Background: In England neonatal care is delivered within operational delivery networks. Units within these networks are one of three designations (Neonatal Intensive Care, Local-Neonatal or Special-Care Units), based on their ability to care for babies with different degrees of illness or prematurity. With the development of network care-pathways, the most premature and sickest are triaged where possible for delivery in services linked to Neonatal Intensive Care units. This has created anxiety for teams in Local-Neonatal and Special-Care units. Less exposure to sicker babies meant limited opportunities to maintain expertise for when they do unexpectedly deliver at services linked to their own units, and thereafter require transfer for ongoing care, to Neonatal Intensive Care units. Simultaneously, Local-Neonatal and Special-Care teams develop skills in care of the less ill and premature baby which was considered of benefit to all. A need for mutual learning through networking between teams of different designations emerged.Method: An interactive programme, ‘Supporting The Sick Neonate’ was developed in the West Midlands. It focused on equal partnership between unit designations, employing high, medium and low fidelity simulation as the vehicle around which networking between units was centered. Sessions of simulation and debrief were augmented with novel networking time to enable multidirectional learning and understanding of practices. Candidates and facilitators were regarded as participants, spanning different designations. A consultant-focus was adopted to promote long term networking. Qualitative assessment of the programme over four years was captured through -graded and free text surveys.Results: 155 individuals involved in frontline neonatal care participated. 77 were consultants, supported by neonatal trainees, staff grade doctors, clinical fellows, advanced neonatal nurse practitioners and nurses in training. All were invited to participate in the qualitative survey. 79% felt that it was highly relevant; 96% agreed that for consultants this was appropriate adult learning. 98% agreed that consultant training encompassed more than bedside clinical management, including forging communication links between teams. Thematic responses around networking were positive.Conclusion: Simulation augmented with networking time with a consultant-focused model proved successful for networking and shared learning for the Neonatal fraternity in the West Midlands.

SituationPharmacists are fundamental components of the neonatal workforce and should have job plans with protected capacity for providing advice and support in neonatal pharmacy.1Using Neonatal and Paediatric Pharmacists Group staffing recommendations2a shortfall of 0.675 whole time equivalent (wte) band 8a pharmacist resource was identified. A business case was developed and funding was approved to increase the existing neonatal pharmacist’s input to the neonatal intensive care unit (NICU) from 0.325 wte to 1 wte from June 2021. The main driver was the number of medication incidents reported, particularly involving gentamicin. Prior to June 2021 the neonatal pharmacist was part of a multi-disciplinary task and finish group established to reduce medication, especially gentamicin, errors. A detailed action plan and a new gentamicin guideline and prescription were developed which included significant training and teaching of both medical and nursing staff. A review of all gentamicin errors reported electronically via Datix from June 2019 to June 2022 was undertaken. A reduction in gentamicin errors was achieved prior to June 2021 and was successfully sustained up to June 2022.Also feedback was sought from a multi-disciplinary team to ascertain the impact of increased pharmacist resource. The following improvements were identified:Sustained improvement in other medication related incidents.Bedside teaching for nursing and junior medical staffPharmacist attendance at handover and on ward rounds.Co-operative decision making on neonatal treatments in real time with consultants.Pharmacist prescribing.Development of guidelines, prescribing proformas and prescription charts.Communication between pharmacists in network providing peer support.Support with unlicensed medicines and drug shortages.Support in neonatal governance, perinatal mortality review and palliative care.Safety improvements in storage, transport, and use of resuscitation medications.Support with discharge and community follow up of medication challenges.ConclusionThe role of the neonatal pharmacist is pivotal to ensuring safe and effective use of medicines on a NICU. A key element of the role is to provide training and support to medical and nursing staff to ensure medication safety and utilisation is followed. Sustenance in quality improvement is a well-recognised challenge in health-care settings which was achieved as a likely result of increased pharmacy presence. The improvements identified all contribute to improved patient safety. This may be further improved by the development of standard prescription charts, guidelines, and drug formulary, across the local network or nationally.ReferencesDepartment of health. Toolkit for high quality Neonatal services. October 2009. Available at: Toolkit for High-Quality Neonatal Services (londonneonatalnetwork.org.uk)Neonatal and Paediatric Pharmacists Group. Neonatal Pharmacy staffing on Neonatal Units – Recommendations for Trusts Commissioning. October 2018. Available at: http://www.nppg.org.uk/wp-content/uploads/2018/10/NPPG-Neonatal-Pharmaciststaffing-recommendations-published-with-RPS-Oct-2018.pdf

Background In England, neonatal care is delivered in operational delivery networks, comprising a combination of the Neonatal Intensive Care (NICU), Local-Neonatal (LNU) or Special-Care Units (SCU), based on their ability to care for babies with different degrees of illness or prematurity. With the development of network care pathways, the most premature and sickest are mostly triaged for delivery in services linked to NICU. This has created anxiety for teams in LNU and SCU. Less exposure to sicker babies has resulted in limited opportunities to maintain expertise for when these babies unexpectedly deliver at their centre and thereafter require transfer for care, to NICU. Simultaneously, LNU and SCU teams develop skills in the care of the less ill and premature baby which would also be of benefit to NICU teams. A need for mutual learning through inter-unit multidirectional collaborative learning and engagement (hereafter also called neonatal networking) between teams of different designations emerged. Here, neonatal networking is defined as collaboration, shared clinical learning and developing an understanding of local systems strengths and challenges between units of different and similar designations. We describe the responses to the development of a clinical and systems focussed platform for this engagement between different teams within our neonatal ODN. Method An interactive 1-day programme was developed in the West Midlands, focussing on a non-hierarchical, equal partnership between neonatal teams from different unit designations. It utilised simulation around clinical scenarios, with a slant towards consultant engagement. Four groups rotating through four clinical simulation scenarios were developed. Each group participated in a clinical simulation scenario, led by a consultant and supported by nurses and doctors in training together with facilitators, with a further ~two consultants, as observers within the group. All were considered learners. Consultant candidates took turns to be participants and observers in the simulation scenarios so that at the end of the day all had led a scenario. Each simulation-clinical debrief session was lengthened by a further ~ 20 min, during which freestyle discussion with all learners occurred. This was to promote further bonding, through multidirectional sharing, and with a systems focus on understanding the strengths and challenges of practices in different units. A consultant focus was adopted to promote a long-term engagement between units around shared care. There were four time points for this neonatal networking during the course of the day. Qualitative assessment and a Likert scale were used to assess this initiative over 4 years. Results One hundred fifty-five individuals involved in frontline neonatal care participated. Seventy-seven were consultants, supported by neonatal trainees, staff grade doctors, clinical fellows, advanced neonatal nurse practitioners and nurses in training. All were invited to participate in the survey. The survey response rate was 80.6%. Seventy-nine percent felt that this learning strategy was highly relevant; 96% agreed that for consultants this was appropriate adult learning. Ninety-eight percent agreed that consultant training encompassed more than bedside clinical management, including forging communication links between teams. Thematic responses suggested that this was a highly useful method for multi-directional learning around shared care between neonatal units. Conclusion Simulation, enhanced with systems focussed debrief, appeared to be an acceptable method of promoting multidirectional learning within neonatal teams of differing designations within the WMNODN.