The London Neonatal ODN works with the 5 London Local Maternity Systems (LMSs) and STPs to improve care pathways. Together we are working on a number of projects and supporting maternity through their service transformations.
The Better Births report recommended that women be given more choice for their maternity care. Several maternity units have been selected to become early adopters and many of those are in the London area covered by the Neonatal ODN. These maternity units have submitted documentation outlining their plans for establishing recommendations from Better Births, and many include collaboration with neonatal services, as well as investment in neonatal priorities such as in utero transfer to ensure babies are born in the best place for their gestation, and reducing avoidable term admissions.
Later in the year there will be a joint neonatal and maternity stakeholder event to discuss ongoing partnership between the two services, and outline recent survey results and focus for the near future.
Joint Maternity & Neonatal Guidance
Pan London In Utero Transfer Guidance
In utero transfers are required when pregnant women are likely to deliver a baby who requires expertise or not available at the local unit; or when pregnant women have illness in pregnancy requiring expertise not available at the local maternity unit. Ex utero transfers (postnatal transfers) that occur immediately after birth are associated with increased neonatal morbidity and mortality and some of these represent missed opportunities for in utero transfers and some of these represent missed opportunities for
in utero transfers. The guideline has been produced by the pan-London In Utero Transfer working party hosted, by the London Maternity Clinical Network following consultations with the Emergency Bed Service (EBS) at the London Ambulance Service (LAS). It is intended to build upon the British Association of Perinatal Medicine (BAPM) 2008 document on
management of acute in utero transfers2
Pan London In Utero Transfer Leaflet
This leaflet, developed by the London Neonatal ODN explains to mothers and families the importance of networked neonatal care in providing access to specialist neonatal services at the right time and close to home.
The leaflet empowers mothers with the knowledge and rationale used in the clinical decision-making process, which means that sometimes mothers are transferred ‘in utero’ to a specialist hospital for continuing care.
Patient Safety Collaborative
The patient safety collaborative aims to instil a culture of safety in maternity services and is training midwifery staff in quality improvement. The ODN is assisting in issues that relate to neonatal care and where units have decided to make an improvement to neonatal services. The steering group is currently establishing Communities of Practice within London, and developing metrics for the assessment of neonatal data.
Atain (Avoiding Term Admission in Neonatal units).
The Atain programme aims to reduce term admissions to neonatal units by preventing harm to term babies in delivery, which would otherwise be avoidable. This will keep babies with their mothers, preventing unnecessary separation which can be stressful to both mother and baby.
The focus is on training maternity staff to reduce morbidity and to correctly determine if a baby needs specialist care. Further units should focus on how these discussion can be conducted, and learning points shared between maternity and neonatal staff. The online training tools have been praised highly by neonatal staff.
Atain is directly advantageous to the working of the ODN and therefore it is fully supporting midwifery staff to take on the programme and improve their term admissions.
Embedding Transitional Care Services in London – A Resource for London Maternity & Neonatal Services
The document highlights the definitions and requirements for maternity and neonatal teams in order to meet the CNST Maternity Incentive scheme – Year 2, Safety Action 3: Avoid term admissions into neonatal unit (ATAIN) Programme and develop Transitional Care services.
The resource offers suggested staffing configurations, TC admission criteria, staff competencies, a sample action plan template, national guidance links, and case studies.
Mortality and Morbidity
In a further effort to reduce neonatal death, all child deaths will now require a review. Guidance is currently under review and neonatal services and assisting.