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Activity & Quality Report Quarter /19

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Presentation on theme: "Activity & Quality Report Quarter /19"— Presentation transcript:

1 Activity & Quality Report Quarter 1 2018/19
Staffordshire, Shropshire & Black Country Neonatal Operational Delivery Network Activity & Quality Report Quarter /19

2 SSBCN ODN Activity Report 2018/19
SSBCN ODN Admissions NNU Only Quarter 1  Admissions by Gestation (NNU Only) Admissions by Birth weight (NNU Only)

3 SSBCN ODN Activity Report 2018/19
SSBCN ODN Admissions NNU Only Quarter 1 SSBCN ODN Admissions to NNU by Gestation SSBCN ODN Admissions to NNU by Birth weight

4 SSBCN ODN Activity Report 2018/19 SSBCN ODN Admissions All Locations
 All Admissions (NNU/TC/PNW) by Gestation Each Trust SSBCN ODN

5 Quarter 1 Term Admissions to NNUs
SSBCN ODN Activity Report 2018/19 – SSBCN ODN Admissions Quarter 1 Term Admissions to NNUs % of NNU admissions that are Term babies % of Term Live Births admitted to NNU by Unit

6  SSBCN ODN Activity Report 2018/19 – HRG Activity Levels Quarter 1

7  SSBCN ODN Activity Report 2018/19 – HRG Activity Levels Quarter 1
Continued………………. HRG Activity Outside NNU on PNW/TC

8 Badger HRG activity on NNU
 SSBCN ODN Activity Report 2018/19 – Occupancy Levels in NNU’s Quarter 1 Badger HRG activity on NNU Annual Unit IC HD SC Total RSUH 81% 76% 84% RHH 54% 145% 95% 94% PRH 63% 86% 66% 68% WMH 77% 144% 78% RWH 92% 73% 82% SSBCN ODN 90% 80%

9 SSBCN ODN Activity Report 2018/19- Location of Care Report
SSBCN ODN Activity Outside Network NB. Includes activity in BCH, BWH, Alderhey and LWH which may be appropriate Out of Area activity in SSBCN ODN % of babies with all care in SSBCN ODN

10 SSBCN ODN Outcomes 2018/19 – Quarter 1
SSBCNMN Outcomes Monitoring Matrix 2018/19 Quarter Trust Cooling (network babies) Laser Treatment for ROP 2 year assessments Deaths by Gestation Deaths by Birth Weight 24 & under 32- 36 > 37 Total < 750 > 2500 Quarter 1 RWH 4 Babies born Oct - Dec 15 2 1 6 3 RSUH 5 PRH RHH WMH City Survival 80.0% 90.0% 96.4% 99.8% 99.7% 99.1% 96.6% 93.5% 99.2% 100.0% Totals 8 37/47 =79% 14

11 National Specialised Services Neonatal Critical Care Quality Dashboard
Ref NIC02 NIC04 NIC13 NIC14 Percentage of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g who receive specialist neonatal care and undergo retinopathy screening in line with national guidelines on timing Rate of blood stream infection per 1000 catheter days taken after 72h of age Proportion of newborn babies < 34 weeks who receive specialist neonatal care who have an admission temperature of less than 36C Percentage of babies <27+0 weeks gestation (or multiple pregnancies <28+0 weeks) who are born in a hospital with a NICU in the network Quarter Trust Numerator Denominator Value National Mean Quarter 1 RWH 19 100.0% 92.70% <5 4.16% 5.62% 2.56% 3.88% 12 14 75% RSUH 21 90.5% 2.70% 6.45% PRH 13 139 0.00% 18 RHH 8 170 13.60% WMH 9 5.00% Quarter 2 22 93.60% 1.96% 4.54% 3.79% 16 25 64% 90.0% 11.76% 10 145 17 20 95.0% 190 14.70% 88 24 Quarter 3 26 94.20% 2.40% 5.66% 43 3.61% 77% 74% 404 15 99 6.25% 16.10% Quarter 4 32 34 94.0% 94.1% 8.85% 5.4% 2.04% 4.12% 84% 76% 399 2.77% 8.77% 7.25% 0% 93.0% 85 Nb. Quarter 4 report from UHNM not received yet and therefore UHNM data not verified

