WELSH RISK POOL Vicky Langford

Welsh Risk pool Maternity care represents the major risk to Health boards in terms of potential litigation costs. The WRP conduct an annual assessment looking at the management of risk within the maternity services and evidence of implementation

WRP Standard 15 There are 21 areas for assessment that require written evidence to support the following: There is a system which defines the responsibility of care throughout all stages of pregnancy The initial risk assessment of women should ensure an informed, individual plan of care There is a nominated clinical team member responsible for intra-partum care which includes clearly documenting the planning, decision making process and actual care and outcome of the management of each birth

Areas for assessment: There is guidance on antenatal screening procedures and the management of the mother following test results Communication processes exist throughout pregnancy, labour and postnatal periods There are named individuals responsible for the management of delivery unit approved policies. The labour ward forum should be included in the consultation process. There is a named consultant obstetrician and obstetric anaesthetist available at all times to provide advice and cover for the delivery unit, in line with safer childbirth.

Areas for assessment: There is a system in place to ensure the safe management of the maternity unit during periods of increased activity There is a department standard for the maximum time between identifying presumed fetal compromise and the undertaking of a caesarean section, which is subject to regular audit, review of results and monitoring of action plans as per NICE guidelines There is a guideline regarding the management of known fetal abnormalities and babies who are stillborn or born severly abnormal

Areas for assessment: Adequate equipment is provided to allow resuscitation of mothers and babies and there is a training programme that ensures all relevant staff receive training and that training is recorded. There should be clear guidelines and training on fetal monitoring which includes CTG interpretation. Training should be competency based and updates should be undertaken on a 6 monthly basis There is a system that defines the responsibility of care throughout all stages of the postnatal period

Area for assessment: There are approved written policies for the management of maternity care and evidence that these are implemented The recommendations from the Confidential enquiries are considered within the planning of the departmental activity and care of mothers and babies Where the maternity unit staffs its own theatres, guidelines and skills should be developed in consultation with senior staff within main theatres

Area for assessment: Supervision of Midwives All staff will receive training on child protection, at a level appropriate to their role and responsibilities. There is a process for the management of risk, including identification, recording, investigation and learning lessons. The individual directorates/ departments providing maternity services have health and safety policies, in line with the organisation-wide policy and consistent with the revitalising Health and Safety agenda

Annual assessment 2011 Staff Interviews 7 interviews on each site including varying grades of clinical staff, medical and nursing staff Results 50% of overall score \

Assessment Feedback Maternity Both medical and midwifery staff feel supported and valued No acceptable capacity limit has yet been set however acuity is measured regularly 100% completion of K2 training is to be commended A distinct improvement in collaborative working across the organisation both in the development of cross site policies and procedures but also networking Band 7 funded from IM&T to ease the transition process for the introduction of the Myrddin system which has been welcomed by staff Records audited as part of annual supervisory review, and staff viewed auditing other people’s notes as more constructive than auditing their own notes

Feedback Maternity continued: Collaborative teaching across the sites has helped to break down barriers between the sites and midwives are given a formal induction to new sites which has been welcomed and it is apparent that the integration of the Health Board has much improved since last year and staff do not view it as a takeover

WRP SCORE 2011 96% Well done ABMU!!!