East Cheshire, Greater Manchester

Patient Safety Collaborative - Maternity and Neonatal

The Maternity and Neonatal Safety Improvement Programme (MatNeoSIP) element of the national programme is led and co-delivered by the NHS England & Improvement patient safety team, who work with the 15 regionally based Patient Safety Collaboratives (PSCs) and with maternity teams from 132 NHS trusts. MatNeoSIP builds on the work of the Maternal and Neonatal Health Safety Collaborative, a three-year programme, launched in February 2017.

In Greater Manchester and Easter Cheshire (GMEC) the Maternity and Neonatal Safety Improvement Programme (MatNeoSIP) is delivered by Health Innovation Manchester (HInM) under the leadership of Wendy Stobbs (Senior Programme Development Lead), Caroline Finch (Programme Development Lead) and Rebecca Williams (Project Officer), Leanne Hill (Project Support Officer).

MatNeoSIP aims to:

  • Contribute to the national ambition set out in Better Births, to reduce the rates of maternal and neonatal deaths, stillbirths and brain injuries that occur during or soon after birth by 50% by 2025
  • Contribute to the national ambition, set out in Safer Maternity Care, to reduce the national rate of preterm births from 8% to 6% by 2025
  • Improve the safety and outcomes of maternal and neonatal care by reducing unwarranted variation and provide a high-quality healthcare experience for all women, babies, and families across maternity and neonatal settings.

 

Underpinning the clinical improvement areas / workstreams are eight key system enablers;

  1. Addressing inequalities – understand local health inequalities to ensure selected intervention improve the lives of those with the worst health outcomes fastest
  2. Patient and carer co-design – employ a co-production approach with patients, carers and service users who represent the diversity of the population served
  3. Safety culture – use safety culture insights to inform quality improvement approaches
  4. Patient safety networks – co-ordinate and facilitate patient safety networks to provide the sub-regional delivery architecture for improvement
  5. Improvement leadership – identify and nurture leadership, including clinical leaders, to lead improvement through the networks
  6. Building QI capacity and capability – use a dosing approach to build quality improvement through the networks
  7. Measurement – develop a robust measurement plan including relevant process, balancing and outcomes metrics
  8. Improvement and innovation pipeline– undertake horizon scanning and prioritisation to inform future national workstreams

 

The programme focuses on two areas of improvement:

  • To improve the optimisation and stabilisation of the preterm infant
  • To improve the prevention, identification, escalation, and response (PIER) to maternal and neonatal deterioration

To reduce the rates of maternal and neonatal deaths, stillbirths and brain injuries that occur during or soon after birth by 50% by 2025. To reduce the national rate of preterm birth from 8% to 6% and reduce the rate of still births neonatal death and brain injuries occurring during or soon after birth by 2025

  • Ensure all babies are born in appropriate care setting for gestation (place of birth). Singleton <27+0 weeks gestation or <800g, or all multiples <28+0 weeks gestation
  • Ensure magnesium sulphate is offered to women where preterm birth is imminent or planned <30+0 weeks gestation
  • Ensure intrapartum antibiotic prophylaxis is offered to women in established preterm labour between 24+0 weeks and 33+6 weeks gestation
  • Ensure antenatal corticosteroids are offered to women in threatened preterm labour <34+0 weeks gestation
  • Ensure optimal cord management is received by all babies <34+0 weeks gestation
  • Ensure optimal normothermic range (between 36.5-37.5 degrees celsius) for all babies <34+0 weeks gestation
  • Ensure maternal Breast Milk is received with 24 hours of birth by all babies <34+0 weeks gestation

 

Support all maternity and neonatal providers to repeat culture surveys (SCORE) sand debriefing to influence local improvement plans

  • Ensure the use of Maternity Early Warning Score (MEWS) is embedded within and effective PIER pathway for managing deterioration
  • Ensure the use of Neonatal Early Warning Trigger and Track (NEWTT2) is embedded within an effective PIER pathway for managing deterioration

 

Support all maternity and neonatal providers to repeat culture surveys (SCORE) sand debriefing to influence local improvement plans

All seven of GMEC Local Maternity and Neonatal System (LMNS) providers (nine units) will be supported by HInM to deliver on this NHSE (NHS England) commissioned safety improvement work. Supporting the teams and working with key system stakeholders who are focussed on the safe, personal, and effective care of our expectant mothers and their families.

The GMEC PSC (Patient Safety Collaborative) approach to the delivery of the MatNeoSIP is as follows:

  • Between April 2022 and March 2023 our initial focus will be on the optimisation workstream.
  • We are collaborating with the Quality Improvement Lead Nurse for the Northwest Neonatal Operational Delivery Network (NWNODN).
  • We will be working directly with maternity optimisation teams to deliver and embed the seven key evidenced based preterm perinatal optimisation interventions that are proven to improve outcomes.
  • Teams will be reviewing the monthly NWNODN data tool which will initially enable them to undertake a diagnostic exercise to understand their baseline data.
  • Following on from this they will be able to utilise QI methodology to achieve sustained improvements.

We are taking a regional approach regarding our four Special Interest Group (SIG) events and collaborated with the Quality Improvement Lead Nurse for the Northwest Neonatal Operational Delivery Network, and the Programme Manager for the Northwest Coast Innovation Agency.  If you would like further information regarding the SIG events please contact rebecca.williams@healthinnovationmanchester.com or please access FutureNHS

Maternity Early Warning Score (MEWS)

The deterioration workstream involves the testing, adoption and spread using a PIER framework of the nationally developed Maternity Early Warning Score to ensure standardised approach for managing deterioration and support for birthing people.

The Newborn Early Warning Trigger and Track (NEWTT2)

The testing, adoption and spread of the national developed NEWTT2 tool with the aim to improve recognition of deterioration in the newborn that leads to intervention and admission to the neonatal unit.

Birmingham Symptom-specific Obstetric Triage System (BSOTS)

BSOTS is a maternity triage system which involves completion of a standard clinical triage assessment by a midwife within 15 minutes of the woman’s attendance which defines clinical urgency using a 4-category scale. This guides timing of subsequent assessment and immediate care (if required) using algorithms with the outcome of improved safety and patient flow. We are working with key system partners to adopt BSOTS within all triage department in GMEC.

For more information regarding the Maternity and Neonatal Safety Improvement Programme please contact Caroline Finch caroline.finch@healthinnovationmanchester.com

To keep up to date with the latest information please join our Futures NHS page

Resources

For our up to date leaflet ‘Improving the outcome for preterm babies: information for parents’ click here.

For the ‘North West Guideline: Preterm Birth’ click here.

For the ‘Optimisation Posters’ click here for A4 and here for A3.

Case Studies

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