Adverse birth events

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Adverse birth events admission to neonatal care
Jane AbbottHead of Programmes
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Bliss is the UK charity working to provide the
best possible care and support for all premature
and sick babies and their families.

• Supporting families with practical and emotional
  support.
• Working with health professionals to improve the
  care delivered to babies and their families
• Campaigning to ensure neonatal services have the
  resources they need

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Overview

• 1 in 9 babies each year in England (70,000)
  require hospitalisation immediately after birth
• Most (54,000) due to preterm birth
• Preterm births increasing
• Overall birth rate inc
• Inc maternal age
• Inc in multiple births

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• Whats it like for parents who expect a normal
  birth but have unexpected neonatal admission?
• Parents are expecting this..

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40 of premature births are unexplained and
spontaneous

• What do parents experience
• Shock, confusion, fear
• The nurses do the same thing everyday, day in
  day out, but when you walk into that unit it is
  like you could have walked onto the moon
• Bliss/Picker focus group, 2010

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What do they need?

• Information
• about their baby
• about the unit
• Support
• practical and emotional
• Facilities
• to stay close to their baby
• to cope with day to day life on unit

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And parents for whom preterm birth is predicted
or who have term but sick baby?

• Antenatal unit visit (Picker survey 41 given
  chance to visit)
• Need for info, support and facilities is same
• Term sick babies may or may not have had
  antenatal diagnosis (group often given less
  focus)

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Parents experiences

• 85 able to touch their baby before admission
• Only 46 given photo of their baby
• 59 mothers cared for on same ward as mothers
  who had their baby with them
• 27 didnt get any written info about babys
  condition and treatment
• 45 not included in discussions about their
  babys care as much as they wanted

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Family Centred Care

• Putting parents at heart of their babys care
• Recognising the needs and role of parents
• Parents and HPs working in partnership
• Evidence of benefit (short and long term) for
  babies, families and service.
• POPPY report 2009

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Challenges to service

• Toolkit min nurse staffing levels (11, 12, 14)
• Bliss report 2010
• less than third units meeting min stds
• less than quarter of intensive care units
• Approx 1,150 extra nurses needed.

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Bliss SOS report 2011

• 1 in 3 units had made/were planning to make
  further cuts
• 140 posts already lost
• Further 32 units with planned cuts
• Cuts to nurses qualified in specialty
• More than half units not meeting Toolkit
  standards of 70 nursing workforce qualified in
  specialised neonatal care

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Implications of cuts

• Strong evidence to support Toolkit standards
• Inc ratio of specialist nurses in ITU HDU
  associated with decrease is risk-adjusted
  mortality (Hamilton et al 2007)
• Nurses in intensive care units spend average of
  56 mins in every hour giving direct care to
  babies (Milligan D et al 2008)
• Understaffing leads to problems inc delays to
  essential treatment and reduced clinical care
  (Pilllay T et al 2011)

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What is Bliss doing? What are we asking for?

• Increase quality and consistency of FCC across
  all units/networks
• Toolkit principle 3
• Bliss Baby Charter Standards
• Bliss audit tool and accreditation scheme

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• Bliss SOS report recommendations
• Trusts to review programme of cuts to frontline
  services use Toolkit to find ways to make
  services run more efficiently
• Trusts commissioners to work together to show
  how they will meet Toolkit standards by 2020
  (prioritising increasing specialist and
  non-specialist nursing posts)
• Clear mandate from Govt to NHS Commissioning
  Board to prioritise implementation of Toolkit
  NICE standards
• Retain networks and their role (with authority to
  hold trusts to account)

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Thank youJane AbbottHead of
Programmesjanea_at_bliss.org.uk020 7378 1122