Improvement Story Four
Optimising Preterm Labour & Delivery – ‘everyone’s business’
Northumbria Healthcare FNHS Trust
Contributors
George Brooks, Neonatal Nurse Consultant.
Angela Stringfellow, Matron for Improvement
Katy Lissaman, Matron for Inpatient Maternity Services
Lisa Routledge PROMPT trainer, Labour Ward Manager
Dr Katie Barker, Lead Obstetrician
Ms Jenna Wall, Head of Midwifery
What aspects of culture did you focus on and what changes did you make?
As the most northern maternity service in England, we cover a vast geographical area. Delivering over 3000 babies on the consultant-led site has resulted in our ANNP-led level I SCU being one of the busiest in the country.
Initially we wanted to introduce the components of the PreCePT project but soon realised we wanted to get perinatal optimisation right; to maintain compliance to our robust Intra-Uterine Transfer (IUT) pathway, to offer care of demonstrable benefit wherever possible prior/during IUT and in those rare incidences where IUT could not be possible. We focused making perinatal optimisation ‘everyone’s business’. We wanted to ensure all midwifery, neonatal and obstetric teams were aware of the broad principles of optimisation and their specific responsibilities pertaining to the issue of Pre-Term Birth.
The midwifery workforce is predominantly stable and in common with most maternity units we work with ever changing team of obstetric trainees, many of which have never worked in a district general hospital maternity service so required support to deliver optimisation within our care setting. Communicating how we should deliver the components of the Perinatal Optimisation Pathway by discussion in in-service skills drills or by the usual process of sharing update of guidelines failed to provide enough information as to the rationale underpinning our gestational specific care options.
A workbook was introduced for all obstetric, midwifery and Neonatal unit staff to help them know about the interventions offered to maximise the health potential of the preterm fetus and care post-delivery. This has since been developed into a short e-learning model on our Trust’s Learning & Development (L&D) site.
What effect this has had on your team culture?
There is an improved shared sense of responsibility for perinatal optimisation. Providing learning materials which provide the rationale for interventions became a driver for improvement as teams engaged more with them once they had a more detailed appreciation of the benefit. Perinatal optimisation is viewed as shared goal. This sense of perinatal community of practice has aided the introduction of further innovation such as a comprehensive antenatal colostrum harvesting policy.
What barriers have you had to overcome?
The training package was well-received, but some professionals (e.g. community midwives) did not fully appreciate their part in perinatal optimisation. On reflection more may have been done by providing examples as to how specific professional groups may impact on the perinatal optimisation journey.
What helped to make this successful?
The Midwifery & Obstetric leadership led by example by completing the learning package first and we were supported by our local L&D Team. In addition to making it more attractive in format, using an electronic version helped collate the number of completed learning packages and ensured it could be made mandatory learning on employee’s training needs analysis (local list of required training in employment specific to the individual’s role).