Title Support for Parents in Cases of Actual or Suspected Poor Outcome for their Newborn Guideline. Department. Maternity Services

Transcription

1 Document Control Title Support for Parents in Cases of Actual or Suspected Poor Outcome for their Newborn Guideline Author s job title Specialist Midwife Risk Co-ordinator Directorate Surgical Specialties Directorate Date Version Status Department Comment / Changes / Approval Issued 0.1 May11 Draft Initial version for consultation. 1.0 June 11 Final Approved at the June Guideline Group and the Maternity Services Patient Safety Forum. 1.1 Sep 11 Revision Minor amendments by Corporate Governance to document control report, version control, headers and footers and formatting for document map navigation. 1.2 Sep 13 Revision Minor amendments by Corporate Governance 1.3 Sept 14 Revision Amendment to include guidance in the case of termination of pregnancy for fetal abnormality. 2.0 June 15 Final Approved at the Guideline Group and the Patient Safety Forum. Main Contact Specialist Midwife Risk Coordinator Ladywell Unit North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB Lead Director Director of Nursing Superseded Documents Issue Date July 2015 Review Date July 2018 Review Cycle Three years Consulted with the following stakeholders: Senior Midwives Obstetricians & Gynaecologists Women s & Children s Directorate Management Approval and Review Process Maternity Guidelines Group Local Archive Reference G:\Policies and Procedures Local Path Filename Page 1 of 12

2 Support for Parents in Cases of Actual or Suspected Poor Outcome for their Newborn Guideline V2.0 26Oct15 Policy categories for Trust s internal website Tags for Trust s internal website (Bob) (Bob) Page 2 of 12

3 CONTENTS Document Control Introduction Purpose Definitions Process for Providing Support Stillbirth or Neonatal Death Actual or Suspected Poor Outcome Other Than Death Other Sources of Support and Provision of Information Provision of information for parents who have communication or language support needs Education and Training Consultation, Approval, Review and Archiving Processes Monitoring Compliance and Effectiveness References Associated Documentation... 7 Appendix 1 Audit methodology for Support for Parents in cases of actual or suspected poor outcome for the newborn... 8 Appendix 2 - Audit Criterion for Support for Parents in cases of actual or suspected poor outcome for the newborn... 9 Appendix 3 - Sources of Support and Provision of Information Page 3 of 12

4 1. Introduction This document sets out Northern Devon Healthcare NHS Trust s best practice guidelines for the support for parents in cases of actual or suspected poor outcome for the newborn. Whether expected before birth or not, the realisation that a poor outcome is possible for their baby is a difficult and stressful experience for parents. Good communication and maintaining a positive and supportive relationship with parents is vital. Health Care Professionals have an essential role in providing accurate and timely information to parents in these difficult circumstances. 2. Purpose This guideline describes the processes for support of parents where there has been a poor outcome for the newborn, such as death or disability, or where it is suspected that the long term outcome for the newborn will be poor. This guideline applies to all staff working within the maternity services and must be adhered to. All discussions and action plans must be clearly documented in the Perinatal Institute notes. Non compliance with this guideline may be for valid clinical reasons only. The reason for non-compliance must be documented clearly in the patient s notes. 3. Definitions Stillbirth an infant born without signs of life after 24 weeks gestation. Neonatal Death an infant born alive who dies within the first 28 days of life. Poor outcome any diagnosis or illness with suspected long term consequences for the infant. 4. Process for Providing Support 4.1 Stillbirth or Neonatal Death Reference should be made to the following Trust guidance: Stillbirth guidelines Late Fetal Loss guidelines Neonatal Death Guidelines Page 4 of 12

5 These guidelines are available on the Trust intranet site Bob. Spiritual support can be sought through the Trust s Chaplaincy Service on Bleep 103 or on Extension Actual or Suspected Poor Outcome Other Than Death Where an actual or suspected poor outcome other than death has been identified before delivery, reference should be made to the following Trust guidance: Guideline for referral when a fetal abnormality is detected in pregnancy. Extreme Prematurity Guidelines A fetus born alive after termination for a fetal abnormality is deemed to be a child and must be treated in his or her best interests and managed within published guidance for neonatal practice. A fetus born alive with abnormalities incompatible with long-term survival should be managed to maintain comfort and dignity during terminal care. (RCOG, May 2010). Where a poor outcome is expected and the baby is greater than 22 weeks gestation the on-call paediatrician will be informed prior to delivery The paediatrician should be called to all live births under 37 weeks gestation. This guideline is available on the Trust intranet site BOB. On each shift on Bassett Ward the parents are allocated a named Midwife who will introduce themselves at the beginning of shift and be available to offer care, support and information throughout the shift. The parents will be offered the opportunity for discussion with an experienced paediatrician within 24 hours of their baby s admission to Special Care Unit (SCU) or at the earliest opportunity after a problem is identified if the baby does not require admission to SCU. The parents will be kept fully informed of their baby s progress by members of the paediatric and midwifery teams. All discussions will be documented in the Perinatal Institute notes. After discharge, the baby and his or her parents will be offered a follow up appointment with the named Consultant Paediatrician in 6-8 weeks where appropriate. Follow up with the named obstetrician will also be arranged within a similar timescale where appropriate. 4.3 Other Sources of Support and Provision of Information Written information should be given, as appropriate, to support verbal information. Refer to Appendix 3 for a list of resources. Parent(s) will be offered information from appropriate sources of support, such as: Antenatal Results & Choices (ARC) Page 5 of 12

