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……………….

8. % of babies at 44 weeks corrected gestation on NNU
SSBCN ODN Activity Report 2018/19- Location of Care Report Quarter 1
HRG Activity Outside of NNU on PNW/TC
% of babies at 44 weeks corrected gestation on NNU

9. 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%

10. 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

11. 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

12. 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%
TBC
6.60%
2.00%
84%
399
2.77%
114
138
4.35%
93.0% 85 23
NB. Quarter 4 data has not been verified by each neonatal service at the time of this report being compiled

13. SSBCN ODN NNAP Performance Quarter 1 2018/19

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

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

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

17. 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

18. 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
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

19. SSBCN ODN Badger Exception Monitoring - Quarter 1 2018/19
BadgerID
Unit
Designation
Criteria
Exception Days
Outcome
CEL Comment
A426IC
S&WB
LNU
NitricOxide 2
Transferred 22 Hrs
(27/40 bw 662g)
AATVJC
Ventilated Inc HFOV
Not Discharged
ABNIIC
Ventilated 3
DischHome/Ward
AE29HC
Inc HFOV
AEW1HC 14
AFUHHC
Ventilated Inc HFOV
ChestDrain
AGMNIC
Transferred 18 Hrs
AMEZGC
Insulin
ANOSIC 8
APTXHC
Ventilated Inc HFOV
Inotropes
ASPIJC 13
Transferred 391 Hrs
AUELIC
Ventilated & Inotropes
AX38IC 4
AYNMJC
Transferred 77 Hrs
AG8OJC
RHH
29 weeks, 2 episodes ventilation, 1 <24 hours, 1 <72 hours ?sepsis
AGITHC
31 weeks , ventilated <72 hours
ASVLIC
No evidence NO given at any point
A4J8FC
SaTH
25 weeks repatriated D75, ventilated <96 hours with episode ?NEC
A67VJC 7
NotDischarged
27 weeks, 2 episodes of ventilation 1<72 hrs, 1 <96 hrs
A6IUJC
Cooling &
Died
37 weeks, due to be transferred to RSUH but? Deteriorated before transfer, died at 28 hours of age
AB7LIC
29 weeks, ventilated <96 hours
AC4VHC
34 weeks, ventilated <72 hours
AHGMJC
Low Weight
30 weeks, wt 738g
AOLKJC
37 weeks, inotropes & ventilated <48 hours
AQDSIC
Prostagladin
Transferred 98 Hrs
33 weeks gestation, CHD ?delay awaiting bed BCH
AXR5IC
39 weeks, ventilated, inotropes and chest drain <48 hours
AY6LIC
WMH
25 weeks, repatriated D21. Ventilated <48 hours ?NEC
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 different to the other LNUs in SSBC as they can ventilate for 7 days before the need to ring the NICU, 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, 5 of these were in S&WB, and 2 babies were born in LNUs below 800g
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)

20. 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

21. 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

22. SSBCN ODN Neonatal Parents Experience Survey 2018/19
Quarter /19

23. 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

24. SSBCN ODN Neonatal Nurse Staffing 2018/19 - Quarter 1