Title: Preparing for CNST Maternity Levels 1, 2 and 3: Experience of the Liverpool Womens Hospital
1Preparing for CNST Maternity Levels 1, 2 and 3
Experience of the Liverpool Womens Hospital
- Helen Scholefield
- Consultant Obstetrician Lead for Clinical Risk
Management
2- Where are trusts now?
- Why separate maternity standards?
- Why aim higher
- Team approach
- The standards
- Difficult level 1 criteria
- Level 2 3 criteria
- How we covered them
- Feedback from assessors where we could improve
3Trust CNST Maternity Levels
4Why separate Maternity Standards
5Organisation with a Memory 2000
- Reduce risk in Obstetrics by 25 by 2005
68 standards
- Organisation
- Learning from experience
- Communication
- Clinical Care
- Induction, Training and competence
- Health records
- Implementation of CRM
- Staffing levels
7Incentives for achieving higher levels
- Improve safety for patients
- Staff ,ownership of CRM through training,
teamwork, avoid being second victim of error,
sense of shared achievement - Financial- 1.7 million saving in achieving Level
3 for LWH - Trust performance indicators
- Use as lever with Trust to gain resources for
maternity services
8CNST Planning Group
- Develop action plan including all criteria.
- Designated persons and time scales for required
action- takes longer than you think - Use scoring in Summary of Standards to check on
progress and areas of difficulty - Dont overlook criteria from lower levels as need
90 in those - Regularly reassess.
9Think Evidence
- Use the guidance in the manual
- Make sure every thing in each criterion is
covered - Have evidence for each item of verification
- Keep in separate file for each standard
- Keep it up to date review regularly
10Key People
- Training and postgraduate education leads
- Audit department
- Midwifery and directorate management
- Clinical Risk Management MW
- LW, clinic and ward managers
- Complaints manager
- Someone from neonatology and anaesthetics
- Clerical help with minutes
11Engagement- up ad down the organisation
- Directorate management
- Executives
- Board
- Consultants
- All staff
12Big things at Level 2 3
- Implement risk strategy
- Lessons from incidents
- Confidential enquiry lessons
- Robust system for all test results
- Antenatal risk assessment documented
- Annual Skills Drills all staff
- Full risk assessment
- Appropriate clinical staffing ( consultants and
midwives) - Audit
13Standard 1- Organisation
-
- Risk management strategy
- Philosophy, objectives, responsibility,
coordination, accountability, implementation,
author, review date. - Board minute that approved it.
- Job descriptions of nominated lead(s)
- Risk management (1.1.2)
- Delivery Suite (1.1.4)
- Use consultant job plans
-
14Organisation
- Risk management strategy distributed to all
professional staff (1.2.1) - Evidence of implementation and annual review
(1.2.2) - Original and revised strategies
- Action plans
- Minutes of meetings
15S Standard 2 Learning from Experience Learning
from experience
- Incident reporting (2.1.1).
- Use list of triggers in manual.
- Make sure all staff reporting.
- Analysis, review, and actions (2.1.2)
- Need to show for each area
- Numbers and trends
- Actions taken, changes needed.
16Learning from experience
- Strategic approach to incidents that might lead
to a claim (2.2.1) - Use guidance in manual for guideline
- Start early after incident
- File of evidence, update regularly
- Evidence of lessons learned and action arising
from adverse incident reporting (2.2.2 ) - Changes in practice in response to complaints
(2.2.3)
17Standard 3 - Learning from experience
- Considers and applies the recommendations made in
the National Confidential Enquiries (2.2.4 ).
Audit of service against these (2.3.1) - Action plans for each one (Dont forget CISH
NCEPOD) - Audit showing changes in practice or rationale
for not implementing recommendations - New policies
- Minutes of meetings where discussed
18Standard 3- Communication
- Patient information ( 3.1.1 3.2.1)
- Alternatives, risks and benefits , consequences
- Different formats and languages
- P.I.G terms of reference and minutes
- Labour Ward forum (3.1.5 )
- Terms of reference
- Group members - 50 attendance
- anaesthetist, neonatologist, junior MW medical
staff, consumer. - Minutes
19Communication
- System for test results( 3.2.2 3.3.1)
- Guideline to cover this.