6 Stillbirth and Neonatal Death Society (SANDS) or BLISS (For babies born too soon, too small, too sick) They will be signposted towards further sources of information as required. 4.4 Provision of information for parents who have communication or language support needs Communication and information should be provided in a form that is accessible to parents who have additional needs, such as those with physical, cognitive or sensory disabilities. For those who do not speak or read English, Language Line should be used where possible. Telephone Number: Education and Training Responsibility for education and training lies with the Lead Clinician for the Maternity Services. 6. Consultation, Approval, Review and Archiving Processes The author consulted with all relevant stakeholders. Please refer to the Document Control Report. The guidelines will be reviewed every 3 years. The author will be responsible for ensuring the guidelines are reviewed and revisions approved by the Lead Clinician for the Maternity services in accordance with the Document Control Report. All versions of these guidelines will be archived in electronic format by the author within the Team policy archive. Any revisions to the final document will be recorded on the Document Control Report. To obtain a copy of the archived guidelines, contact should be made with the Maternity Team. 7. Monitoring Compliance and Effectiveness Monitoring of implementation, effectiveness and compliance with the Support for Parents guidelines is the responsibility of the senior clinical/management team. The maternity services audit programme and methodology of process, reporting and escalation is described in Appendix 1 using the audit criterion in Appendix 2. Page 6 of 12

7 8. References SANDS - Stillbirth and Neonatal Death Society. Accessed June, Royal College of Anesthetists, Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, Royal College of Paediatricians and Child Health (2007) safer childbirth: minimum standards for the organization and delivery of care in labour London: RCOG. Nice (2007) Intrapartum care: care of healthy women and babies during childbirth Clinical guideline 55 London: RCOG Press. Royal College of Obstetricians and Gynaecologists: Termination of Pregnancy for Fetal Abnormality in England, Scotland and Wales, Report of a working party, May 2010: RCOG. 9. Associated Documentation Stillbirth Guidelines Extreme Prematurity Guidelines Late Fetal Loss Guidelines Neonatal Death Guidelines Guideline for referral when a fetal abnormality is detected in pregnancy Incident Management policy Page 7 of 12

8 Appendix 1 Audit methodology for Support for Parents in cases of actual or suspected poor outcome for the newborn NDHT Obstetrics, Gynaecology and Midwifery Guideline: Support for Parents in cases of actual or suspected poor outcome for the newborn V0.1 CNST Ref: Standard: 5 Criterion: 8 Monitoring arrangements Clinical Audit Y Annually Monitoring Arrangements Monitoring Y Variety of circumstances Northern Devon Healthcare Trust will monitor compliance of this guidance against all minimum requirements within the CNST maternity standards by an annual audit, supported by specific audits during the year that are triggered by the clinical incident reporting system, or in response to a change in practice. Lead for Monitoring Compliance Senior Midwife/ Risk Lead for Women s Inpatient Services Method Sample 1% or 10 sets, whichever is the greater, of all health care records where support for parents has been required in variety of circumstances Audit tool An audit tool will be developed using the standard statements set out in Appendix 2 Data collection process Process for collating and reporting data Patient notes will be audited by a clinically qualified member of staff. The information will be recorded using the audit tool. Data will entered and analysed using appropriate software to show compliance levels. All the results of the audit and audit report will be reviewed by a multi-disciplinary team at the Patient Safety Forum. Frequency of monitoring/audit Annual Process for reviewing results and ensuring improvements in The Patient Safety Forum will develop an action plan to improve compliance and ensure improvements in Page 8 of 12

9 Target Ref Support for Parents in cases of actual or Suspected Poor Outcome performance occur performance occur. Action plans will be implemented by the Risk Co-ordinator and Practice Development Midwives to ensure learning takes place. The Patient Safety Forum will monitor progress of action plan monthly and exceptions will be reported via this group to the Clinical Governance Committee. Identified risks related to non-compliance with these guidelines through audit will be registered on the Trust Risk System by the Risk Coordinator. Appendix 2 - Audit Criterion for Support for Parents in cases of actual or suspected poor outcome for the newborn Criterion statements for audit tool Criterion statements Exceptions Indicator/Location of information National guidance Reference Trust guideline reference Where is the information against which compliance can be audited recorded? Eg. Postnatal notes Eg Stork screen Page no/ Field Which national guidance does this demonstrate compliance with eg. NICE CG13 p22 On which page of the Trust guideline is the relevant statement? 1 System for providing appropriate support for parent(s) in cases of actual or suspected poor outcome for the baby 2 System for providing information for parent(s) in cases of suspected poor Page 9 of 12

10 outcome for the baby 3 Process for providing support to parent(s) who have communication or language support needs 4 Requirement to document all discussions with parent(s) 5 Process for ensuring parent(s) have information about the relevant support groups Page 10 of 12

11 Appendix 3 - Sources of Support and Provision of Information Leaflet title Available from When to be given to parent(s) and pack reference Review date Sands Leaflets SANDS After the death or stillbirth of your baby SANDS Saying Goodbye to your baby SANDS The Next Pregnancy: Guidance for Parents For Family &Friends How you can Help SANDS SANDS The loss of your Grandchild SANDS Mainly for fathers SANDS About the other Children SANDS Support for you when your baby dies Sexual Problems following a Stillbirth SANDS SANDS Bereavement Support Group (TAMBA) We are sorry that you have had a miscarriage Arc leaflets TAMBA Twins & Multiple Birth Society The Miscarriage Association Talking to children ARC Handbook for Parents when an abnormality is diagnosed in their unborn baby ARC Help for fathers ARC Supporting you throughout your pregnancy Bliss leaflets ARC Parent Information Guide BLISS NHS leaflets Screening tests for your baby NHS Having a mid-pregnancy NHS Page 11 of 12

12 ultrasound scan? NDHT leaflets After your amniocentesis NDHT Information and advice following your bereavement NMC leaflets NDHT Support for parents NMC Page 12 of 12