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 Colin Peters Elaine Mackay Damian Boyd Midwifery Clinical Lead Neonatal Clinical Lead Project Officer Associate Improvement Advisor Jo Thomson Sula Kirkpatrick Dagmara Lukowiec Alan Cameron Improvement Advisor Administrative Officer Senior Project Officer Obstetrics Clinical Lead
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 Area of focus: Reviewing adverse events – deep dive into perinatal adverse outcomes How did COVID-19 affect work? Lessons learned? What will we do differently? • We were successful in keeping ALL of our • Staff adaptation to rapid change We are still working that out! services working • We need to keep our eye on the ball! • Emphasis on safety and dissemination of • Building resilience in the system Creating more opportunities to build a information • Redeployments of colleagues/students • Compassionate organisational stronger QI foundation • Reduction in face-to-face communication leadership • Rapid change – responding to this system • Change fatigue and disengagement Promoting shared empowerment: wide • Investment in QI is vital to motivate Shifting from command and control • All consuming nature of change • Investment in people • Environment changing on a daily basis Shared ownership • Changing whilst keeping services functioning - SAFELY What would you ask other Boards? Do you think the global pandemic has affected adverse outcomes? If so, what makes you think this?
The real power in leadership is in encouraging and creating more leaders.
Q&A
NHS Lanarkshire Lorna Lennox & Augusta Anenih
NHS Lanarkshire Area of focus: Term Admissions to Neonatal Unit How did COVID-19 affect work? Lessons learned? What will we do differently? • Maternity Unit reverted to LDRP setup. • Systems thinking in making change • • Centralisation of services to one single Retain the labour ward, AN /PN area. • Rapid PDSA cycles are achievable! ward set up. • Non essential work suspended i.e. • Consider rapid testing all pregnant • Importance of behavioural science BLISS, QI, MCQIC women on admission • Staffing (reorganisation of staff, • Patient Safety remained a priority • Utilise technology for teaching shielding, self isolating) while maintaining quality • Digital technology for care • Restricted Visiting. • Digital technology for staff training and Redeployment of 2 nd /3 rd year student • • Be proactive in real time rather client care midwives. than reactive now • Homebirths suspended • 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?
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 A run chart showing rate of term admissions admitted to the neonatal unit in NNU 300 (from Dec 14 to Aug 20 at the University Hospital Wishaw) rate of term admissions admitted to the 250 neonatal unit per 1,000 200 PDSA - NEWTT escalation pathway 150 PDSA 1 - Theatre Temp Covid-19 Lockdown 100 Coorie In Project 50 0 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…
Reason for Term admissions to NNU - March - August 2019 35 100% 90% 30 80% 25 70% 60% 20 50% 15 40% 30% 10 20% 5 10% 0 0% ? Infection / Ventilated / Other Issues Respiratory colour Change Feeding Jaundice / Cooling Neonatal Hypoglycaemia Covid-19 Antibiotics CPAP conditions issues phototherapy Abstinance suspected syndrome Reason for Term admission to NNU - March - August 2020 (since Covid-19 restrictions ) 45 100% 90% 40 80% 35 70% 30 60% 25 50% 20 40% 15 30% 10 20% 5 10% 0 0% Ventilated / Respiratory Other Issues Hypoglycaemia ? Infection colour change Cooling Jaundice / Covid-19 Neonatal Hypothermia CPAP conditions /Antibiotics phototherapy suspected Abstinance syndrome
Reason for short stay Term admissions March - August 2019 (n:112) 70 100% 60 80% 50 60% 40 30 40% 20 20% 10 0 0% Cannulation / Observation Respiratory Other Feeding/ • Lower numbers in antibiotics conditions reasons vomiting 2020, 79% reduction. Reason for short stay Term admissions March - August 2020 • Same top three (during covid restrictions) (n:23) indications. 10 100% 8 80% 6 60% 4 40% 2 20% 0 0% Respiratory Cannulation / Observation Feeding/ Other conditions antibiotics vomiting reasons
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