Maternity and Neonatal
Greater Manchester and Eastern Cheshire Patient Safety Collaborative
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 MatNeoSIP work is delivered by Health Innovation Manchester (HInM) under the leadership of Wendy Stobbs (Senior Programme Development Lead) with clinical input of Chantal Knight (Maternity Safety Lead) and Programme Management and Quality Improvement Lead input from Tom Openshaw (Programme Development Lead).
MatNeoSIP aims to:
- improve the safety and outcomes of maternity and neonatal care of all women, babies and families in England, reducing unwarranted variations in care and experience of care
- help reduce maternal and neonatal deaths, stillbirths and brain injuries that occur during or soon after birth by 50% by 2025 – a national target set out in Better Births.
The programme focuses on three areas of improvement:
- increasing the proportion of smoking-free pregnancies
- optimising and stabilising very preterm infants
- early recognition and management of physical deterioration of mothers or babies during labour and immediately after birth (early postpartum).
Our aim is to reduce the national rate of preterm births from 8% to 6% and reduce the rate of stillbirths, neonatal death and brain injuries occurring during or soon after birth by 50% by 2025
- Access and referral to specialist smoking cessation services
- Brief intervention training for maternity and neonatal staff
- CO monitoring offered to all pregnant women
- Develop system-wide pathways to achieve a smoke-free pregnancy
- Utilise the PIER framework to identify and respond to deterioration throughout the entire pathway
- Antenatal corticosteroids offered to women in threatened preterm labour
- Intrapartum antibiotic prophylaxis offered to all women in established preterm labour
- Magnesium sulphate offered to women where preterm birth is imminent or planned
- All babies born in appropriate care setting for gestation (place of birth)
- Effective use of Maternity Early Warning Score (MEWS) to identify and respond to maternal deterioration
- Optimal cord management received by all babies less than 34 weeks gestation
- Continuation of the care pathway to ensure babies are discharged to a smoke-free home
- Effective use of MEWS and Neonatal Early Warning Trigger and Track (NEWTT) to identify and respond to both maternal and neonatal deterioration
- Optimal normothermic range for all babies less than 34 weeks gestation
- Maternal breast milk received within 6 hours of borth by all babies less than 34 weeks gestation
Using the Patient Safety Network approach (the new name for the previous MatNeoSIP Local Learning System) all seven of GMEC Local Maternity System (LMS) providers (nine units) will be supported by HInM to deliver on this NHSE&I 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 approach to the delivery of the MatNeoSIP is as follows:
Between April 2021 and March 2022 our primary focus will be on the deterioration workstream. This involves us working directly with maternity improvement teams at each of the nine units to deliver on local improvement projects (in relation to deterioration) using Quality Improvement (QI) methodology. We are working with the improvement teams to build QI capability and each member of the improvement team is a participant on the Patient Safety Practitioner Programme delivered by our delivery partner, The Advancing Quality Alliance (AQuA).
In addition we are working with key system partners to develop, test and adopt and spread interventions across the LMS relating to improve the early recognition and management of deterioration in particular Omega-3 supplementation and a system wide approach to the Birmingham Sypmptom-specific Obstetric Triage System (BSOTS).
We are also working collaborative with the Greater Manchester Health and Social Care Partnership to support the ongoing delivery of their hugely successful Smoke-free Pregnancy Programme. A key aspect of our work is to improve CO monitoring throughout pregnancy including at initial booking and at 36 weeks, inline with national standards of 95% and 85% respectively.
Our primary focus from April 2022 – March 2023 will be the optimisation workstream where we will work collaboratively with the North West Neonatal Operational Delivery Network and the nine units to embed the seven interventions included within the new national preterm optimisation care pathway. Throughout 2021 – 2023 we undertaking a diagnostic exercise to understand our baseline.
Underpinning the three clinical improvement areas/workstreams are seven key system enablers;
- Addressing inequalities – understand local health inequalities to ensure selected interventions improve the lives of those with the worst health outcomes fastest
- Patient and carer co-design – employ a co-production approach with patients, carers and service users who represent the diversity of the population served
- Safety culture – use safety culture insights to inform quality improvement approaches
- Patient safety networks – co-ordinate and facilitate patient safety networks to provide the sub-regional delivery architecture for improvement
- Improvement leadership – identify and nurture leadership, including clinical leaders, to lead improvement through the networks
- Building QI capacity and capability – use a dosing approach to build quality improvement capacity and capability
- Measurement – develop a robust measurement plan including relevant process, balancing and outcomes metrics
- Improvement and innovation pipeline – undertake horizon scanning and prioritisation to inform future national workstreams
Work being undertaken in this space includes:
- Supporting the LMS to design and test improvement projects included within the equity and equality strategy.
- Continuous coproduction with our Maternity Voices Partnerships MVP. Our MVP colleagues are identified as core members of our Patient Safety Network Leads Group and the task and finish groups for the three clinical improvement areas / workstreams.
- Delivery of the Patient Safety Leads Programme and Patient Safety Practitioner programme (delivered by our delivery partner AQuA), which aims to develop improvement leadership including building the QI and patient safety capability of its participants.
- Our Patient Safety Network Leaders group includes key system stakeholders who provide clinical and strategic oversight of our improvement work.
- Our Patient Safety Network Learning Events are designed to be responsive to the learning needs of our LMS – themes include reducing inequalities and informed decision making.
For more information regarding the Maternity and Neonatal Safety Improvement Programme please contact Tom Openshaw (Programme Development Lead)