For parents-to-be, pregnancy is an exciting and busy time planning for the arrival of a new family member. The last thing parents imagine is their new bundle of joy requiring admission to the neonatal unit. When this happens it can be an arduous emotional journey for all members of the family.

When a term baby (born at over 37 weeks of pregnancy) is unexpectedly admitted to the neonatal unit, it can be an indirect indication that preventable harm may have been caused at some point in the mother's or baby’s care.

The separation of mother and baby soon after birth interrupts the natural bonding process and interferes with the smooth postnatal adaptation of the newborn.

This decreases the opportunity for temperature regulation and stabilisation of vital signs including breathing rates, and has a negative effect on maternal mental health, breastfeeding success rates and long-term morbidity for mother and child.

Reducing unplanned neonatal unit admissions
With this in mind, the Scottish Patient Safety Programme (SPSP)'s Maternity and Children Quality Improvement Collaborative (MCQIC) maternity and neonatal programmes are working together to test various ways of reducing unplanned term admissions to the neonatal unit.

Data submitted to MCQIC from NHS boards across Scotland suggest that for every 1,000 babies born at term, around 60 are admitted to the neonatal unit.

According to research, over 20% of term admissions could have been prevented. Common causes for these admissions include:

• breathing problems
• cold body temperature
• infection
• low blood sugar level, and
• breastfeeding challenges.

NHS boards across Scotland
MCQIC has worked with NHS boards across Scotland to create a programme of quality improvement (QI) activity for maternity and neonatal services. The programme helps reduce the number of term babies admitted to the neonatal unit and includes:

• accessible quality improvement tools such as a measurement plan, driver diagram and change ideas linked to the early recognition and correct response to potentially sick babies.
• supporting the use of data to identify areas to focus improvement activity, and monitoring the impact of interventions over time.
• shaping collaborative working relationships between maternity and neonatal colleagues. The care given to mothers and babies during pregnancy and childbirth and the additional neonatal care that newborn babies may need is delivered in separate services. Key is pulling these services together to co-design improvement plans.
• building local teams' quality improvement capacity and capability. MCQIC deployed coaching support to frontline teams through networking events, project surgeries and support visits focusing on team building, communication and culture.

With support from the MCQIC team, a number of maternity units have participated within these activities to help reduce unplanned admissions to the neonatal unit.

Example: NHS Tayside
One such example is NHS Tayside's project, 'Unite: keeping families together'. Through analysing their data, the team identified that almost half of admissions were attributed to babies born over 37 weeks of pregnancy.

To find out why, the team further analysed the data and found that breathing complications, weight loss from breastfeeding challenges and cold body temperature were the main reasons for these admissions.

They identified that maternity and neonatal services working in partnership would be crucial to making improvements. Key steps to achieve this included:

• Developing a coalition team consisting of neonatal staff, maternity staff and parents and creating an identity for this work – aptly named 'UNITE'. Time was then spent talking and listening to build an appreciation of each other's systems.
• Testing changes to clinical practice, such as introducing weekly breastfeeding workshops and parent information videos and educating staff in both services.
• Launching new guidelines and resources for staff and parents, based on testing.
• Positioning parents as partners in care, through focused education and peer support to enable them to safely and confidently care for their babies and stay with them.
• Collecting and analysing data in a robust manner, to determine what changes were leading to improvement.
• Sharing positive practices via social media.

The team learned the importance of:

"…giving all grades of staff the opportunity to be creative and involved in initiatives in their area."

Impact and results
As a result of this work in NHS Tayside, improvements have been demonstrated in:

• team working between maternity and neonatal services. Maternity and neonatal teams have an improved working relationship and understanding of each other's systems.
• 21% reduction in the number of babies admitted to neonatal unit and thus separated from their mum, and
• increased resources and support for families and staff.

NHS Tayside is but one example of the wealth of work across Scotland that is helping to reduce the number of babies being admitted to the neonatal unit, leading to a 20% reduction across eight units in Scotland.

This means approximately 30 more babies each month in Scotland receive care at the bedside, beside mum, resulting in less disruption to breastfeeding and better long-term outcomes for mum and baby.

Find out more about:

1. SPSP MCQIC
2. Unite: Keeping families together
3. NHS Improvement