No abstract

Introduction Patient safety is a strong driver for quality improvement within the NHS. Maternity units deal with unintended harm to patients on a daily basis. Ensuring a strong patient safety culture within the workforce is important in achieving good clinical outcomes. In Norwich we were unsure of how staff perceived patient safety issues. Objective To measure staff attitude to patient safety. Setting Large tertiary hospital delivering 5800 babies annually. Methods Questionnaires were a previously validated tool and left on delivery suite. Members of the Trust patient safety initiative invited staff on shift to complete. Anonymised questionnaires were returned to the audit department via self addressed envelopes and electronically read in to an excel database. Qualitative comments were hand abstracted. Results 83 questionnaires were returned from 150 questionnaires, response rate of 55%. Only 3% of responders rated overall patient safety in their work area as poor or failing, with 65% responding that when a mistake is made it is always or most of the time reported. Only 6% of responders felt the unit failed to discuss ways to prevent errors from happening, but 24% felt that mistakes are held against them. Staff felt that mistakes have led to positive changes (64% of responders). Inadequate staffing for workload was a significant concern for 74% of responders, which reflected comments made in free text section of questionnaire. Conclusions Maternity health professional understand importance of reporting and learning from mistakes to improve patient safety but staff shortages continue to be major concerns.

Introduction In East Anglia 25% of babies are delivered by caesarean section (CS). Much work has focused on reduction of elective caesareans by vaginal birth after CS clinics and external cephalic version for breech. We describe a quality improvement programme to decrease emergency caesareans. Objective Decrease emergency CS by 20% within 6 months without increasing other adverse obstetric indicators. Setting Tertiary hospital delivering 5800 babies annually. Methods Three interventions were used, viz: Introduction of ‘Safe HANDS’ meeting: safe handling of all neonatal deliveries. A daily multi-disciplinary team meeting on the delivery suite with discussion of CS cases occurring past 24 h and performance review. Maternity dashboard widely available to maternity staff. Introduction of weekly statistical process control charts (SPC) of emergency LSCS to maternity staff. Interventions were implemented using plan, design, study, act format. Results Pre-interventions mean weekly emergency CS number was 15. Introduction of maternity dashboard failed to show change. Introduction of Safe HANDS meeting and SPC charts resulted in reduction to 12 CS per week. Adverse obstetric indicators using composite scoring for anal sphincter injury, postpartum haemorrhage >1000 ml, cord pH <7.1, apgars <7 at 5 min, perinatal death and unanticipated admission to NICU did not increase. Conclusions Introduction of daily meeting for performance review alongside weekly data presentation using SPC charts results in reductions in emergency CS in our population. The model is likely to be transferrable to other service providers within the NHS.

A 37 year old woman with left ventricular non compaction syndrome (an autosomal dominant condition where the left ventricular myocardium remains trabeculated) booked in her first pregnancy at 9+/40. Preconceptually, she was advised against pregnancy in view of the risks of thrombosis, cardiac failure and arrhythmia. At booking, echocardiography demonstrated an EF (ejection fraction) of 28%, which improved to 36% with Furosemide. Low molecular weight heparin was started as thromboprophylaxis but β blockade was declined by the patient until after 12/40 (Bisoprolol 1.25mg OD). From booking a multi-disciplinary approach was taken. At 28+2/40 she developed reduced exercise tolerance and orthopnoea associated with a reduction in her EF to 31%. Her symptoms were managed by titrating up her diuretic doses. At 34+4/40 cardiac function deteriorated further (EF = 25%). Delivery was recommended, with steroid cover, but the patient declined this. After discussion with her cardiologist she agreed and a live baby boy was delivered by LSCS under epidural anaesthesia. Post-partum she was cared for on HDU with IV Furosemide and ionotrope support. She was discharged on day five with Furosemide and Amiloride and having converted to Warfarin anticoagulation. Conclusion The management of cardiomyopathy in pregnancy, particularly when there is poor adherence to medical advice, will be discussed. A proactive and multi-disciplinary approach to her care resulted in a live birth without significant compromise to maternal health.

No abstract