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Safety Standards in Labour

Safety Standards in Labour. RCOG 30 th April 2008 Professor Martin Whittle. Stillbirths 1986 - 1995. Safer Childbirth Factors leading to a Third Report. Evidence from CESDI and CEMACH Staff shortages – midwives and doctors Perinatal networks Changing Expectations and Choice

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Safety Standards in Labour

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  1. Safety Standards in Labour RCOG 30th April 2008 Professor Martin Whittle

  2. Stillbirths 1986 - 1995

  3. Safer ChildbirthFactors leading to a Third Report • Evidence from CESDI and CEMACH • Staff shortages – midwives and doctors • Perinatal networks • Changing Expectations and Choice • Patient Safety • Medical Litigation • Improving safety, Morale and Team work • Commissioning Services

  4. Safer ChildbirthContents • Organisation • Staffing Roles • Staffing levels • Education, Training, continuing Professional and Practice Development • Facilities and Equipment • Recommended Standards

  5. Safer Childbirth • Organisation Multidisciplinary working Maternity networks Good communication Dynamic leadership Governance structures Risk Management

  6. Safer ChildbirthStaffing Levels Obstetricians Minimum for all units 40h presence now 5 – 6000 60 h presence now 4 – 5000 2008 2.5- 4000 2009 6000+ 24h presence 2008

  7. Fixed Consultant Obstetrician LW sessionsUnits with 10 or more sessions

  8. Consultant Numbers • 1998 1142 40h cover <10% • 2001 1215 28 % • 2004 1500 • 2005 1612 50% • 2006 1648 • Requires 2500 to fully implement Towards Safer Childbirth

  9. Consultant Expansion (UK) • 1999 0.7% • 2000 5.9% • 2001 7.6% • 2002 7.3% • 2003 4.0% • 2004 1.9% • 2005 5.3% • 2006 3.6% RCOG, 2007

  10. Newly Qualified Doctors (UK) Men Women • 1995 3.5% 6.5% • 2004 None 2% • 2006 2.0% 7.7% Source BMA

  11. Safer ChildbirthStaffing Levels Anaesthetists Consultant 10 sessions a week More consultant time allocated for tertiary units Extra time for antenatal referrals

  12. Safer ChildbirthStaffing Levels Paediatricians Defined by BAPM standards

  13. Safer Childbirth • Staffing Roles Midwives Experts in normal birth An experienced member of the maternity team Consultant midwives Maternity care assistants Education and training

  14. Safer Childbirth • Staffing roles Obstetricians Provide leadership Ensure effective teamwork Bring clinical experience Develop and implement standards Undertake effective audit Train and educate

  15. Safer Childbirth Specialist medical cover and intensive care • Multidisciplinary approach essential • Prompt access essential • Clear local arrangements/ protocols • ALERT or similar course • CCMDS or similar for data collection

  16. Safer Childbirth Education , Training and CPD • Multi - professional team training – skills and drills • Record of training attendance

  17. Safer ChildbirthRecommended Minimum Standards Standard 1 Organisation and documentation The organisation has a robust and transparent clinical governance framework which is applicable to each birth setting

  18. Safer ChildbirthRecommended Minimum Standards Standard 1 Organisation and documentation The organisation has a robust and transparent clinical governance framework which is applicable to each birth setting

  19. Safer ChildbirthRecommended Standards Standard 2 Multidisciplinary working Effective multidisciplinary working is essential to an efficient delivery of the service

  20. Safer ChildbirthRecommended Minimum Standards Standard 3 Communication Communication is the keystone of good clinical practice

  21. Safer Childbirth Recommended Minimum Standards Standard 4 Staffing levels Safe staffing levels of all professional and support staff as recommended are maintained, reviewed and audited annually for each birth setting

  22. Safer ChildbirthRecommended Standards Standard 5 Leadership There are clear profiles for clinical leadership promoting good practice and multidisciplinary communication

  23. Safer ChildbirthRecommended Minimum Standards Standard 6 Core responsibilities Standard 7 Emergencies and transfers Each birth setting has protocols based on clinical, organisational and system needs

  24. Safer ChildbirthRecommended Minimum Standards Standard 8 Training and education The organisation must ensure that all professional staff have the opportunity for CPD including agreed mandatory education and training sessions

  25. Safer ChildbirthRecommended Minimum Standards Standard 9 Environment and facilities Facilities in birth settings should be at an appropriate standard and take account of the woman’s needs and the views of the service users by being less clinical, non-threatening and more home-like whenever possible

  26. Safer ChildbirthRecommended Minimum Standards Standard 10 Outcomes Birth settings should audit childbirth outcomes, evaluating annually linked clinical care, any changes or trends, in addition to other meetings

  27. Safer Childbirth • Key Points (1) Greater focus on women centred care Recruitment and retention of midwives Changes in experience of obstetric trainees Increasing consultant involvement on Labour Ward Matching resources with workload

  28. Safer Childbirth • Key Points (2) Team approach with a shared philosophy of care The need for leadership The maternity network governance structure Need to improve communication Multidisciplinary team working Annual report and audit

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