Improvement Story Three

South West Neonatal Network/ Northern Devon Healthcare NHS Trust

Contributors: Janet Hutchins, Neonatal Nurse SCBU and Kerry Causer-Rowe, Labour Ward Coordinator and Katrina Dearson, Theatre Lead Nurse

What aspects of culture did you focus on and what changes did you make?

A strong team will have a sense of ownership in the planning, problem-solving, and goal-setting for the vision of the team. We invited everyone who had a role in preterm caesarean section to walk through of what we were trying to achieve (including Midwives, Neonatal Nurses, Obstetricians, Paediatricians, Anaesthetists, theatre nurses, Operating Department Practitioners, and Maternity Care Assistants).

Following the walk-through, we changed our thought process from separate professional teams, to that of one perinatal team. Ideas were generated by staff from across this new team, who felt empowered to embed good practice into their own area of work:

• Theatre staff found a way to manage optimal cord clamping in babies requiring support which did not compromise the sterile field.
• We now have an area where we can keep a grab bag with equipment needed to support optimal cord clamping in our preterm babies born by C-section.
• A Periprem checklist has been added to the pre-theatre safety huddle .
• We held a multi-disciplinary simulation which was well attended by representatives from across the Perinatal team.

What effect this has had on your team culture?

Better team working with shared goals. Theatre staff realised the perinatal team included them too and were more supportive of our aims.

What barriers have you had to overcome? 

Our obstetric theatre has limited space to support respiratory support during optimal cord management. There was some negativity and relatively little experience about the use of new equipment, and negative attitudes to change ie. we have always done it this way and it has worked.

What helped to make this successful? 

Including the whole multidisciplinary team was key to our success. Once we had everyone in one space and could explain the evidence of the benefits in what we were trying to achieve, all involved were keen to find solutions and had suggestions as to how best achieve our aims.