Patient safety in a pandemic year

In this blog to celebrate Patient Safety Awareness Week, our Maternal and Neonatal Clinical Lead, Ann Remmers, reflects on her experiences during a pandemic year.

Little did we know this time last March what was in store for us in 2020/21 and many of us would have been very surprised to find out that we would still be in the grip of a pandemic a year later. Patient Safety Awareness Week 2021 provides a time for reflection on how much has been achieved and to look forward to the next year.

The pandemic has certainly brought patient safety to the fore and touched people’s lives in different ways. Our front line NHS staff and key workers are among those who have borne the brunt of COVID-19, often at great personal sacrifice.

The impact of COVID-19 has been far and wide and has caused us to look at new and inventive ways to communicate and support each other.

Gone are the large face-to-face conferences where we would meet up for one or two days to share ideas, listen to experts and patient stories, helping us to improve outcomes and experience for patients. The last two in-person Maternity and Neonatal events I attended were in March last year within a week of each other. One was Better Births: four years on and the other was the Maternity and Neonatal Safety Collaborative final event of the three-year programme. Both events took place in Manchester and entailed long and crowded train journeys. It seems hard to imagine that now.

Large events aside, we have been unable to meet together (even in small groups) and have become adept at using Zoom or Teams.

In the first wave resources were understandably diverted to dealing with the immediate consequences of the pandemic. Clinical staff found themselves moved to areas where they were most needed. This sometimes meant that some services which were not considered essential (to the pandemic response) were greatly reduced. Carbon monoxide monitoring ceased due to concerns of infection risk which took away a significant tool to reduce smoking in pregnancy (one of the national ambitions is to reduce still births and neonatal deaths by 50% by 2025).

We were left wondering how we could continue with our maternity and neonatal safety and improvement work. Staff have found innovative ways to continue to support women to stop smoking in pregnancy like the Maternity Healthy Lifestyles Pod in the foyer of Gloucestershire Royal Hospital.

In the first wave, we were very fortunate in the South West not to experience the high numbers of cases and deaths that some other parts of the country did but even so it felt that we would have to pause a lot of our safety work.

Prior to the pandemic we were about to launch our PERIPrem care bundle which would provide premature babies with expert care and interventions that would greatly improve their outcomes. The project would build on our successful national roll out of PReCePT in 2019. Two amazing consultant neonatologists came to us (as part of our Evidence into Practice call) with the idea to introduce the care bundle: Professor Karen Luyt (the clinician behind PReCePT) and Dr Sarah Bates.

The PERIPrem team were ready to start supporting trusts with quality improvement methodology, resources and tool kits to launch the project – that’s when the pandemic hit. Surely this would mean putting the project on hold? It was disappointing but necessary to wait until the clinical staff in the maternity and neonatal units had the capacity to launch the project.

We decided to ask them what they wanted to do. The overwhelming response was they wanted to be part of the project and felt it was a positive thing to do at a time when things were so difficult in the health service. We would need to provide them with what they needed without overwhelming them. It was clear this would be a launch like no other! We enlisted the experts, including parents, in our teams to help us develop online tool kits and videos. The PERIPrem perinatal teams have been amazing and we have seen some real improvements in the use of the elements of the care bundle.

PERIPrem has given us a real head start in the West and South West to fulfil one of the three key ambitions of the national Maternity and Neonatal Safety Improvement Programme to improve outcomes for pre-term babies.

We have found that trusts and Local Maternity and Neonatal Systems have been keen to continue with this important improvement work despite the pressures of the pandemic. We have established our Maternity and Neonatal Patient Safety Network to support these national ambitions bringing together all the people, systems and organisations involved in caring for mothers and babies.

The MatNeo Patient Safety Network, which held its latest meeting on 17 March, brings together midwives, doctors, neonatal nurses, ambulance services, Maternity Voice Partnerships, safety champions, Local Maternity and Neonatal Systems, families, primary care and other networks to bring some real focus to sharing and learning how to continually improve maternity and neonatal services. This collaborative way of working is not only supportive but provides the opportunity to enquire and learn from others. There are 15 such Patient Safety Networks across England hosted by their respective AHSNs.

This pandemic has highlighted existing health inequalities; in addition there are some pretty stark statistics about outcomes and experience for black and brown women and their babies.

For example, while stillbirth rates have reduced by over 16% and neonatal mortality has reduced by 11% between 2013 and 2018, “rates of death are falling more slowly among [Black and Asian] babies compared to White babies” and thus initiatives to reduce baby loss are “failing to reach many women from higher risk ethnicities”.  (MBRRACE-UK, 2018, Perinatal Mortality Surveillance Report for 2018)

Stillbirth rates for Black and Black British babies are over twice those for white babies and neonatal mortality rates are 45% higher. (MBRRACE-UK, 2020, Perinatal Mortality Surveillance Report Summary)

Looking at outcomes for all those who receive maternity and neonatal care and understanding why these outcomes and experiences are so different is an essential part of our framework for improving safety.

I am looking forward to the next year as hopefully our lives start to get back to some sort of normality. I am particularly looking forward to increasing our service user and Maternity Voice Partnership involvement and making an impact on health inequalities.

Together with all the people in our West of England maternity and neonatal networks we will continue our focus on learning together and improving outcomes and experience for all.

Posted on March 11, 2021 by Ann Remmers, Maternal and Neonatal Clinical Lead at the West of England AHSN

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