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

10 20 30 40 50 60

Reasons for Term Admission 2016-17 2017-18

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

• ngoing 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

• f 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?

Thank you!