12 SSBCN ODN NNAP Performance Quarter 1 2018/19

13 SSBCN ODN NNAP Performance Quarter 1 2018/19 continued….

14 SSBCN ODN NNAP Performance Quarter 1 2018/19 continued….

15 SSBCN ODN NNAP Performance Quarter 1 2018/19 continued….

16 In-Utero Exceptions Quarter 1 2018/19
Unit Gestation Reason(s) for IUT Transfer Destination Previous IUT in this Pregnancy Outcome (If Known) Delivered Undelivered Unknown Comments - Below gestational threshold for NNU ·  NNU Full ·  No NNU Capacity in Network ·  No Labour Ward Capacity in Network ·  Other (please state) Quarter 1 RWH RSUH 16 $ * 16 X NNU Full (includes 3 X No NICU Cots in Network) Warrington Telford Birmingham Women's Oldham Leighton Leighton Withenshaw Birmingham City Arrow Park Preston Bolton Burton Warrington Worcester Telford St Mary's Manchester* Unknown X 16 $ NNU refused to allow induction of labour *Cardiac patient requiring a higher level of CCU care S&WB 1 24+6 Below Gestational Threshold (No NICU Cots in Birmingham) Coventry No Unknown PRH 6 * 3 X Below Gestational threshold (Includes No NICU Cots in RSUH X 2 & No NICU Cots in Network X 1) X NNU Full New Cross New Cross Countess of Chester Birmingham Women's * Walsall Manor Coventry No X 6 Undelivered Undelivered Undelivered Delivered Undelivered Delivered * Fetal Anomaly RHH 8 $ $ $ ~ 4 X Below Gestational threshold (Includes No NICU Cots in RWH X 1 and No NICU Cots in Network X3) X MDT requested delivery at Level 3$ (Includes No NICU Cots in RWH X 1 and No NICU Cots in Network X 2) X Maternal Reason (cardiac)~ Stoke Coventry Leicester Stoke Stoke Birmingham Women's Liverpool Unknown No X 8 Undelivered * Delivered Delivered Unknown Delivered Unknown Undelivered Undelivered * * Delivered later at RHH WMH 4 X Below Gestational threshold (Includes No NICU Cots in RWH X 3 and No NICU Cots in Network X 1) X NNU Full Stoke Stoke Worcester * Stoke Worcester Liverpool Undelivered X 6 All antenatal care resumed in Walsall * Delivered in Walsall 2 days later Network Totals 37 <27 x X X >34 X 6 Below Gestational Threshold X MDT Requested delivery in NICU X (No NICU Cots in RWH X No NICU Cots in RSUH X No NICU Cots in Network X 10) NNU Full X No Labour Ward capacity X Maternal Reason X 1 SSBC X West Midlands X Outside X Unknown X 1 No X Yes X 0 Delivered X Undelivered X Unknown X 19

17 Ex-Utero Exceptions Quarter 1 2018/19
Exceptions Number Exception Reason Required care above the clinical threshold for unit designation *Reported in quarter exception occurred  Delayed Repatriations * Reported in quarter baby discharged Admissions from outside SSBCN * Reported in quarter baby discharged Outcome Quarter 1 RWH  TBC RSUH  5 4 X Transfer out due to NNU capacity  1 X Outside Admission 1 baby for 8 days  Transfers out of NNU for capacity reasons:  All were >36 weeks gestation, 1 – PICU at RSUH, 1 – Leighton and Twins to Telford. Outside Admissions: 1 Baby from BWH for 8 days CHB TBC  PRH 9 8 X Clinical Threshold X Birthweight Threshold 4 X Ventilation > 48 hrs X Prostaglandin X Inotropes X Chest drain X Cooling and Inotropes Birthweight < 800g week baby BW 735g, discussed with NICU and agreed plan to stay at PRH X Ventilation >48hrs discussed with NICU and agreed plan to stay at PRH, 2 X Ventilation >48rs not discussed as successful planned extubations at 55 and 58hrs Baby on Prostaglandin discussed and transferred to BCH baby on inotropes and 1 baby with chest drain for 1 day each only, not discussed and both discharged home baby cooled and on inotropes discussed with NICU and agreed plan to re-orientate care to palliation NND at 28 hrs RHH 8 1 X Clinical Threshold X Transfer out due to NNU Capacity X Delayed repatriations X Outside Admissions 1 X Ventilation >48hrs 2 Babies for 4 days in total 4 Babies for 73 days 1 baby ventilated for 55 hrs, not discussed with NICU as successful planned extubation Baby transferred to C2 due to NNU Capacity Delayed Repatriations babies from New Cross delayed for 4 days in total Outside Admissions babies booked at BWH but admitted from George Eliot X 3 and Northampton X 1 for a total of 73 days WMH 3 1 X Delayed Discharge X Outside Admissions 1 baby for 6 days 2 babies for 23 days Delayed Repatriations baby from Good Hope delayed for 6 days in total Outside Admissions babies 1 X Good Hope and 1 X Heartlands for a total of 23 days Network Totals

