Quality and Safety Committee Wednesday 30th March 2016 Agenda Item No: Q16/32.2 Appendix 2 – January 2016
Open and Honest Care in your Local Hospital
Report for: Data from: Report Produced:
The Open and Honest Care: Driving Improvement Programme aims to support organisations to become more transparent and consistent in publishing safety, experience and improvement data; with the overall aim of improving care, practice and culture. January 2016 2nd February 2016
This report is based on information from January 2016. Friends and Family data is taken from January 2016 as this is the latest data available. The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about Maternity performance.
1. SAFETY Maternity Safety Thermometer On one day each month we use the maternity safety thermometer, which is a nationally agreed tool to monitor care in maternity services. We use it to check to see how many women and babies experienced certain types of harm whilst in our care. It is called a safety 'thermometer' because it is a tool designed to take a sample of information available and so acts similarly to a 'temperature' check of safety, experience and improvement. This helps us to understand where we need to make improvements. When we are using the term ‘harm’ in the context of maternity care it is important to understand that for many women these ‘harms’ are known complications of labour and birth and can not necessarily be avoided. The maternity safety thermometer records whether any of four physical 'harms' occurred and asks three questions about women's experiences of maternity care. The four physical ‘harms’ we record information on in the maternity safety thermometer are;
Severe tears in the skin and muscle around the vagina (also known as perineal tears or 3rd and 4th degree tears) Heavy blood loss following birth more than 1000mls (also known as post-partum haemorrhage) Apgar score less than 7 at 5 minutes which is an indication of how well your baby was at birth (this is a score out of 10 where 2 points are given for each of the following: heart rate, breathing, colour, muscle tone and response to touch - 10 being the best score) Women who report having a maternal infection starting between the onset of labour and 10 days of giving birth.
The term ‘harm free care’ (HFC) is the percentage of women who do not experience any of these ‘harms’ during their labour and birth as recorded in the maternity safety thermometer. The score below shows the percentage of women who did not experience any of these harms measured in the Maternity Safety Thermometer and is known as harm free care. Please note the Safety Thermometer harms identify data collected from women on one day per month and are a snap shot of the 'harms'. The breakdown of these results, are shown below alongside the actual incidence of harms. 75% 96% 75%
of women did not experience any of the four physical harms in this Trust of women did not express concern over their perception of safety of women did not experience any of the combined harms in this Trust. Page 2 of 9
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For more information, including a breakdown by category, please visit: http://www.safetythermometer.nhs.uk/index.php?option=com_content&view=article&id=11&Itemid=285
Outcomes in our maternity service Most women have a normal birth but some women need to have some help to give birth to their baby and have an operative birth. Operative birth could be a caesarean section, vacuum or forceps birth. Whilst having an operative birth can be potentially life-saving there is great variation across the country. It is important to note that the need for an operative birth is dependent on risk factors and can vary in different populations so this information should not be used in isolation.
This month Actual cumulative numbers to date since January 2016
Total number of births 517
Spontaneous vaginal birth 325
Planned Caesarean 48
517
325
48
Emergency Caesarean 76
Forceps Ventouse or Vacuum 49
Vaginal Breach 5
76
49
5
The 'Actual' harms represent the total number of those harms identified occurring for all women giving birth this month.
Of the
517
women who gave birth this month the following 'actual' harms occurred:
Severe perineal tears (3rd and 4th degree) Post Partum Haemorrhage (more than 1000mls) Maternal Infection Apgar score less than 7 at 5 minutes
Actual Incidence of Harms 12 39 No data 7
Total percentage harms of all women 2.3% 7.5% No data 1.3%
Safety Thermometer Prevalence of Harm 3% 10% 4.5% 3.5% Page 3 of 9
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The number of stillbirths is recorded each quarter. The number of stillbirths which occurred in our Trust for the last quarter (December 2015)
Actual Stillbirths
Of the
2
Stillbirths
2
0
% Stillbirths of total births
0.38%
were expected due to congenital abnormalities or other unavoidable complications
Safe Staffing Guidelines recently produced by the National Institute for Health & Care Excellence (NICE) make recommendations that focus on safe nursing for adult wards in acute hospitals and maternity settings. As part of the guidance we are required to publish monthly reports showing the registered nurses/midwives and unregistered nurses we have working in each area. The information included in the report shows the monthly planned staffing hours in comparison with the monthly actual staffing hours worked on each ward and/or the percentage of shifts meeting the safe staffing guidelines. In order to view our reports please visit: http://www.bradfordhospitals.nhs.uk/patients/safe-staffing
2. EXPERIENCE To measure patient and staff experience we ask a number of questions. The idea is simple: if you like using a certain product or doing business with a particular company you like to share this experience with others. The answers given are used to give a score which is the percentage of patients who responded that they would recommend our service to their friends and family.
