What is the ODN doing to improve care for babies in London?

National Service Review

NHSE are currently undertaking a review of all neonatal services in the country. This has already culminated in a report on services which is going to consultation imminently. A number of workstream have been implemented to address the issues highlighted by the report. The ODN has been supporting NHSE and the London units through the review by providing information and data where possible and will lead on the implementation of recommendations of the report and the workstreams, on units.

Peer Review by NHS QST

In addition to the national service review NHSE and the quality surveillance team (QST) are conducting peer reviews of all the units in the UK. The assessment will be annual with the peer review facilities visits every few years. Parents have also been invited to become trained reviewers for the peer review teams. The review will assess how well the units adhere to the service specifications and guidelines produced by the networks, and require work programmes to swiftly rectify any issues. The ODN is coordinating this process with QST and providing documentation where possible. A full report is due in the Spring.

TPN

One of the many ways in which the ODN is trying to provide safer care for babies is by standardising the use of total parenteral nutrition (TPN). TPN is the fluid by which premature babies are given all their nutrients before they are able to feed. Currently different units use different mixes per baby, however there are standard regimens that have been devised and tested that produce positive results, are more cost effective for broad procurement, and would be safer. The ODN is leading the standardisation and procurement process by which all units within a network have agreed on a regimen. Procurement is currently being negotiated and an interim pricing agreement will allow units to utilise the new TPN regimens in Febrary’18.

Maternity Services

The maternity services in London are currently undergoing transformation and the ODN is actively involved in recommending practices to be implemented during this time of change, and for the London early adopters of the Better Births Initiatives. This includes the uptake of the Atain programme to reduce term admissions to neonatal units; reducing the instance of harm during birth, and preventing undue separation of babies from their mothers. To find out more about the ODN’s work with Maternity Services visit our collaboration page.

Community Outreach CQUIN

In order to reduce the length of stay of babies on units and have them reunited faster with their families several of the London units are taking on an NHS England initiative to increase the capacity and involvement of community nurses and midwives. This could mean expanding services to cover a larger area, provide discharge coordination, or provide weekend services and out of hours contact, enabling parents to care for complex conditions at home. The project has scoped out a variety of best practice in London Units, and is producing a document and metrics to take tot he next stage.

Parent Advisory Group

The PAG dedicated to the implementation of Family Integrated Care on neonatal units. They are supporting the uptake of initiatives led by Imperial such as parent led ward rounds, care education, and continuous presence on units, where the parents are seen as part of the team, and the primary carer for their child.

Last Year the parent advisory group released a case for change for parent engagement and involvement on neonatal units. The PAG are working hard to implement the changes and the ODN and NHSE is in full support of these initiatives. The next step will be to measure what improvement units have been able to make.

You can find out more about the PAG here.

In Utero Transfers

In order to reduce neonatal death in London and improve outcomes, all babies of less than 27 weeks gestation should be born at a hospital with a level 3 neonatal unit. This means that in utero transfers of women in premature labour need to be increased. The ODN is working closely with the local maternity systems to improve communication, and the understanding of the importance of this care pathway for premature babies, in that it has been shown to increase the chance of survival.

Perinatal Mental Health

The London neonatal ODN recently worked in partnership with the London perinatal mental health network (from the London clinical network) to produce guidance on the newborn assessment for babies exposed to psychotropic medication in utero. The guidance is aimed at neonatologists, midwives, obstetricians and GPs, all of whom will care for a medicated baby at some point in their care pathway. The guidance outlines a set of recommendations for increased communication between staff and the mother, to ensure both mother and baby are cared for appropriately and undue separation is avoided. This was important to the work of the ODN as contact with the mother and support for breastfeeding can increase the health of the baby thereby reducing their length of stay on a unit and risk of readmission.

Pan London Guidance

In order to continue to reduce the number of neonatal deaths in London, the ODN is committed to producing pan London guidance on a number of care factors including thermoregulation and cooling, and visiting policies. This will standardise the care given to neonates in London and thereby increase the continuity and safety of care.