To mark the World Health Organisation’s annual World Patient Safety Day, which takes place on Friday 17 September 2021, the RCOG will be highlighting the College’s work to improve safe maternal and newborn care.
The World Health Organisation’s annual World Patient Safety Day takes place on 17 September.
The theme for this year is ‘Safe maternal and newborn care’, a topic that is very much central to the Royal College of Obstetricians and Gynaecologists mission to improve the quality of care provided to pregnant women and their babies.
To highlight the multifaceted work that is being done across the College to improve patient safety, we have asked individuals from several projects, including from the RCOG’s collaborative partners, to share with us how they are working to improve maternity safety.
Each project champions innovation and works collaboratively with healthcare professionals, women, and their families to improve safe maternal and newborn care.
Tackling inequalities with the COVID Maternity Equality Project (CMEP)
Dr Matina Iliodromiti, Clinical Senior Lecturer in Women’s Health, QMUL; Principal Investigator of CMEP
I am an Obstetrician and the Principal Investigator of the COVID Maternity Equality Project (CMEP). I have seen many changes in maternity care during the pandemic and CMEP was set up to see if these changes have reduced inequalities in birth outcomes. Reducing inequalities means that all women and their babies have equal access to safe maternity services regardless of where they live or what their background is.
The CMEP team consists of researchers and clinicians, but also a group of more than 20 women from different backgrounds who have given birth during the pandemic. This group of women will use their experience to guide us throughout the project.
We will learn from maternity units that did well during the pandemic and seek to understand how the changes in maternity care provision can make maternity care more equal, and therefore safer for all. We will share these findings widely so other Units can learn from these positive changes.
Improving maternity culture with the Workplace Behaviour Toolkit
Dr Sarah Quinn and Dr Ellen Knox, RCOG Workplace Behaviours Advisors
We know that rudeness in the workplace negatively impacts not only the person on the receiving end, but witnesses and patients too.
Data from Civility Saves Lives shows that rudeness impacts on clinical performance, reduces the recipient’s cognition by 50%, and the cognition of witnesses by 20%, and the cognition of witnesses by 20%. Observers are more likely to make a calculation error and 50% less likely to help others. Rudeness in the workplace has proven to lead to less effective clinicians and negatively the safety of those they care for.
In stressful, busy clinical settings, poor behaviours are often unintended but they can have a devastating effect on patient safety. We know from our collaborations with many groups and individuals in producing the “Workplace Behaviours Toolkit” that people are often afraid to speak up because they fear repercussions and adverse impact on their career.
However, we must work together to provide a safe environment where poor behaviours can be addressed and “called out with compassion”. The toolkit provides practical examples and case studies for individuals and organisations to promote and encourage better behaviours among their colleagues and employees.
Reducing severe perineal tears with the OASI Care Bundle
Lizzie Percy, Midwifery lead of OASI2
After childbirth, 1 in 3 women suffer urinary incontinence, 1 in 10 anal incontinence, and many experience sexual dysfunction and pain. This significantly increases when a women sustains a more severe tear, known as an OASI (Obstetric Anal Sphincter Injury).
Around 6% of first time mums sustain an OASI, with 50% of them having a degree of anal incontinence.
As a midwife, I regularly see women who were unaware that tears could happen, or their longer term impact. Women need to know about what choices they have, and what they can do to reduce their chances of a severe tear. The OASI Care Bundle, and the subsequent OASI2 project are about empowering women with this knowledge.
OASI2 encourages antenatal discussions to reduce severe tears, including techniques such as perineal massage, using a warm compress, which are outlined within the care bundle.
Women are offered a gentle examination after birth to ensure that an OASI isn't missed. When missed, a women also misses her best chance of repair and recovery. As well as prevention, the care bundle hopes to improve detection.
Educating women, midwives, and obstetricians is key to improving birth experiences and maternal safety. By raising awareness and communicating the methods to manage perineal care, we are improving maternal health, and by default, the care of their baby too.
