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Showing results for tags 'Baby'.
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Safety, experience, or both?
Claire Cox posted an article in Maternity
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Birthrights: COVID-19
PatientSafetyLearning Team posted an article in Good practice and useful resources
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RCOG: Video briefing on human factors and situational awareness
Claire Cox posted an article in Maternity
Key themes: Situational awareness Handover resources Interruptions and distractions Delegation Task-fixation, helicopter view & closed-loop communication Ask for help. -
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Video of a Schwartz round
Claire Cox posted an article in Good practice
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What will I learn? An overview of the NHS Innovation Accelerator (NIA) Support available: the role of the AHSNs An innovator’s journey: ORCHA Lessons and insights from the NIA- Posted
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Key learning points Staff reported feeling increasingly confident in supporting skin to skin contact and monitoring risk factors through using RAPP, which improves mothers’ experiences as they are able to spend more time with their newborn. Initial audit information suggests that the implementation of the RAPP tool has supported the prompt recognition and response to deterioration risk factors. This is reducing the need for further intervention by the neonatal team. -
Content Article
What can I learn? How to implement each of the five elements, focusing on how processes and pathways can be developed and where improvements can be made. Process indicators and outcome indicators for each of the five elements. The importance of other interventions outside of the remit of the care bundle, such as continuity of carer models, following NICE guidance, delivering ‘healthy pregnancy messages’ before and during pregnancy and offering choice and personalised care to all women.- Posted
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What can I learn? Mortality rates reduced with 300 fewer baby deaths in 2016 compared with 2013. Improved survival for twins: the stillbirth rate has reduced by almost half since 2014 and neonatal deaths have reduced by almost a third during the same period. Regional variation is still evident in England. Post-mortem examination continues to vary between stillbirths and neonatal deaths. Almost all parents of stillborn babies were offered a post-mortem and of these 1 in 2 consented to a post-mortem. 8 out of 10 parents of babies who died neonatally were offer- Posted
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News Article
Justice is being denied to too many families
Patient Safety Learning posted a news article in News
Harry Richford's death underlines the need for the health secretary to bring back the national maternity safety training fund – and there are other issues that require urgent attention – The Independent reports. Harry Richford had not even been born before the NHS failed him. An inquest has concluded he was neglected by East Kent University Hospitals Trust in yet another maternity scandal to rock the NHS. His parents and grandparents have fought a tireless campaign against a wall of obfuscation and indifference from the NHS. In their pursuit of the truth they have exposed a maternity ser -
News Article
A hospital trust under the spotlight over avoidable baby deaths provided inadequate antenatal care, with inexperienced junior midwives working alone and doctors not always available to assess high risk women, the Care Quality Commission (CQC) has found. The latest CQC report on maternity services at East Kent Hospitals University Foundation Trust follows a report last month by the NHS Healthcare Services Investigation Branch on 24 maternity care investigations at the trust. Read full story (paywalled) Source: BMJ, 28 May 2020 -
News Article
Agency is criticised over its investigation into baby’s death from hypoxia
Patient Safety Learning posted a news article in News
The coroner investigating the botched birth of a baby boy who died from hypoxia has strongly criticised the Healthcare Service Investigation Branch (HSIB) over its report on his death. Karen Henderson, who conducted the inquest into the death of baby Theo Young in May 2018 at East Surrey Hospital said that the HSIB had asked Surrey and Sussex Healthcare NHS Trust not to undertake its own investigation, “effectively preventing the recognition of causes of concern and therefore being unable to undertake any immediate and necessary remedial action at the earliest opportunity to prevent futur- Posted
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East Kent baby deaths: Scale of deaths at trust 'not clear-cut'
Patient Safety Learning posted a news article in News
The boss of an NHS trust at the centre of concerns about preventable baby deaths has claimed the scale of the failings is not clearly defined. Susan Acott, Chief Executive of East Kent Hospitals Trust, said there had only been "six or seven" avoidable deaths at the trust since 2011. However, the BBC revealed on Monday that the trust previously accepted responsibility for at least 10. Ms Acott said some of the baby deaths were "not as clear-cut". A series of failings came to light during the inquest of Harry Richford who died seven days after his birth at the Queen Elizabeth the- Posted
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Re-writing conversations
Claire Cox posted an article in By patients and public
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Each baby counts: Aims and objectives
Claire Cox posted an article in Maternity
Currently, stillbirths, neonatal deaths and brain injuries occurring due to incidents in labour are investigated at a local level. The Each baby counts project team will, for the first time, bring together the results of these local investigations to understand the bigger picture and share the lessons learned. From 2015, they began collecting and analysing data from all UK units to identify lessons learned to improve future care. They will then be able to make recommendations on how to improve practice at a national level. This page brings together all of the information and resource- Posted
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PROMPT Maternity Foundation training programme
PatientSafetyLearning Team posted an article in Processes
It has been shown to improve outcomes for real women and their babies. The introduction of PROMPT training at Southmead Hospital has resulted in:- Posted
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View all of the material published throughout the course of the Inquiry.- Posted
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The STROBE study, published in BMC Pregnancy and Childbirth, will help establish understanding of the effectiveness of locally-delivered simulation training for operative vaginal birth. Robust evidence supporting the effectiveness of such an approach would add weight to the argument supporting regular, local training for junior obstetricians in operative vaginal birth.- Posted
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Recommendations The Government should immediately issue a fulsome apology on behalf of the healthcare system to the families affected by Primodos, sodium valproate and pelvic mesh. The appointment of a Patient Safety Commissioner who would be an independent public leader with a statutory responsibility. The Commissioner would champion the value of listening to patients and promoting users’ perspectives in seeking improvements to patient safety around the use of medicines and medical devices. A new independent Redress Agency for those harmed by medicines and medical devices sho- Posted
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- Medical device
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