St Michael’s Hospital
Division of Women’s & Children’s Services
Maternity Dashboard Data- January 2009
In order to reduce and manage risk, the Maternity Service within UH Bristol NHS Foundation Trust has implemented a ‘Maternity Dashboard’. This is a Performance and Governance score card which is reviewed on a monthly basis at the Women’s Services Clinical Governance meeting and allows the service to identify patient safety issues in advance so that timely and appropriate action can be instituted to ensure woman centred, high-quality, safe maternity care.
Areas of concern are currently:
Number of ethnic members on the labour ward forum
This dashboard item is included on recommendation of the RCOG following the Healthcare Commission Report into the maternity services at NorthwickPark. At this hospital a large number of women were black and minority ethnic (BME) and issues related to culture and language were thought to have contributed to some of the maternal deaths that were investigated. At UHBristol, one in four women giving birth are BME (Compared to 1 in 10 at NBT and 1in 12 in Weston).
We are actively seeking BME representatives for the labour ward forum and hope that we will achieve at least 2 members by July 2009. We do have a member of the BME community on the antenatal working party and focus groups are on-going with Somali representatives from the PCT.
Midwife to birth ratio:
The maternity dashboard demonstrates that the midwife to birth ratio within the maternity services at UH Bristol for the past 12 months has been in the region of 1:38/40.The benchmark used is a ratio of 1:28. Previous benchmarking with the Healthcare Commission and Birthrate Plus – a benchmarking tool from the Royal College of Midwives have also highlighted that the midwifery staffing levels are very low. This has a high risk status on the Divisional Risk Register. The challenge of recruitment and retention of midwives within the maternity serviceis an ongoing priority and strategies have been developed to attract and support both experienced and newly qualified midwives. A recent bid for extra resources has been submitted to the Primary Care Trust, which the service hopes will be successful.
In addition to establishing an adequate midwife to birth ratio, the maternity service needs to ensure that there are adequatenumbers of senior midwives (Band 7) working on central delivery suite in order to ensure that the senior midwife responsible for co-ordinating activity on each shift has supernumerary status. This is key to driving performance improvement and maintaining safety for mothers and babies.
Caesarean section rate
The increase seen in October and December has settled slightly. A ‘normal birth’ group led by Belinda Cox, Practice Development Midwife has been set up as a sub group of the labour ward forum and Belinda also leads a vaginal birth after caesarean (VBAC) group.
In addition the supervisors of midwives have taken the lead on the re-launch of the birthing suite within the central delivery suite to encourage normality and increase the normal birth rate.
Blood transfusions (4 units of blood)
The increase in the number of transfusions of 4 units of blood or more has been discussed in the Maternal Critical Care (MCC) Working Party meeting and the Women’s Service Clinical Governance meeting.
Number of cases of hypoxic encephalopathy
Each individual case of hypoxic encephalopathy (HIE) is investigated and presented at the monthly multi-professional neonatal morbidity and mortality meetings. The number of HIE cases has risen in recent months. A full case note review and root cause analysis (RCA) where applicable has been organised. The action plans will be monitored by the relevant working parties and then reported to the Women’s Service Clinical Governance Meeting. Outstanding actions from the RCA will be presented to the Divisional Board in April 2009.
Maternal Death
There has been one maternal death in January 2009. This is currently subject to an inquest.
There were two peripartum hysterectomies in January 2009. Both were in women with a placenta percreta (where the placenta imbeds abnormally into the wall of the uterus) as a result of a low lying placenta and previous Caesarean section scars. These were the only peripartum hysterectomies in the previous 12 month period.
Authors: Janet Pollard Patient Safety Midwife
Bryony Strachan Consultant Obstetrician
UH BristolMarch 2009