- Patient information on screening.
- System for ensuring tests done, reported ,
relayed and acted on. - Training
- Uptake and detection rates (dont forget neonatal
screening)
20 Communication
- At risk women (3.2.3)
- Mental health guideline and screening process
- Domestic violence
- Documentation of these risks
- Availability of interpreters
- Follow up of non attendees
21Communication
- Emergency Caesarean Section (3.2.4)
- Unit standard
- Annual audit recommendations and action plan
- Review of audit and remedial actions
- System for early referral where fetal
abnormalities have been identified (3.2.5) - Guideline/pathways
22Standard 4 - Clinical Care
- 27 clinical guidelines (4.1.1)
- evidence based, dated, minutes of meeting where
approved - Systematic approach to guideline development
(4.2.1) - Policy, minutes of meetings, distribution
archiving old versions - Audit of guidelines at least 14/27 within 3 years
(4.3.1)
23Clinical Care
- High Dependency care (4.1.3)
- Guideline including lines of communication
- Recovery (4.1.4)
- Post op/recovery guideline
- Training in monitoring, airway and resuscitation
for MWs
24Standard 5 - Induction training and competence
- CTG training (5.1.3)
- Need evidence of 6 monthly attendance
- Formal study day
- Informal- computer package, video, consultant DS
sessions - Annual skills drill (5.2.1, 5.3.1)
- Obstetric Emergency day covers
- CTG, CPR, Neonatal resuscitation, cord prolapse,
breech, shoulder dystocia, massive haemorrhage - Ran at least monthly
-
25Induction training and competence
- Junior doctors competency (5.2.2)
- Skills checklist based on RCOG log book.
- Educational supervisors go through this at
induction - Log book of supervised procedures
26Standard 6- Health Records
- Record keeping audits (6.1.2, 6.2.1, 6.3.1)
- Audit tool
- Must cover electronic records as well as paper
- check reports and results and action plans are
available. - Level 3 need to show improvement
- Need evidence of changes cited in action plans
27Health Records
- These were previously level 2 now level 1
- Medical and midwifery records (6.1.3).
- chronological order
- all professional notes are filed together
- Designated place for recording (6.1.4).
- of hyper-sensitivity reactions
- other information relevant to all healthcare
professionals
28Standard 7 Implementation of Clinical Risk
Management
- All clinical risk management systems are in place
and operational (7.2.1). - Evidence of nominated lead playing an active role
- Staff awareness of systems
- Staff feed back, news letters, notice boards
- Collaboration with audit, claims and complaints
- Involvement of service users
29Implementation of Clinical Risk Management
- Multidisciplinary clinical risk assessment
(7.2.2, 7.3.1) - Check tool covers guidance in manual for breadth,
content, depth and action - Prioritisation of risk
- Action plan, responsible persons
- Board acceptance- need minutes
- Progress on action points
30Standard 8 - Staffing levels
-
- Dedicated anaesthetic (8.1.2) and ODA cover
(8.1.3) - check recommended levels are reflected in the
rota, and the rota is clear. - Labour ward medical cover (8.2.1)
- 40 hours dedicated consultant cover- job plans
and timetables - Available out of hours within 30 minutes
- Resident SpR
31Staffing levels
- Midwifery staffing (8.2.2, 8.3.1)
- 11
- Birthrate plus
- Contingency plans etc
- Supervision of midwives(8.1.1, 8.2.3)
- Action plan on LSA report
- Evidence of monitoring of annual reviews
-
32Summary
- Good reasons for aiming high
- Team approach especially with training
- Attention to detail
- Evidence is crucial- training and induction
records - Keep reviewing your position
- Dont forget lower level criteria
- Good luck