Examination of the Newborn by Registered Midwives Protocol (CG484)

Transcription

1 Examination of the Newborn by Registered Midwives Protocol (CG484) Approval and Authorisation Approved by Maternity Clinical Governance Committee Job Title or Chair of Committee Chair, Maternity Clinical Governance Committee Date 7 th September 2018 Change History Version Date Author Reason 4.0 Aug 2016 C Harding, Consultant Midwife Review due Pg 3, 6, 7, 8 & 9 references & definitions updated Pg 7-8 competency updated 4.1 Oct 2017 Jean Sangha Amended to reflect introduction of 4.2 Apr 2018 L Cox, Iffley Ward manager 5.0 August 2018 L Cox, NIPE Lead NIPE Smart system Pg 5/ Hips criteria added to include babies that have been breech presentation at 36 completed weeks of pregnancy, regardless of presentation at birth. Reviewed minor changes throughout on pg 5, 7, 8 & 9 This document is valid only on last printed Page 1 of 9

2 Contents 1.0 Introduction Purpose Protocol Function Definitions Protocol Content Training and Education Criteria for babies SUITABLE FOR examination by Midwives Criteria for EXCLUSION for examination by Midwives Components of the Examination Information giving Consent The context of the physical examination: Communication with the parent(s) Professional responsibility Documentation Consultation Dissemination/Circulation Monitoring of Effectiveness and Compliance Maintaining Competence Auditable Standards References:... 8 Appendix A Criteria for Assessment of Competence... 9 This Protocol should be read in conjunction with the following: Performing the examination of the newborn (GL403 - Paediatrics), May 2018 Infection Control standard precautions protocol (CG173), September 2015 MAT-SOP-006 NIPE SMART Standard operating procedure, V1.1 Nov 2017 This document is valid only on last printed Page 2 of 9

3 1.0 Introduction The examination of the newborn is accepted as good practice and is an integral part of the universal Child Health Promotion Programme (NSC, 2016a). It is a duty traditionally carried out by Doctors but recent government health and workforce strategies/policies promotes other health professionals undertaking the examination providing they are suitably trained to do so. There is a body of evidence to support the notion that nurse/midwife practitioners perform the examination as well as paediatric house officers, this is also associated with increased levels of maternal satisfaction (Lee et al, 2001, Wolke et al, 2002). 2.0 Purpose The purpose of this protocol is to enable suitably trained midwives to undertake the Newborn Infant Physical Examination (NIPE) 3.0 Protocol Function This protocol is applicable to midwives working both within the primary and acute health sectors and who are employed by the Royal Berkshire Foundation NHS Trust. 4.0 Definitions When a baby is born, an initial general examination is routinely carried out by the midwife to ensure the absence of gross physical abnormalities. This is an integral part of the midwife's role (NMC, 2012). Examination of the Newborn in this document refers to a more comprehensive examination that is undertaken within 72 hours of the birth, the aim of which is to detect less obvious adverse conditions or abnormalities. This examination aims to identify and refer all babies born with congenital abnormalities of the heart, hips, eyes or testes, where these are detectable, within 72 hours of birth (NSC, 2016a) 5.0 Protocol Content 5.1 Training and Education Examination of the Newborn can only be undertaken by a midwife who has successfully completed a training programme included in their midwifery training or a post graduate qualification in the topic (minimum academic level 6) comprising both practical and theoretical components as per university guidance and recommendations. This document is valid only on last printed Page 3 of 9

4 Evidence of success (certificate or letter from the university) is to be presented to the ward manager and a record is made on the Maternity training database. Potential candidates for training are to be highlighted through the Trust s annual appraisal system. 5.2 Criteria for babies SUITABLE FOR examination by Midwives weeks gestation irrespective of mode of birth No known fetal abnormalities Familial history with potential to affect the baby's wellbeing e.g. 1 st degree relative with congenital cardiac defect Breech presentation and/or babies with history of 1 st degree relative with Developmental Dysplasia of the Hips 5.3 Criteria for EXCLUSION for examination by Midwives Apgar <7 at 5 minutes and/or cord PH <7.10 Thick meconium liquor requiring inflation breaths Identified abnormalities on ultrasound scan or at birth Maternal medical condition e.g. uncontrolled diabetes, Haemoglobinopathy, blood born viruses Substance misuse HIV positive mother Transitional care babies 5.4 Components of the Examination Information giving By the time of the examination, parents should have received written information in the antenatal period. However it is good practice to explain the following information: Components of the examination Limitations to the screening e.g. some conditions cannot be detected as part of the routine examination Risks Outcomes Further sources of information This document is valid only on last printed Page 4 of 9

5 5.4.2 Consent Consent of parent(s) should be ascertained prior to the examination and documented in NIPE Smart. Non-consent of parent(s) to the examination should be recorded and followed up The context of the physical examination: Review any problems arising from family, social, medical or maternity history including antenatal screening and labour. As the opportunity arises discuss matters such as: infant feeding vitamin K prophylaxis hepatitis B and BCG vaccines reducing the risk of SIDS local networks and support services explain problems such as jaundice In addition to a general physical examination (link to Examination of the Newborn guideline under Paediatric docs relating to obstetrics), the following components not routinely included in midwifery checks of the newborn, are part of this extended examination: Check eyes: opacities and red reflex Cardiovascular system heart rate, rhythm, sounds, murmurs and femoral pulse volume. During auscultation consider lung sounds and observe baby for respiratory rate and effort Abdomen: observe shape and palpate to identify organomegaly Check male for undescended testicles (bi lateral undescended testes require referral to Paediatrician. Unilateral undescended testes can be noted but referral is not required this will be checked at routine 6/52 check with GP) Hips check symmetry of the limbs and skin folds and perform Barlow and Ortolani s manoeuvres. Referral for hip USS is required for positive family history (1 st degree relative) of DDH or breech presentation or babies that have been breech presentation at 36 completed weeks of pregnancy, regardless of presentation at birth. Re-measure head circumference Communication with the parent(s) Confirm findings with parents and allow time for discussion. This document is valid only on last printed Page 5 of 9