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Women and Family experience The Friends and Family Test The Friends and Family Test requires all women, at 36 weeks, (ante natal), after the birth, (Labour/Birth), prior to transfer from hospital (Postnatal in hospital) and on discharge from the midwife, (postnatal at home) to be asked: How likely are you to recommend the maternity service to friends and family? We are now calculating and presenting the FFT results as a percentage of respondents who would/would not recommend the service to their friends and family. The maternity services had the following scores: Antenatal * Labour/Birth* Post Natal in Hospital* Post Natal at home*
100 100 96 100
% recommended % recommended % recommended % recommended
This is based on This is based on This is based on This is based on
9 107 52 13
responses responses responses responses
*This result may have changed since publication, for the latest score please visit: http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/
We also ask women questions about their experiences in relation to feeling safe during labour. The responses are below and have been taken from the NHS Safety Thermometer
Were you left alone by midwives or doctors at a time when it worried you during labour or birth? If you raised a concern about safety during labour or birth did you feel that it was taken seriously? Were you ever separated from your baby? (babies transferred to Special care baby unit)
Yes 2.5% 95% 16%
No 97.5% 5% 84%
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Women’s’ or family story
From a community health worker: ‘I was at a women’s group yesterday evening and one of the members came up to me to give some feedback on her sister’s recent birthing experience. She had originally taken part in our 2013/14 maternity focus groups and had given negative feedback about her experience and her family, particularly her sister, not being able to be involved and support her while on the ward and the cleanliness of the ward. Her sister has just given birth again and she said that while her birth experience was difficult (for clinical reasons), the team and particularly the midwives on the labour ward and the postnatal ward were really caring and understood that she had a poor clinical experience and so really made her feel comfortable, informed and involved. The ward and the environment felt clean and spacious. Her family, including her sister, were able to visit and support her and even stay over. She wanted me to feedback that she felt that their views had been heard and that changes had happened – and they felt these changes were really visible. They wanted me to feed this back and say thank you. I’ll feed this in to our grass roots insight report but wanted to share this.’
Staff experience The Friends and Family Test The Friends and Family Test (FFT) requires staff to be asked, at periodic points: How likely are you to recommend our organisation to friends and family if they needed care or treatment?’ and ‘How likely are you to recommend our organisation to friends and family as a place to work?’
FFT percentage recommended care* FFT percentage recommended work*
83 66
% recommended % recommended
This is based on This is based on
214 214
responses responses Page 6 of 9
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*This result may have changed since publication, for the latest score please visit: http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/
We also asked
214
staff the following questions
Would you recommend this maternity service as a place to work? Would you recommend the standard of care from this maternity service to a friend or relative if they needed treatment? Are you satisfied with the quality of care you give to the patients, carers and their families?
% Recommended 66 83 No data
3. IMPROVEMENT Improvement story: we are listening to women and their families and are making changes to improve the maternity service. Bradford was praised recently during a review of their antenatal screening service for innovation in relation to screening champions. Within each community team we have a nominated midwife or screening champion who acts as a link between the screening co-ordinator and the community midwives. Their valuable role involves cascading information and training ensuring all team members are up to date and confident with new developments within the screening programmes. They attend the quarterly antenatal and new-born screening meetings and act as a link for all queries and concerns. This new innovation has a positive effect on the woman of Bradford as early diagnosis and prompt treatment remains the most effective way of improving the outcome of care.
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Supporting information Midwifery Supervision Our Supervisor of Midwives/midwife is ratio currently 1:17. The recommendation is 1:15 which is what we are working to, in order that we provide the best support possible to midwives and mothers. We have 2 candidates currently training, 2 further candidates applying for March 2016 training programme in Sheffield which will help to improve our ratio. Please see below for ‘Your Voice Matters’ poster.
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Your Voice Matters
You Said: ‘We need more basic practical support after the birth’
We Did: We have increased the number and the skills of our maternity support workers. Also 1 agreed named person can stay with you 24 hours a day
‘We need help with getting breast feeding off to a good start’
We have breast feeding champions in all areas. A new breast feeding assessment tool is being used. We have a breast feeding clinic to help with problems
‘Women with antenatal and post-natal depression need support’
There is a new mental health training programme for staff. We now have 24 hour one stop phone access to mental health services.
‘We want to know our midwife and have personalised care’
A 3 year pilot programme started in October 2015. 400 women are enrolled with the Better Start/Opal Team which will focus on continuity and more antenatal and post-natal visits. Any successful outcomes will be used to plan the future of Bradford maternity services.
Thank you for your feedback which we use to improve our maternity services for women and families. Maternity – OAHC Report We are working with cleaning services to improve.
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