Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
Document Control Title
Support for Parents in Cases of Actual or Suspected Poor Outcome for their Newborn Guideline Author’s job title Specialist Midwife Risk Co-ordinator Directorate Department Surgical Specialties Directorate Maternity Services Date Version Status Comment / Changes / Approval Issued 0.1 May11 Draft Initial version for consultation. 1.0 June 11 Final Approved at the June Guideline Group and the Maternity Services Patient Safety Forum. 1.1 Sep 11 Revision Minor amendments by Corporate Governance to document control report, version control, headers and footers and formatting for document map navigation. 1.2 Sep 13 Revision Minor amendments by Corporate Governance 1.3 Sept 14 Revision Amendment to include guidance in the case of termination of pregnancy for fetal abnormality. 2.0 June 15 Final Approved at the Guideline Group and the Maternity Services Patient Safety Forum. Main Contact Specialist Midwife Risk Coordinator Ladywell Unit North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB Lead Director Director of Nursing Superseded Documents Issue Date Review Date Review Cycle July 2015 July 2018 Three years Consulted with the following stakeholders: Senior Midwives Obstetricians & Gynaecologists Women’s & Children’s Directorate Management Approval and Review Process Maternity Guidelines Group Local Archive Reference G:\Policies and Procedures Local Path Maternity Services Filename Maternity Services Page 1 of 12 Support for Parents in cases of actual or Suspected Poor Outcome for their Newborn Guidelines V2.0 26Oct15
Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
Support for Parents in Cases of Actual or Suspected Poor Outcome for their Newborn Guideline V2.0 26Oct15 Policy categories for Trust’s internal website Tags for Trust’s internal website (Bob) (Bob) Maternity Services
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
CONTENTS Document Control........................................................................................................................ 1 1. Introduction ......................................................................................................................... 4 2. Purpose ................................................................................................................................ 4 3. Definitions............................................................................................................................ 4 4. Process for Providing Support ............................................................................................... 4 4.1 Stillbirth or Neonatal Death ................................................................................................ 4 4.2 Actual or Suspected Poor Outcome Other Than Death ...................................................... 5 4.3 Other Sources of Support and Provision of Information .................................................... 5 4.4 Provision of information for parents who have communication or language support needs ................................................................................................................................... 6 5. Education and Training ......................................................................................................... 6 6. Consultation, Approval, Review and Archiving Processes ....................................................... 6 7. Monitoring Compliance and Effectiveness ............................................................................. 6 8. References ........................................................................................................................... 7 9. Associated Documentation ................................................................................................... 7 Appendix 1 – Audit methodology for Support for Parents in cases of actual or suspected poor outcome for the newborn ........................................................................... 8 Appendix 2 - Audit Criterion for Support for Parents in cases of actual or suspected poor outcome for the newborn .............................................................................................. 9 Appendix 3 - Sources of Support and Provision of Information .................................................... 11
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
1.
Introduction This document sets out Northern Devon Healthcare NHS Trust’s best practice guidelines for the support for parents in cases of actual or suspected poor outcome for the newborn. Whether expected before birth or not, the realisation that a poor outcome is possible for their baby is a difficult and stressful experience for parents. Good communication and maintaining a positive and supportive relationship with parents is vital. Health Care Professionals have an essential role in providing accurate and timely information to parents in these difficult circumstances.
2.
Purpose This guideline describes the processes for support of parents where there has been a poor outcome for the newborn, such as death or disability, or where it is suspected that the long term outcome for the newborn will be poor. This guideline applies to all staff working within the maternity services and must be adhered to. All discussions and action plans must be clearly documented in the Perinatal Institute notes. Non compliance with this guideline may be for valid clinical reasons only. The reason for non-compliance must be documented clearly in the patient’s notes.
3.
Definitions Stillbirth – an infant born without signs of life after 24 weeks gestation. Neonatal Death – an infant born alive who dies within the first 28 days of life. Poor outcome – any diagnosis or illness with suspected long term consequences for the infant.
4.
Process for Providing Support 4.1
Stillbirth or Neonatal Death Reference should be made to the following Trust guidance:
Stillbirth guidelines
Late Fetal Loss guidelines
Neonatal Death Guidelines
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
These guidelines are available on the Trust intranet site ‘Bob’. Spiritual support can be sought through the Trust’s Chaplaincy Service on Bleep 103 or on Extension 2362.
