Background

 

Most families never consider that they may have to be separated from their baby when they’re born but almost 1 in 10 babies born at full term in our region is admitted to the neonatal unit, often being separated from their parents at their most vulnerable time. Separation of mothers and babies in the days after birth impacts negatively on bonding, maternal mental health and breastfeeding rates. It is estimated from large scale work carried out by NHS improvement England that 20% of term admissions may be avoidable. Reducing term admissions keeps families together impacting positively on the infant and their families along with the staff and workflow of the NNU and the postnatal ward.

The recent publication of the Maternity Services Review in Scotland highlighted not only the need to reduce term admissions but to enhance family centred care by keeping families together where-ever possible.  After term admissions, late preterm babies (34-36 weeks) represent the highest proportion of admissions to the NNU. This cohort of babies often have enhanced care needs that are beyond the scope of standard practice postnatal wards with subsequent admission to the neonatal unit and separation of babies from mothers and families at a time when being united is most valuable.   In addition to keeping families together reducing avoidable admissions increases unit capacity for extreme preterm infants and unexpectedly seriously unwell term babies and reduces the likelihood that these families would have to be transferred to other hospitals.

What are we trying to accomplish?

 

Our initial aim was to reduce the number of term born babies admitted to our neonatal unit by 20% over a 9-month period through creation of a project named Unite.  With collaboration across three separate clinical areas (Labour suite, postnatal and neonatal) we have surpassed our aim and reduced term admissions by 25% in 6 months.  We now aim to expand the scope of the project to encompass babies born at 34-36 weeks gestation (late preterm).  We aim to facilitate enhanced care of late preterm babies on the postnatal ward by improving the quality of our care through staff education and environmental changes.  In addition, we aim to have parents as partners in care and hope to provide focussed education and peer support for this cohort of parents to allow them to safely and confidently care for their babies and remain united. 

 

We have focussed on 3 main reasons for admission as they are potentially avoidable:

 

·        Respiratory admissions

·        Hypoglycaemia and/or poor feeding

·        Hypothermia

 

How will we accomplish this?

To date we have created a coalition of midwives, advanced nurse practitioners, care assistants, doctors and parents. We have successfully implemented many small changes that have led to improved parent education, greater access to parental peer support, reduced term admissions and created a huge sense of energy and unity across the three clinical areas. We are spreading and sharing our positive practices using social media and have active Twitter, Facebook and Instagram accounts with positive feedback and support from across the UK.  We are keen to harness this energy and continue our work with term admissions but to also translate it to the care of late preterm babies.    We are currently collecting baseline data on late preterm babies including interviewing parents and staff to explore the surrounding issues.  We will create specific enhanced care bundles, staff and parent education packages and changes to the current postnatal environment to allow late preterm babies to remain united with their families.

Q funding will allow us to continue with our initiatives for reducing term admissions including parental information in the form of feeding wall displays and thermal care milestone cards.  It will allow us to expand our focus to include late preterm babies by developing staff and parental education and training programmes in enhanced care including thermal care and NG tube feeding. It will aid us in development of in-hospital peer support for parents including an “early bird” group for parents of late preterm babies with support from experienced staff and parents.  It will allow us to create a welcoming, suitable and safe environment for late preterm babies and their families, including use of visible room thermometers, heated mattresses, and creation of an appropriate area for engaging with parental peer support and education.  Careful consideration of the environment will allow us to break down some barriers across neonatal and maternity services with a seamless flow between babies being cared for on the neonatal unit and those we help stay with their families.  Overall this project aims to improve the maternity and postnatal experience of families across our region and beyond, helping babies stay with their mothers and improving cross speciality working.