NHS Borders What will we do differently?

• A SOP has been written with training devised so that midwives can perform this

procedure

• We will gather feedback from women and staff
• Email in box covid.maternity@borders.scot.nhs.uk
• We have a COVID face book page

NHS Borders What would you ask other Boards?

• What is the uptake rate of using the Cook balloon in other boards?
• Do midwives in other boards insert the Cook balloon?
• Do you have any other education in place?
• Do other boards have patient experience feedback for the Cook balloon?

Q&A

Amanda Gotch

NHS Grampian

NHS Grampian

How did COVID-19 affect work?

• We were successful in keeping ALL of our

services working

• Emphasis on safety and dissemination of

information

• Redeployments of colleagues/students
• Reduction in face-to-face communication
• Rapid change – responding to this system

wide

• All consuming nature of change
• Environment changing on a daily basis
• Changing whilst keeping services

functioning - SAFELY

What will we do differently? We are still working that out! Creating more opportunities to build a stronger QI foundation Promoting shared empowerment: Shifting from command and control Shared ownership Lessons learned?

• Staff adaptation to rapid change
• We need to keep our eye on the ball!
• Building resilience in the system
• Compassionate organisational

leadership

• Change fatigue and disengagement
• Investment in QI is vital to motivate
• Investment in people

What would you ask other Boards? Do you think the global pandemic has affected adverse outcomes? If so, what makes you think this? Area of focus: Reviewing adverse events – deep dive into perinatal adverse outcomes

The real power in leadership is in encouraging and creating more leaders.

Q&A

NHS Lanarkshire

Lorna Lennox & Augusta Anenih

How did COVID-19 affect work?

• Maternity Unit reverted to LDRP setup.
• Centralisation of services to one single

area.

• Non essential work suspended i.e.

BLISS, QI, MCQIC

• Staffing (reorganisation of staff,

shielding, self isolating)

• Restricted Visiting.
• Redeployment of 2nd /3rd year student

midwives.

• Homebirths suspended

What will we do differently?

• Retain the labour ward, AN /PN

ward set up.

• Consider rapid testing all pregnant

women on admission

• Utilise technology for teaching
• Digital technology for care
• Be proactive in real time rather

than reactive now Lessons learned?

• Systems thinking in making change
• Rapid PDSA cycles are achievable!
• Importance of behavioural science
• Patient Safety remained a priority

while maintaining quality

• Digital technology for staff training and

client care

• The “retroscope” gives us clarity

What would you ask other Boards?

• Have you seen an increase in Term admissions especially those requiring respiratory support with no known underlying

risk?

• Does your data tell a different story?

Area of focus: Term Admissions to Neonatal Unit

NHS Lanarkshire

March – August 2019 March – August 2020

Difference % Total deliveries 2212 2060

• 152

6.87% less

Term (≥ 37weeks) 2027 1923

• 104

5.13% less Late Preterm (34 – 36+⁶ wks.) 127 90

• 37

29.1% less Preterm (<34wks) 58 47

• 11

19% less Total Term Admissions 130 141 +11 8.46% more % Term admissions 6.41% 7.33% 0.92 14% higher

Coorie In Project PDSA 1 - Theatre Temp PDSA - NEWTT escalation pathway Covid-19 Lockdown 50 100 150 200 250 300

Dec… Feb… Apr… Jun… Aug… Oct… Dec… Feb… Apr… Jun… Aug… Oct… Dec… Feb… Apr… Jun… Aug… Oct… Dec… Feb… Apr… Jun… Aug… Oct… Dec… Feb… Apr… Jun… Aug… Oct… Dec… Feb… Apr… Jun… Aug…

rate of term admissions admitted to the neonatal unit per 1,000

A run chart showing rate of term admissions admitted to the neonatal unit in NNU

(from Dec 14 to Aug 20 at the University Hospital Wishaw)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 5 10 15 20 25 30 35 40 45

Ventilated / CPAP Respiratory conditions Other Issues Hypoglycaemia ? Infection /Antibiotics colour change Cooling Jaundice / phototherapy Covid-19 suspected Neonatal Abstinance syndrome Hypothermia

Reason for Term admission to NNU - March - August 2020 (since Covid-19 restrictions)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 5 10 15 20 25 30 35

? Infection / Antibiotics Ventilated / CPAP Other Issues Respiratory conditions colour Change Feeding issues Jaundice / phototherapy Cooling Neonatal Abstinance syndrome Hypoglycaemia Covid-19 suspected

Reason for Term admissions to NNU - March - August 2019

0% 20% 40% 60% 80% 100% 10 20 30 40 50 60 70 Cannulation / antibiotics Observation Respiratory conditions Other reasons Feeding/ vomiting

Reason for short stay Term admissions March - August 2019

(n:112)

0% 20% 40% 60% 80% 100% 2 4 6 8 10 Respiratory conditions Cannulation / antibiotics Observation Feeding/ vomiting Other reasons

Reason for short stay Term admissions March - August 2020

(during covid restrictions) (n:23)

• Lower numbers in

2020, 79% reduction.

• Same top three

indications.

How did COVID-19 affect work?

• Maternity Unit reverted to LDRP setup.
• Centralisation of services to one single

area.

• Non essential work suspended i.e.