4.2
Actual or Suspected Poor Outcome Other Than Death Where an actual or suspected poor outcome other than death has been identified before delivery, reference should be made to the following Trust guidance:
Guideline for referral when a fetal abnormality is detected in pregnancy. Extreme Prematurity Guidelines
A fetus born alive after termination for a fetal abnormality is deemed to be a child and must be treated in his or her best interests and managed within published guidance for neonatal practice. A fetus born alive with abnormalities incompatible with long-term survival should be managed to maintain comfort and dignity during terminal care. (RCOG, May 2010). Where a poor outcome is expected and the baby is greater than 22 weeks gestation the on-call paediatrician will be informed prior to delivery The paediatrician should be called to all live births under 37 weeks gestation. This guideline is available on the Trust intranet site ‘BOB’. On each shift on Bassett Ward the parents are allocated a named Midwife who will introduce themselves at the beginning of shift and be available to offer care, support and information throughout the shift. The parents will be offered the opportunity for discussion with an experienced paediatrician within 24 hours of their baby’s admission to Special Care Unit (SCU) or at the earliest opportunity after a problem is identified if the baby does not require admission to SCU. The parents will be kept fully informed of their baby’s progress by members of the paediatric and midwifery teams. All discussions will be documented in the Perinatal Institute notes. After discharge, the baby and his or her parents will be offered a follow up appointment with the named Consultant Paediatrician in 6-8 weeks where appropriate. Follow up with the named obstetrician will also be arranged within a similar timescale where appropriate.
4.3
Other Sources of Support and Provision of Information Written information should be given, as appropriate, to support verbal information. Refer to Appendix 3 for a list of resources. Parent(s) will be offered information from appropriate sources of support, such as: Antenatal Results & Choices (ARC) www.arc-uk.org,
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
Stillbirth and Neonatal Death Society (SANDS) www.uk-sands.org, or BLISS (For babies born too soon, too small, too sick) www.bliss.org.uk. They will be signposted towards further sources of information as required.
4.4
Provision of information for parents who have communication or language support needs Communication and information should be provided in a form that is accessible to parents who have additional needs, such as those with physical, cognitive or sensory disabilities. For those who do not speak or read English, Language Line should be used where possible. Telephone Number: 0800 028 0073.
5.
Education and Training Responsibility for education and training lies with the Lead Clinician for the Maternity Services.
6.
Consultation, Approval, Review and Archiving Processes The author consulted with all relevant stakeholders. Please refer to the Document Control Report. The guidelines will be reviewed every 3 years. The author will be responsible for ensuring the guidelines are reviewed and revisions approved by the Lead Clinician for the Maternity services in accordance with the Document Control Report. All versions of these guidelines will be archived in electronic format by the author within the Maternity Services Team policy archive. Any revisions to the final document will be recorded on the Document Control Report. To obtain a copy of the archived guidelines, contact should be made with the Maternity Team.
7.
Monitoring Compliance and Effectiveness Monitoring of implementation, effectiveness and compliance with the Support for Parents guidelines is the responsibility of the senior clinical/management team. The maternity services audit programme and methodology of process, reporting and escalation is described in Appendix 1 using the audit criterion in Appendix 2.
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
8.
References
9.
SANDS - Stillbirth and Neonatal Death Society. www.uk-sands.org Accessed June, 2011.
Royal College of Anesthetists, Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, Royal College of Paediatricians and Child Health (2007) safer childbirth: minimum standards for the organization and delivery of care in labour London: RCOG.
Nice (2007) Intrapartum care: care of healthy women and babies during childbirth Clinical guideline 55 London: RCOG Press.
Royal College of Obstetricians and Gynaecologists: Termination of Pregnancy for Fetal Abnormality in England, Scotland and Wales, Report of a working party, May 2010: RCOG.
