What it was like for us The reality of a CNST assessment

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What it was like for usThe reality of a CNST
assessment

• Annette Anderson
• Maternity Clinical Risk Manager
• Supervisor of Midwives
• Homerton University Hospital
• NHS Foundation Trust
• 18th March 2009

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Background

• Consultant led unit
• High risk culturally diverse population in
  Hackney
• Level three neonatal unit with expansion to a
  Perinatal centre in the next 18 months
• 4952 births for 2008
• 143 midwives
• 10 obstetric consultants
• Achieved Level 2 CNST in December 2005

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Planning

• Read and make initial notes
• Devise action plan which indicates level of work
  needed.

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• Allocate standard leads (the most appropriate)
  and have criterion leads in mind.
• Overseeing responsibility

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Planning

• What guidelines do you have?
• Do they include the minimum requirements?
• Refer to the Evidence Template
• Review
• Write new policies
• Ratification (How? Who? When?)

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Example

• 2.2.2 Auscultation of fetal heart rate
• (L1) Before review no inclusion of NICE
  guidance when to transfer from intermittent to
  continuous auscultation
• (L2) Select notes for review from audit notes or
  other notes that demonstrate implementation.

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ExampleAuscultation of the fetal heart rate

• Before
• After
• Notes to demonstrate

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Keeping On Track

• Fortnightly meetings
• Small Group as possible
• Standard leads feedback on progress
• Use evidence template
• Can get competitive!

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Challenging areas (1)

• Transfer of the sick newborn
• Concern about baby (FBS)

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Evidence TemplateDos and Donts

• Excellent!
• Do use as much as possible (traffic lights).
• Dont hyperlink for L1 too early.
• Do create folders for each standard and
  criterion.
• Do have a deadline date a few weeks before
  assessment date.
• Do make sure your links correct.

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Onsite Assessment

• Wireless Laptop
• Additional Help for the 2 days
• Select notes that demonstrate implementation file
  in number order
• Each set of notes can be used for more than 1
  criterion
• Stay Positive

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Challenging areas

• 2.4.3 Patient Information and discussion
• 2.4.5 Maternal Transfer

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The one that nearly got away..

• 2.3.4 Brachial Plexus Injury
• Demonstration of review of cases
• Shoulder Dystocia Proforma RCoG minimum
  requirements.

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• Overall a positive experience
• We passed!
• Good to know where we are
• And what we need to improve on..
• For future assessments would use the same
  approach.
• Good Luck!

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• THANK YOU
• annette.anderson_at_homerton.nhs.uk
• 0208 510 7329