6 5.5 Professional responsibility Where a deviation from the norm becomes apparent referral to a suitably qualified professional as may reasonably be expected to have the necessary skills and experience is required (NMC, 2012). Parent(s) of babies who are referred should be given a full explanation of the reason for and timescale of the referral. 5.6 Documentation Record the details and the findings of the examination on electronic system NIPE SMART. Once this is completed 3 copies of the examination result should be printed, 2 copies should secured in the PHCR (red book) and 1 copy should be forwarded to the named GP. Staff trained to undertake Neonatal and Infant Physical Examination (NIPE) will be trained on how to enter the examination results by using the NIPE SMART computer programme. A secure password will be needed to access the system. This system will be used for audit purposes. Any problems identified should be discussed with parents and if referral is necessary this can be undertaken by completing the attached referral letter to the relevant specialist within the NIPE SMART programme. 6.0 Consultation This document was sent to: Maternity Clinical Governance Committee Maternity Guidelines Committee Paediatric Consultants Midwives competent in undertaking Examination of the Newborn 7.0 Dissemination/Circulation The ratified document will be placed on the Trust Intranet Site under the Maternity Department. Additionally the following midwives will be sent the document: Those currently undertaking the course for Examination of the Newborn Those who have successfully completed the Course Departmental Managers This document is valid only on last printed Page 6 of 9

7 8.0 Monitoring of Effectiveness and Compliance 8.1 Maintaining Competence Midwives are required to achieve post-basic learning, work in a framework of professional supervision, and maintain competence to carry out the physical examination and screening of the newborn. The health care professional performing the examination should be appropriately trained, meet the core competencies and remain regularly updated (NSC 2016b). Currently there are no national recommendations as to the number of examinations needed per annum to maintain competence however; the RBHFT stipulates that midwives trained in this competency are required to undertake at least 15 examinations per annum. It is recommended that each midwife maintains a register of examinations as evidence of achievement (NSC, 2008). This register should record details, including time and age of baby at examination, location of examination, problems identified, referrals made, healthcare professionals involved and discussions with parents. Parents of babies who are referred should be given a full explanation of the reason for and timescale of referral. The midwives individual register will be reviewed as part of their annual Personal Development meeting with their line manager. NIPE should be considered within the midwife s annual appraisal process to compliance is being maintained. As part of Revalidation requirements evidence of on-going study is to be presented to the manager on 3 yearly basis, examples include attendance at a study day on Neonatal Examination, reviewing the RCM DVD (available from the Practice Development Midwife) or via the E-Learning for Health portal There is a plan to introduce annual updates for Nurse / Midwife NIPE practitioners. 9.0 Auditable Standards 9.1 All newborn infants will have a first clinical examination within 6 hours of delivery carried out by a midwife or a paediatrician to detect preclinical abnormalities. This will be documented by fully completing the Midwives first examination section of the neonatal record and filed in the maternal health care record or neonatal health care record. 9.2 All newborn infants will have a full clinical examination within the first 72 hours from birth carried out by a midwife, obstetrician, paediatrician or GP to detect This document is valid only on last printed Page 7 of 9

8 preclinical abnormalities. This will be documented by fully completing the electronic system NIPE SMART 9.3 The outcome of both neonatal examinations will be discussed with the parents and documented electronically on NIPE SMART Print outs of the examination are placed in the Child health record Red Book. 9.4 In all cases where a referral is required to the paediatric team for suspected or detected abnormality, evidence of prompt referral will be documented in the neonatal record and filed in either the maternal or paediatric health care records 9.5 All midwives trained to perform the full clinical examination of the newborn will perform a minimum of 15 examinations per annum References: 10.1 Lee et al (2001) Routine neonatal examination: effectiveness of trainee paediatrician compared with advanced neonatal nurse practitioner. Arch Dis Child Fetal Neonatal Ed. 85: F100 F NMC - The Code (2015) 10.3 NSC Newborn and Infant Physical Examination Screening Programme Standards valid for data collected from 1 April National Screening Committee available online at: NSC 2016 b) Newborn and Infant Physical Examination Screening Programme Handbook 2016/17 National Screening Committee Wolke et al (2002) Routine examination of the newborn and maternal satisfaction: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 86(3): F This document is valid only on last printed Page 8 of 9

9 Appendix A Criteria for Assessment of Competence Guidance for assessment of competence and criteria for successful completion of the course is available from the University s study guide on Examination of the Newborn. The midwife / Nurse must be assessed in both theory and practice. Prior to the practical summative assessment, the midwife must undertake and present evidence to the university of the required number of examinations (set by the university) to complete the course, these will include both supervised and unsupervised examinations. Whilst the midwife is undertaking the course she is not professionally responsible for undertaking the first examination on the newborn therefore all examinations undertaken by her/him will have to be repeated by a health professional trained to undertake the task. This document is valid only on last printed Page 9 of 9