REVIEW OF TERM ADMISSIONS AT SHERWOOD FOREST HOSPITALS 2016-2018 - PowerPoint PPT Presentation

REVIEW OF TERM ADMISSIONS AT SHERWOOD FOREST HOSPITALS 2016-2018 THEMES AND TRENDS Susie Al-Samarrai Paula Shore

Introduction  Since January 2016 a structured approach has been taken to review the term admissions to NNU at Kings Mill Hospital  The core group members include a Consultant Obstetrician, Consultant Neonatologist, Neonatal Registrar (ST6) and Midwife  The review meetings occur monthly and assess avoidability based on care given during pregnancy, birth and the postnatal period

Background  Birth rate 2016 3678  Term admissions n=149 (4.0%)  Birth rate 2017 3462  Term admissions n=109 (3.1%)  Reviews conducted using ATAIN proforma to address learning points following detailed case note and BadgerNet information review

Results Reasons for Term Admission 2016-17 2017-18 60 50 40 30 20 10 0

Review of ‘Top 3’  Respiratory  2016 n=59 (40.9%) Vs 2017 n=48 (44%)  Review in 2017 highlighted numbers born following planned LSCS  Guidance changed to increase use of steroids and avoidance of non-indicated LSCS prior to 39/40  Current antenatal steroid uptake rate 90% (NNAP benchmark 86%)  TTN rate zero for 2017

Review of ‘Top 3’  Sepsis  Audit in 2016 and revised guidance re ‘Care of Newborn’ – highlighted need for consistent identification of ‘red flags’  2016 – n=30 (20.3%) of term admissions due to sepsis  2017 – n= 9 (7.3%)  Represents a 69% reduction in admissions with timely identification of at-risk mothers and babies

Review of ‘Top 3’  Hypoxic-Ischaemic Encephalopathy (1-3)  2016 – 18.2% of term admissions (n=27)  2017 – 11% of term admissions (n=11)  Represents 56% reduction in admissions due to HIE  QIP undertaken around CTG interpretation in 2017  All midwifery staff attended 1-day CTG Masterclass  Co-ordinating midwives and obstetricians all attended 2-day CTG Masterclass

Supporting Work  Regional project to review CTG interpretation, adopting physiological interpretation undertaken from November 2017  SFH have key stakeholders in development of guideline and competency assessment package to be used to support training and implementation across the region

Supporting Work  Term Admissions meeting has helped to drive ongoing shared learning through perinatal M&M meetings, local and regional governance meetings  Adoption of the ATAIN proforma has helped address issues and unify results produced  Also helps identify which babies may better be cared for in transitional care environment

Celebration of Good Practice  Thermoregulation ☺ Hat on ☺ Skin-to-skin ☺ Early feed  ‘ Three little steps’ campaign  No admissions due to hypothermia in 2017

Celebration of Good Practice  Each Baby Counts  RCOG Flagship QIP – aim to reduce the number of babies who die or are left severely disabled as a result of incidents occurring during term labour  Required to report all babies who are referred for therapeutic cooling to EBC as well as those who die in labour or in the first 7 days of life  No term babies referred for cooling for more than 15 months from SFH  No babies reported to EBC for more than 15 months

Next steps  Waive 2 National Maternity and Neonatal workstream via Patient Safety Collaborative  Reduce admissions related to hypoglycaemia  ?Transitional Care facilities

Questions?

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