Avoiding brain injuries in childbirth with the ABC project
Dr Jenni Burt, Senior Social Scientist at THIS Institute, University of Cambridge
In July, we were delighted to launch the Avoiding Brain Injury in Childbirth Collaboration (ABC).
A unique collaboration between RCOG, the Royal College of Midwives, and The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge, ABC aims to develop a new nationally agreed approach for monitoring and response to fetal wellbeing during labour.
Sub-optimal monitoring and response to fetal heart rate changes have been repeatedly identified as one of the most common contributors to preventable harm. When there are concerns about a baby’s wellbeing during labour, maternity staff need the right tools and support to be able to provide the highest quality of care. Just as important is communicating effectively with women and their birth partners and making sure they are listened to and involved in decisions about their care.
Using THIS Institute’s innovative platform, thiscovery.org, all maternity staff, parents, and birth partners are invited to share their views, experience and expertise and provide feedback as tools are developed. ABC will also support development of a new protocol for complications that can arise with positioning of the baby at caesarean section, specifically when the fetal head becomes impacted.
Preventing Stillbirths and premature births with Tommy's National Centre for Maternity Improvement
Professor Basky Thilaganathan, Clinical Director for the Tommy's National Centre for Maternity Improvement
The Tommy’s National Centre for Maternity Improvement is led jointly by the RCOG and RCM, and is an inter-professional collaboration of women and leading academics. We are putting evidenced clinical effectiveness methodology and digital innovation into practice to do better for our pregnant women and birthing people, for our maternity workforce and for the maternity healthcare system.
There are 25,000 cases of pre-eclampsia, 3,000 stillbirths and 60,000 preterm births per year in the UK and rates of stillbirth and preterm birth vary widely, by up to ±20% across the UK. This variation persists after adjustment for socio-economic/demographic characteristics of the population, which confirms our suspicions that there is significant variation in care. All recent national reports have identified that staff struggle with lack of information, support and resources to provide best care.
Targeted intervention relies on accurate identification of women with at-risk pregnancies. Our current method for antenatal risk assessment remains the same as it was in the 70s: a checklist that asks for the presence of certain risk factors, first adopted into antenatal care some 50-years ago. . This results in poor triage into care pathways and inefficient use of limited medical and staffing resources. Furthermore, it worsens health inequalities for disadvantaged groups that we are battling to tackle.
Putting the research into practice, The Tommy’s National Centre for Maternity Improvement has co-developed a digital tool that provides context specific decision support to maternity workforce and ensures that each woman is offered the right care at the right time no matter where they live. It provides a more accurate risk assessment and generates personalised care recommendations in line with national clinical guidelines. The Tommy’s App is duel-interface web application shared by women and maternity staff. It has been co-developed by women and healthcare professionals together for women and healthcare professionals.
Changing behaviours with Each Baby Counts Learn and Support
Dr Susie Crowe, Consultant Obstetrician and Gynaecologist, Clinical Lead for Each Baby Counts Learn and Support
Each Baby Counts Learn and Support (EBCL&S) was launched in 2018, with the aim to develop interventions to improve the workplace culture issues identified in Each Baby Counts reports. It has been working in 16 maternity units around England, each with a local development lead (LDL). The “learn” element has been the development of the LDL’s leadership and change management skills through a bespoke training programme, as well as the establishment of a community of practice.
The last Each Baby Counts report identified barriers to effective clinical escalation as being a recurrent theme in adverse events, so this was chosen as focus of the programme. The team has developed and tested packages to improve escalation, using a unique behavioural approach. This is the “support” element. There are 3 key staff facing interventions now in place around the country designed to:
- Identify clinical escalation in practice
- Adopt a universal safety critical language
- Optimise team performance
- Improve psychological safety
- Enable better conversations
- Flatten hierarchies
The programme is now entering its final 6 months, during which the team are working on the final outputs. They are undertaking a comprehensive evaluation and analysis of the programme for a final report, and developing a toolkit so that the approach and interventions can be adopted by any maternity unit in the country. Together, they’ll be launched at the national EBCL&S Safety Summit in March 2022.