Safety and Quality Improvement
The Quality & Standards Team is involved with a number of national initiatives within maternity services, with the overall ambition of improving the safety of the service
Below is a short explanation of each of these projects, quality improvement initiatives and programmes, with details of how the RCM is seeking to influence and contribute, so that midwifery and maternity support worker (MSW) voices are heard and included.
The NMPA is a large-scale audit of NHS maternity services across England, Scotland and Wales. The audit aims to evaluate a range of care processes and outcomes in order to identify good practice and areas for improvement in the care of women and babies looked after by NHS maternity services. The NMPA is led by the Royal College of Obstetricians and Gynaecologists (RCOG) in partnership with the Royal College of Midwives, the Royal College of Paediatrics and Child Health as well as the London School of Hygiene and Tropical Medicine.
The RCOG has been working with the RCM to increase awareness of the incidence of OASI (obstetric anal sphincter injury) and to identify risks among health professionals involved in maternity care. This has led to the development of tools to improve the prevention and management of severe perineal tearing. A national group of experts have been involved in the development of the OASI Care Bundle, which is now being rolled out by the fourth and final region. Each region consists of four participating maternity units who have nominated themselves and are committed to participating in the project. Local champions from each unit attended a skills development day and then, using a train-the-trainer approach, are cascading this training to their midwifery and obstetric colleagues.
Healthcare Safety Investigation Branch (England only)
In November 2017, the then Secretary of State for Health, Jeremy Hunt, published a refreshed National Maternity Safety Strategy, Safer Maternity Care, announcing plans for Healthcare Safety Investigation Branch (HSIB) to undertake around 1,000 independent safety investigations. HSIB will investigate cases of intrapartum stillbirth, early neonatal deaths and severe brain injuries from 37 weeks gestation. This is a new, evolving organisation and the RCM is involved with monitoring HSIB’s process.
ATAIN is an e-learning programme which will help healthcare professionals involved in the care of newborns, both in hospital and community settings, to improve outcomes for babies, mothers and families through the safer delivery of care. It focuses on four key clinical areas:
- respiratory conditions
- asphyxia (perinatal hypoxia–ischaemia)
The RCM's Quality and Safety team links with ATAIN to improve take-up rates of the course and to disseminate findings from the collected data. To sign up for the course and gain CPD points which will contribute to your revalidation, visit the website. Once completed, RCM members will be able to store their certificate in iFolio.
Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK)
MBRRACE-UK is the collaboration appointed by the Healthcare Quality Improvement Partnership (HQIP) to run the national Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP), which continues the national programme of work conducting surveillance and investigating the causes of maternal deaths, stillbirths and infant deaths. The RCM's Quality and Safety team have sat on expert ESMiE panels (Enhancing the Safety of Midwifery-Led Births), ensuring the midwifery voice is heard, and highlighting issues that are particular to midwife-led settings.
Perinatal Mortality Review Tool (PMRT)
Led by MBRRACE-UK, the national standardised Perinatal Mortality Review Tool was developed during 2017 and released in January 2018. It is funded by the Department of Health (England) and the Scottish and Welsh Governments, and will be free to all NHS maternity and neonatal units in England, Wales and Scotland. The RCM has collaborated since its inception and continues to be involved by providing feedback. Any members who want to feed into the discussions via the RCM are encouraged to get in touch.
This is a three-year programme, launched in February 2017 and led by the NHS Improvement Patient Safety team, covering all maternity and neonatal services across England. All trusts in England are allocated to a wave. Wave 1 has already happened, Wave 2 launched in May 2018 and wave 3 will take place in 2019. There has been an article in Midwives Magazine about this and each of the trusts should know which wave they are in and what quality improvement project they are undertaking. The RCM is supporting the collaboration by engaging with the projects.
A national QI collaborative between Scottish Patient Safety Programme’s (SPSP) maternity, neonatal and paediatric care strands.
UK Obstetric Surveillance System (UKOSS)
UKOSS was set up in partnership with the RCM, NPEU (National Perinatal Epidemiology Unit) and RCOG. It is a national study and aims to examine rare disorders of pregnancy and currently has six open studies. The RCM is an active stakeholder and nominates midwives from member networks to regional panels and forwards topics that may be of interest to these networks.
UK Midwifery Study System (UKMidSS)
UKMidSS is a new UK-wide infrastructure which will enable national studies of uncommon conditions and events in midwifery units. The first study was on severe obesity and is currently awaiting publication. The second study is looking at neonatal admissions, and data collection is ongoing. The RCM has been involved from the inception of UKMidSS with NPEU.