“ONE TO ONE CARE IN LABOUR – MAKING IT HAPPEN” DAWN APSEE Intrapartum Services Manager GWYNNETH SINGH Supervisor of midwives FEB 2011

Princess of Wales 3 community teams that provide integrated service for low risk women only Bryn Hyfryd Team, Glan y Mor Team, Pen y Fro Team Ward 12 Antenatal/ Postnatal Ward 27 beds Labour Ward 7 midwives to provide Ante Natal/Intra Partum/Post Natal and scrub role for theatre. 6 bedded labour ward, 1 bedded low risk MLU room, theatre and recovery Ward 12

Neath Port Talbot Hospital Neath Port Talbot 3 community teams provide integrated midwifery service for low risk women. Dinas Team, Glynnedd Team, Pelenna Team Antenatal clinic for women requiring Consultant care in pregnancy. Birth Centre for low risk women has 7 birthing rooms including 1 pool for water births and 3 double bedrooms.

Singleton Hospital Singleton Ward bedded ward, providing post natal care for women and infants CDS 8 delivery rooms 4 bedded LDU 2 bedded HDU Triage area Obstetric Theatre Back up Obstetric Theatre Ward bedded ward, providing ante natal care for women, including 2 single early labouring rooms. 1 bereavement room. Singleton MLU 3 delivery rooms, 1 of which has a birthing pool.

Providing safe services Supervisors, Midwives and Managers working together to ensure one to one care is provided for approximately 6,700 women in labour throughout ABMU Health Board can be a challenge Consistent approach to assessing and alerting the need to escalate Evidence that there is a robust and auditable approach to managing risk

Acuity The acuity measurement ensures there is a standardised assessment of activity and complexity of intrapartum care when managing peaks and troughs of the service Indicates the number of midwives required to provide safe care It does not calculate the number or skill mix of staff on the antenatal and postnatal wards When acuity is rising the coordinator is responsible for requesting additional staff but must ensure safe levels maintained in other areas

ACUITY Undertaken on a 4hrly basis when unit at average activity and more frequently when activity rising Acuity should be shared and documented at multidisciplinary handovers Rising acuity will trigger the escalation procedures In times of escalation the acuity score is the common means of communicating the needs of the service to Supervisors and managers

Intrapartum Scorecard NPSA scorecard which demonstrates other governance activity on a 4hrly basis which compliments the acuity data:- Midwifery staffing Other staffing levels women on the labour ward Activity on labour ward Action taken if escalation policy implemented

ESCALATION There are three categories: GREEN - no problem with activity levels AMBER - pressure is rising RED - little or no capacity for further admissions. This is an extreme situation and closure may be required if all other actions have failed (appropriate documentation will need to be completed)

What were the challenges? Not understanding / implementation of using acuity and how it links to escalation policy Reluctance to implement jump call and escalation policy Differing practices across the health board Maternity services across three sites Not having a flexible workforce Lack of confidence and competence of staff

MEETING THE CHALLENGES Ensuring all midwives, supervisors and managers understand the acuity and escalation policy to ensure intelligent decisions made when in escalation Presentation at ABMU Supervisors meeting Presentation at ward managers meeting Mandatory workshops for staff to understand importance of having right person in right place at right time

MEETING THE CHALLENGES More flexible confident workforce Induction package for all newly appointed midwives Induction day for specific midwives that had not provided intra-partum care recently Support to midwives when required to move across site – avoidance of “jack of all trades, master of none” Good leadership and development of roles Induction booklets/Development tools/laminated quick guide to specific areas to support competency of midwives when working in an unfamiliar area

MEETING THE CHALLENGES Integration of policies and practice across ABMUHB Standardisation of equipment wherever possible To ensure consistency across all sites Confidence of staff Reduce the risk of adverse incidents

CONCLUSION Supervisors and managers working together to ensure a safe and effective service for women and babies Good communication is essential in ensuring the right people are in the right place at the right time to maintain a quality service. Ensure midwives feel supported in their role Robust strategies in place for managing the peak periods