Associated Documentation
Stillbirth Guidelines
Extreme Prematurity Guidelines
Late Fetal Loss Guidelines
Neonatal Death Guidelines
Guideline for referral when a fetal abnormality is detected in pregnancy
Incident Management policy
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
Appendix 1 – Audit methodology for Support for Parents in cases of actual or suspected poor outcome for the newborn
NDHT Obstetrics, Gynaecology and Midwifery Guideline:
Support for Parents in cases of actual or suspected poor outcome for the newborn V0.1
CNST Ref:
Standard:
Monitoring arrangements
Clinical Audit
Y
Annually
Monitoring
Y
Variety of circumstances
5
Criterion:
8
Monitoring Arrangements Northern Devon Healthcare Trust Maternity Services will monitor compliance of this guidance against all minimum requirements within the CNST maternity standards by an annual audit, supported by specific audits during the year that are triggered by the clinical incident reporting system, or in response to a change in practice. Lead for Monitoring Compliance
Senior Midwife/ Risk Lead for Women’s Inpatient Services
Method
Sample
1% or 10 sets, whichever is the greater, of all health care records where support for parents has been required in variety of circumstances
Audit tool
An audit tool will be developed using the standard statements set out in Appendix 2
Data collection process
Patient notes will be audited by a clinically qualified member of staff. The information will be recorded using the audit tool.
Process for collating and reporting data
Data will entered and analysed using appropriate software to show compliance levels. All the results of the audit and audit report will be reviewed by a multi-disciplinary team at the Maternity Services Patient Safety Forum.
Frequency of monitoring/audit
Annual
Process for reviewing results and ensuring improvements in
The Maternity Services Patient Safety Forum will develop an action plan to improve compliance and ensure improvements in
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
performance occur
performance occur. Action plans will be implemented by the Risk Co-ordinator and Practice Development Midwives to ensure learning takes place. The Maternity Services Patient Safety Forum will monitor progress of action plan monthly and exceptions will be reported via this group to the Clinical Governance Committee. Identified risks related to non-compliance with these guidelines through audit will be registered on the Trust Risk System by the Risk Coordinator.
Appendix 2 - Audit Criterion for Support for Parents in cases of actual or suspected poor outcome for the newborn
Criterion statements for audit tool
Target
Ref
Criterion statements
Exceptions
Indicator/Location of information
National guidance Reference
Where is the information against which compliance can be audited recorded? Eg. Postnatal notes Eg Stork screen
Which national guidance does this demonstrate compliance with Page no/
eg. NICE CG13 p22
Trust guideline reference
On which page of the Trust guideline is the relevant statement?
Field
1
2
System for providing appropriate support for parent(s) in cases of actual or suspected poor outcome for the baby System for providing information for parent(s) in cases of suspected poor Maternity Services Page 9 of 12 Support for Parents in cases of actual or Suspected Poor Outcome for their Newborn Guidelines V2.0 26Oct15
Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
3
4
5
outcome for the baby Process for providing support to parent(s) who have communication or language support needs Requirement to document all discussions with parent(s) Process for ensuring parent(s) have information about the relevant support groups
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
Appendix 3 - Sources of Support and Provision of Information
Leaflet title
Available from
When to be given to parent(s) and pack reference
Sands Leaflets
SANDS
As necessary
After the death or stillbirth of your baby
SANDS
As necessary
Saying Goodbye to your baby
SANDS
As necessary
The Next Pregnancy: Guidance for Parents
SANDS
As necessary
For Family &Friends How you can Help
SANDS
As necessary
The loss of your Grandchild
SANDS
As necessary
Mainly for fathers
SANDS
As necessary
About the other Children
SANDS
As necessary
Support for you when your baby dies
SANDS
As necessary
Sexual Problems following a Stillbirth
SANDS
As necessary
Bereavement Support Group (TAMBA)
TAMBA Twins & Multiple Birth Society
As necessary
We are sorry that you have had a miscarriage
The Miscarriage Association
As necessary
ARC
As necessary
Handbook for Parents when ARC an abnormality is diagnosed in their unborn baby
As necessary
Help for fathers
ARC
As necessary
Supporting you throughout ARC your pregnancy
As necessary
Review date
Arc leaflets Talking to children
Bliss leaflets Parent Information Guide
BLISS
As necessary
Screening tests for your baby
NHS
As necessary
Having a mid-pregnancy
NHS
As necessary
NHS leaflets
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Support for Parents in cases of actual or Suspected Poor Outcome For their Newborn Guidelines
ultrasound scan? NDHT leaflets After your amniocentesis
NDHT
As necessary
Information and advice following your bereavement
NDHT
As necessary
NMC
As necessary
NMC leaflets Support for parents
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