For World Patient Safety Day 2021, the World Health Organisation (WHO) is calling for people to act now for safe and respectful childbirth.
This is a welcome area of focus for this year’s flagship patient safety campaign, and an area in which Academic Health Science Networks (AHSNs) and the Patient Safety Collaboratives (PSCs) they host, have an impressive track record.
Across the world, deaths of new-borns account for almost half of all under-five deaths. This makes it a significant global issue, but one where change can bring swift improvement. As the WHO explains, ‘the majority of stillbirths and maternal and new-born deaths are avoidable through the provision of safe and quality care by skilled health professionals working in supportive environments.’
In the UK, data from the latest MBRRACE-UK report, Saving Lives, Improving Mothers’ Care, reveals that pregnancy remains relatively very safe here. Nonetheless, in 2016-18, of more than two million women who gave birth, 547 women died during or up to a year later from causes associated with their pregnancy.
Addressing inequalities is one of the key enablers underpinning the National Patient Safety Improvement Programmes. The MBRRACE-UK report highlights that in that period, 34 black women died for every 100,000 giving birth, compared with 15 Asian women, and eight white women in 100,000. Improving equity and equality in maternal and neonatal care is an NHS priority, which has published guidance and four pledges to women, babies and staff.
In the region where I work, the West of England and South West AHSNs have joined forces to bring people together in a Regional Perinatal Equity Network to improve outcomes where inequality exists. We also know that this is a situation which has been made worse by the COVID-19 pandemic.
Maternity is also a theme in the WHO’s Global Patient Safety Action Plan 2021-2030. The plan sets out a seven-step framework for action, from assuring the safety of clinical processes to encouraging greater stakeholder and community engagement in quality of care initiatives for maternal, new-born and child health. By 2030, it aims to reduce global maternal mortality to fewer than 70 per 100,000 live births.
AHSNs are able to use their unique role as system connectors to bring together people at all levels who can make change happen. Maternity and neonatal safety has also been a PSC programme ever since Patient Safety Collaboratives were created in 2014, so we have a long history working with maternity and neonatal units and front-line staff.
Here are a few examples of the difference AHSNs and PSCs have made.
PReCePT (prevention of cerebral palsy in preterm labour) offers magnesium sulphate to eligible women during preterm labour, reducing the risk of a pre-term baby developing cerebral palsy by 50%.
This HSJ Patient Safety Award-winning intervention led to 850 additional mothers in preterm labour receiving magnesium sulphate in 2019/20, avoiding an estimated 30 cases of cerebral palsy.
The learning from the spread of PReCePT to all maternity units in the West of England was adopted as national safety improvement programme, leading to increased uptake across England.
PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) is a new perinatal care bundle improving outcomes for premature babies across the West of England and South West AHSN regions. The bundle consists of a number of interventions that can have a significant impact on brain injury and mortality rates amongst babies born prematurely.
The bundle is the first of its kind, and builds on lessons learned from designing and delivering the PReCePT project, as well as being clinically owned and driven by perinatal staff across the region. The project has been co-produced with parent partners, with specific resources developed to ensure parents are the agents of their premature baby’s care.
It will support maternity and neonatal units in implementing or improving innovative elements of care that will contribute to a reduction in brain injury and death in the smallest and earliest born babies.
‘Place of birth’
The Oxford AHSN Maternity Network brought together stakeholders from across the region, so that more extremely premature babies are born in a Level 3 unit that can provide more specialist care.
This required a significant shift in working practices from making decisions based on availability of beds and staff, to focus on the risks for the mother and baby. The initiative has led to an increase in eligible babies born in a Level 3 unit from 50% to around 75-80%, and it is estimated that the lives of four more extremely premature babies are being saved every year, a 5% increase. Read more.
Maternity and neonatal triage
Unlike mainstream emergency medicine, there is currently no standardised triage system within maternity for unscheduled appointments. The Birmingham Symptom-specific Obstetric Triage System (BSOTS) was co-produced in 2013 by midwives and obstetricians from Birmingham Women’s and Children’s NHS Foundation Trust and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC).
BSOTS is now in 25 maternity units across the UK. Based on numbers from an initial evaluation, that means approximately 33,000 women have been assessed sooner.
The current MatNeo Safety Improvement Programme contributes to two key national ambitions: to reduce the rates of maternal and neonatal deaths, stillbirths and brain injuries that occur during or soon after birth by 50% by 2025 (as set out in Better Births), and to reduce the national rate of preterm births from 8% to 6% (as set out in Safer Maternity Care).
It’s an ambitious vision and some of the areas it’s focusing on are:
- Improving the early recognition and management of deterioration in women and babies.
- Improving the optimisation and stabilisation of the preterm infant.
- Increasing the proportion of smoke-free pregnancies.
Individually, all of these patient safety interventions contribute to the WHO’s goal of making childbirth safer. Collectively, I believe they show our national commitment to giving babies the best start in life and mothers proactive support, providing a positive environment to grow their families.
You can find your local AHSN here to discuss support for patient safety where you work.