The Maternity & Children's

Quality Improvement Collaborative

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Maternity Care

As shown in the list below, there are multiple process and outcome measures available within this programme, on which to work. Each service is prioritising a few of those listed, based on the needs of patients and families.

Maternity services have recently re-launched their programme and are setting their priorities for 2017-2018 in line with HIS requirements. The aims of this programme are to reduce avoidable harm in women and babies through reducing stillbirths and neonatal mortality. Process measures to indicate improvements that affect this outcome are:

  • Reducing severe postpartum haemorrhage (PPH)
  • Increased CTG education, a CTG escalation policy and its reliable implementation (antenatal and in labour / triage), documentation, stickers and "buddy reviews" if CTG abnormal for >/=1hour)
  • Recognising the deteriorating mother with the use of the Maternity Early Warning Score (MEWS) and appropriate escalation
  • Sepsis management and treatment using NHS Lothian's maternity criteria
  • Improvements in VTE risk assessment on booking
  • A focus on smoking cessation and a tailored package of care
  • % of women with a documented discussion about foetal movement
  • Increasing the % normo-thermic babies at transfer from Labour ward
  • A positive and pro-active safety culture is imperative across NHS Lothian: maternity services have implemented daily ward safety briefings, cross-site maternity capacity meetings (focus on safety), significant events debriefs (e.g. all PPHs > 2.5l, eclampsia), and SBAR handovers (shift-to-shift and transfers) to aid effective communication. Maternity services are part of the NHS Lothian Programme of Executive Leadership Walk Rounds
  • Increase the percentage of women satisfied with their experience of maternity care

Being Open

Work began in Maternity Services in 2014 to implement a process to ensure staff are more transparent, honest and involve patients / families in reviews when an unexpected adverse event occurs.

This Being Open work is based on the NPSA framework – ‘Being Open, saying sorry when things go wrong’ (2009). It will also help meet most of the requirement for the Duty of Candour Act (2006) which will begin reporting in 2018.

There are 6 steps in the process which can be aligned to a stable existing Significant Adverse Event (SAE) review process in the 1st instance. Tools and processes have been developed in Maternity Services to aid implementation of the 6 steps.

Patients were interviewed and the feedback informed the improvements made. Changes to the process were supported by development of a communication guide which in turn has been supported by specialist training.

Training includes: difficult conversations / role play and an actress play the part of a bereaved mother. It is run in collaboration with the in-house EC4H team. We use PDSA and QI model for improvement.

Now the process is embedded in Maternity Services it is being spread to other areas in a bid to implement it across all acute services

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Paediatric Care

The total number of measures required to be reported to HIS are 47 with the aims of this programme (outcome measures) being to Reduce avoidable harm in paediatric care by 30% by 2016 by addressing:

  • Serious safety events
  • Ventilator associated pneumonia
  • Central venous catherer bloodstream infection
  • Unplanned admission to intensive care
  • Medicines Reconciliation and harm form medicines
  • Paediatric Early Warning Score (PEWS) Bundle compliance
  • Percent of children and young people who receive the Sepsis 6 bundle within 1 hour
  • Rate of patients / 1000 surgical cases readmitted with surgical site infection within 30 days of surgery
  • Improvement in on-time prophylactic antibiotics
  • Percentage of eligible children and young people with peri-operative normo-thermia
  • Peri-op glucose control
  • PVC and CVC Care Bundle compliance
  • Percentage of families providing positive feedback


Neonatal Care

The aims of this programme are to:

  • Reduce adverse events that contribute to avoidable harm in neonatal care by seeking to reduce harm (from mechanical ventilation, invasive line, high-risk medicines, transitions of care, and undetected deterioration
  • Increase natural feeding
  • Improve service user engagement