NEONATAL MANAGED CLINICAL NETWORK - WEST OF SCOTLAND WORKPLAN JANUARY 2014 DECEMBER 2016 NEONATAL COORDINATORS GROUP 1
Network Aims: To support the delivery of high quality neonatal care for all their residents To ensure that mothers and babies are treated in the right hospital at the right time and by the right staff with the appropr iate skills. To agree a model of care based on core values where provision of care should be provided as close to home as possible, minimising transport where possible but accepting that some babies may require transfer for intensive care services Agree pathways of care and clinical guidelines To provide high quality services by addressing key issues such as data collection, capacity, workforce, education and training of staff To audit activity and outcomes of intensive care both across the network and against national standards To work inter-regionally with the North of Scotland (NoS) and South East and Tayside (SEAT) MCN s for Neonatology Workplan: This workplan has been developed to identify, record and update the progress of the Neonatal Coordinators group, a subgroup of the Neonatal MCN Steering group. WORKPLAN KEY NM LC NA SG NCG DESCRIPTION NETWORK MANAGER LEAD CLINICIAN NETWORK ADMINISTRATOR STEERING GROUP NEONATAL COORDINATORS GROUP RAGB STATUS RED (R) AMBER (A) GREEN (G) BLUE (B) Description Little or no progress has been made in achieving the network objective Significant progress has been made in achieving the network objective, however further work is required to achieve fully The network has been successful in achieving the network objective The network has completed the network objective 2
1. Develop and establish a subgroup with senior charge nurse/neonatal nurse manager/coordinator representation from each of the Board areas to support the implementation of the document Neonatal Care in Scotland: A Quality Framework Develop the group Responsible Description of progress towards Outcome/evidence RAGB Updated NM Lead for group identified B SL Subgroup established with senior B nursing/management representation identified from all neonatal units and neonatal transport services Terms of reference agreed B Group will meet quarterly B Agenda and previous meeting minutes will be circulated at least 7 days prior to each meeting Draft meeting minutes will be circulated within 14 days of each meeting for comments Subgroup update will be sent to the network administrator 2 weeks in advance of every steering group meeting. Contribute to the network annual report B B G 3
2. Enhance the person centred experience by engaging with parents and their families, listening to their views and experiences and ensuring current neonatal service provision meets their needs Provide parents of babies in the neonatal unit with information in an appropriate format and language Ensure there are processes in place to encourage parental involvement in the care and treatment of their baby Provide access to support services where a baby has required to be transferred from their booking hospital Parent satisfaction surveys should be carried out on a regular basis to measure and demonstrate outcomes Responsible Description of progress towards ALL Provide information for parents to support orientation to the neonatal unit, discharge procedures, key contacts, etc Provide written information regarding consent, where appropriate Ensure access to communication and/or advocacy services, where required ALL Care plans should be developed and updated in collaboration with parents Encourage involvement of parents in the planning and delivery of their babys care Encourage involvement of parents in the planning for discharge home and document progress ALL Provide information on where to access information on support services which are available Provide a list of accommodation which is available nearby with locally negotiated rates if required ALL A standard template for parent satisfaction surveys will be developed for the region Outcome/evidence Passport for parents has been circulated for comments to encourage a record of parental involvement RAGB Updated 4
3. Ensure staff have the appropriate skills and competencies required, opportunities to maintain them and that this is reflected in up to date training records Ensure staff competencies are achieved and maintained, providing opportunities for updating where gaps are identified Collaboration with network subgroups where necessary, ie. Education and training where training needs identified Regional clinical guidelines group where development of new guideline/update to existing guideline will be sent to for ratification Record all relevant study related activity in staff training records Keep an up to date record of staff who have current accreditation to confirm they have completed resuscitation of the newborn training course (SMMDP, NLS). Keep an up to date record of staff numbers who have completed the Neonatal Qualification in Speciality (QIS) Responsible Description of progress towards Outcome/evidence RAGB Updated ALL Use of competency document for Drafts being piloted in all NNUs registered staff comments awaited Development of a regional competency Competency framework document now document for non-registered staff published Encourage staff to join and access the neonatal Managed Knowledge (MKN) Network for information on upcoming study days and educational material ALL ALL ALL Ascertain what processes are currently in place Ascertain what processes are currently in place Ascertain what processes are currently in place 5
course Staff have access to and use current clinical guidelines in their practice Agreed pathways are followed Nursing guidelines will be developed/updated as identified Audit of adherence/compliance will be undertaken Audit adherence/compliance, and record report deviations Audit of adherence/compliance will be undertaken 6
4. Improve communication between all neonatal services, including the neonatal transport team, within the West of Scotland region and support an improvement focused culture Provide an update on their current service provision at each subgroup meeting, including an update on any workstreams, current issues being experienced and also sharing of best practices Consult on and support implementation of patient safety initiatives by sharing ideas and experiences and collaborative working where indicated Promote an improvement focused culture Trial and feedback on new products/equipment and share information on issues Feedback on any information relevant to the current PAS pilot and encourage attendance/representation to participate in evaluation of service Responsible Description of progress towards Outcome/evidence RAGB Updated ALL ALL Patient safety champion requested from each neonatal unit by the network to undertake improvement methodology training to support patient safety initiatives. Champions identified within each neonatal unit and working on MCQIC neonatal workstream ALL Provision of data to support and demonstrate clinical quality and service improvement Share network data and audit quarterly reports with neonatal staff Participation in local, regional and national audit programmes ALL ALL 7
Capture delays in all types of transfers in audit data at unit level. Repatriation,or back transfer, being undertaken as soon as clinically appropriate for the baby Standardise documentation used for transfers Standardise special care charts Capture delays and reasons for as well as highlighting critical incidents Multidisciplinary team case discussions will be evidenced prior to repatriation for complex cases 8
5. Deliver effective, efficient neonatal services, avoiding waste and duplication by regional collaboration Collaborate to identify where standardisation of products will standardise practice, education and training across the network, create cost savings and efficiencies. This includes medical equipment and consumables A fair and transparent process for selection of a preferred product/supplier will be evident Responsible Description of progress towards Outcome/evidence RAGB Updated ALL 9