18 SSBCN ODN Badger Exception Monitoring - Quarter 1 2018/19
Badger ID Unit Criteria Days Outcome CEL Comment AFUHHC City ChestDrain Ventilated Inc HFOV 3 6 2 DischHome/Ward Use of HFO and chest drain AYNMJC Transferred 77 Hrs Not an exception for City AX38IC 4 AATVJC 20 NotDischarged 3 episodes of ventilation, 7days, 10 days and 3 days, use of HFO AE29HC Transferred 22 Hrs Use of HFO, appropriate transfer Not an exception for City ASPIJC 13 Transferred 391 Hrs Ventilated >7 days AGMNIC Transferred 18 Hrs Use of HFO, transferred at 18hrs, Not an exception for City APTXHC Inotropes 23 Ventilated >7 days , use of HFO and inotropes ANOSIC 8 3 episodes of ventilation all <7 days, Not an exception for City AUELIC 5 AEW1HC 14 ABNIIC AMEZGC Insulin Insulin use A426IC NitricOxide Use of NO &HFO, appropriate transfer, Not an exception for City AHGMJC PRH Low Weight 7 30 weeks gestation, wt 738g, below weight criteria AQDSIC Prostagladin Transferred 98 Hrs 33 weeks gestation, congenital heart disease, TF at 98 hours ?delay awaiting bed BCH AOLKJC 37 weeks gestation, inotropes and ventilated less than 48 hours A4J8FC 25 weeks repatriated on D75, ventilated <96 hours with ?NEC A67VJC 27 weeks , 2 episodes of ventilation 1<72 hours, 1 <96 hours AB7LIC 29 weeks gestation, ventilated <96 hours AC4VHC 34 weeks gestation, ventilated <72 hours A6IUJC Cooling Died 37 weeks gestation, was due to be transferred to RSUH but? Deteriorated before transfer, died at 28 hours of age AXR5IC 39 weeks , ventilated, inotropes and chest drain <48 hours AY6LIC WMH 25 weeks gestation, repatriated D21. Ventilated <48 hours ?NEC AG8OJC RHH 29 weeks gestation, 2 episodes ventilation, 1 <24 hours, 1 <72 hours ?sepsis AGITHC 31 weeks gestation, ventilated <72 hours ASVLIC 28 weeks gestation, no evidence Nitric Oxide given at any point 27 exceptions in the badger exceptions monitoring report. Over half of these are attributed to the LNU at S&WB (14) whose ventilation threshold is 7 days before the need to ring the NICU, 6 babies were ventilated <7 days and a further 3 babies received HFOV but were transferred out <24hrs of age, therefore only 5 of the 14 exceptions within the report appear to fall outside of their current agreed care pathways. RHH X 3 exceptions reported in badger only one of these the baby ventilated >48 hours was reflected in their self report, the other two appear not to have been exceptions to their agreed care pathways SaTH X 9 exceptions reported in badger, and reflected in their self report too WMH X 1 exception reported in badger however not an exception as ventilated < 48hrs 10 babies were born in LNUs below their gestational threshold in Q1, and 2 babies were born in LNUs below 800g S&WB admitted 5 babies <27 weeks (inc 2 sets of twins), 1 NND <12hrs, 2 transferred out to NICUs <12hrs, and 1 <24hrs of age + 1 baby 27 weeks who remains at City. Dudley admitted 0 babies <27 weeks or <800g Telford admitted 2 babies < 27 weeks both were transferred out to NICUs (1 to RWH and 1 to BWH = 2 x exceptions for RSUH) + 1 baby 30/40 who remained at SaTH till discharge home. Walsall admitted 0 babies <800g and 3 babies < 28 weeks all were transferred out to NICUs (one went to BWH = an exception for RWH)

19 SSBCN ODN Neonatal Patient Safety Incident Report Quarter 4 2017/18
PRH - X5 of clinical assessment incidents were due to having no Tissue Viability support within the trust to review babies. X 2 moderate – details and any shared learning TBC RWH 1X moderate & 1 X Severe and RSUH 1 X moderate – details and any shared learning TBC WMH 1 X moderate = 1st oesophageal perforation, Shared Learning: New documentation checklist and SOP

20 SSBCN ODN Neonatal Patient Safety Incident Report Quarter 1 2018/19
RWH - 3 Moderate and 1 Severe incident, Brief details and any shared learning TBC. DG - 15 of the incidents in "all other" relate to safeguarding as we datix all safeguarding babies and 4 of the low harm are actually classified as near misses on the datix

21 SSBCN ODN Neonatal Parents Experience Survey 2018/19
Quarter /19

22 SSBCN ODN Neonatal Nurse Staffing 2018/19 – Quarter 1
Location Name Unit Level Incomplete Shifts %Shifts Staffed To BAPM Recommendations %Shifts QIS To Toolkit %Shifts With Team Leader % Nursing shifts covered by Bank Avg (Mean) variance from compliance Avg (Median) variance from compliance Additional nurse shifts need to make all shifts BAPM compliant RWH NICU 3.3 5.49 8.24 4.88 -2.88 -2.8 528.8 RSUH 12.09 6.04 65.38 9.22 -2.22 -2.0 418.8 National Avg 54.25 35.72 62.03 7.61 0.35 0.3 PRH LNU 47.8 48.9 73.08 8.85 -0.04 0.0 120.5 WMH 82.42 57.69 2.58 0.95 0.8 18.1 RHH 31.87 10.88 -0.74 -0.9 190.9 S&WB 1 21.55 43.09 4.97 12.32 -1.07 -1.1 232.3 67.53 76.08 32.07 5.38 0.64 0.7 SCU 71.69 94.78 5.04 5.69 0.53 0.5

23 SSBCN ODN Neonatal Nurse Staffing 2018/19 - Quarter 1


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