BLISS, QI, MCQIC

• Staffing (reorganisation of staff,

shielding, self isolating)

• Restricted Visiting.
• Redeployment of 2nd /3rd year student

midwives.

• Homebirths suspended

What will we do differently?

• Retain the labour ward, AN /PN

ward set up.

• Consider rapid testing all pregnant

women on admission

• Utilise technology for teaching
• Digital technology for care
• Be proactive in real time rather

than reactive now Lessons learned?

• Systems thinking in making change
• Rapid PDSA cycles are achievable!
• Importance of behavioural science
• Patient Safety remained a priority

while maintaining quality

• Digital technology for staff training and

client care

• The “retroscope” gives us clarity

What would you ask other Boards?

• Have you seen an increase in Term admissions especially those requiring respiratory support with no known underlying

risk?

• Does your data tell a different story?

Area of focus: Term Admissions to Neonatal Unit

NHS Lanarkshire

Q&A

Dr Colin Peters

MCQIC Neonatal Clinical Lead Healthcare Improvement Scotland

Bronchopulmonary Dysplasia Reduction Package

• Early effective CPAP by prongs or mask should be utilised as the first line management
• Applied within 5 minutes of birth, not intubated within 15 mins of birth.
• A Volume Limited strategy should be used in NICU (eg Volume Guarantee, Targeted

Tidal Volume)

• First ventilated episode in NICU, Volume Limited ventilation used until extubation.
• Surfactant in the first 48hrs surfactant should be administered where FiO2 >30% or for

a ventilated baby requiring oxygen.

• Non-ventilated clinically stable babies after 30mins of minimal handling or any

ventilated baby

• A Less Invasive Surfactant Administration (LISA) approach should be used when

administering in NICU for babies <32 weeks

• PPWP includes elements to reduce BPD eg Steroids, Caffeine, MEBM

Alan Cameron

MCQIC Obstetrics Clinical Lead Healthcare Improvement Scotland

C Section Data - Scotland

Jo Thomson

MCQIC Improvement Advisor Healthcare Improvement Scotland

2020 Essentials of Safe Care – why?

• Maintaining safety
• ‘Essentials’ for every person, in every system, every time
• Stakeholder feedback identified three core themes:

– Essentials of safe care delivery of safe care in every setting /system for every person – Specific improvement areas resulting from care pathway redesign or change in clinical / operation processes – Learning systems the value and impact of forums to come together to learn and share

Principles

• Not a mandated requirement
• Complements and supports existing guidance and standards
• Combines evidence and existing knowledge
• Practical and useable, pragmatic guidance
• In Covid context and beyond
• Sufficiently generic enough for different health and care settings
• Links with other national areas of work, for example Excellence in Care,

Health and Social Care Standards

• Mental Health Leads Group
• GP Practice Managers Network
• Primary Care Leads

Our Engagement So Far

2020 Essentials of Safe Care Driver Diagram (draft)

To enable the delivery of Safe Care for every person within every system every time

Systems and culture for Person Centred Care are embedded and support safety for everyone Communication within and between teams Leadership and Culture of Safety at all levels Safe Clinical and Care Processes

Inclusion and involvement Workforce capacity & capability Structures & processes that enable safe, person centred care Huddles Safety briefs Structured communication (SBAR) Prioritisation of safe care at all levels Staff wellbeing and psychological safety Learning Systems Operational (Safe Staffing) Clinical Care Infection prevention and control

Angela Cunningham

MCQIC Midwifery Clinical Lead Healthcare Improvement Scotland

Feedback

nss.tec@nhs.net

• How frequently would you like MCQIC to host Webinars?
• Does 90 minutes feel about right for timing?
• Too short?
• Too long?
• What topics relevant to the programme do you wish to see

covered moving forward?

• Would your Board be willing to present in future?

Please raise your hand then unmute, use the chatbox or email your responses to New email: his.MCQIC@nhs.scot to be picked up later

Mary Davie & Tara Fairley

Perinatal Network

Damian Boyd

MCQIC Associate Improvement Advisor Healthcare Improvement Scotland

What’s next?

nss.tec@nhs.net

• Clinical Reference Groups
• Meeting virtually:
• MCQIC Quick catch up’s
• MCQIC ‘Virtual Visits’
• Data and Self Assessments

What’s next? QI Capacity and Capability

nss.tec@nhs.net

ScIL (Scottish Improvement Leaders)

For Individuals who need in-depth QI knowledge to support others across their organisation

• NES currently recruiting for cohorts 30 and 32
• Applications open from 5th October until 16th October
• Targeted recruitment areas are:

Lothian, including the State Hospital (Cohort 30) Fife, Borders, Dumfries and Galloway and the Scottish Islands (Cohort 32) Further info / register: https://learn.nes.nhs.scot/1769/quality-improvement-zone/learning-programmes/scottish- improvement-leader-programme-scil/scil-recruitment

SCLIP (Scottish Coaching & Leading for Improvement Programme)

For managers coaching and leading teams to improve their services

• 3 national cohorts for SCLIP planned for next year. No dates set for registration

Further info: https://learn.nes.nhs.scot/10656/quality-improvement-zone/learning- programmes/the-scottish-coaching-and-leading-for-improvement-programme-sclip

Thank you! That is the end of the webinar, thank you for your attendance and participation. Any questions please email: New email: his.MCQIC@nhs.scot

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