Respiratory workload and medical staffing in uk local neonatal units (LNUS) and special care units (SCUS)-time for a rethink (2019)

Type of publication:
Conference abstract

Author(s):
*Tyler W.; Fox G.F.; Fenton A.C.

Citation:
Archives of Disease in Childhood; May 2019; vol. 104

Abstract:
Introduction: The majority of UK neonatal care occurs in SCUs and LNUs with a smaller volume of highly complex care delivered by NICUs. Whilst the significant shortfall in nursing numbers nationally has been highlighted, medical staffing has received little attention. Aim To determine levels of medical staffing in UK LNUs/ SCUs, days of respiratory support provided and admissions weighing <1.5 kg. Methods Questionnaire sent to every LNU and SCU requesting details of medical tier staffing. ODNs provided the number of
respiratory care days (RCD – invasive and non-invasive mechanical respiratory support) delivered 2013-15 and numbers of admissions weighing <1.5 kg. Results 78 (86.7%) LNUs and 38 (95%) SCUs responded. 11/ 90 LNUs delivered <365 RCDs annually. Of these 9 admitted <25 infants weighing <1.5 kg. 6/40 SCUs delivered >365 RCDs annually. Significant numbers of LNUs and SCUs employed nontraining grade medical staff and ANNPs to cover rotas; neonatal CST holders or equivalent support many units (Tables 1 & 2). The 8/11 low-activity LNUs who responded provided partially separate Tier 1 staffing from paediatrics, consistent with SCU staffing recommendations only. Half of the high activity LNUs and all high activity SCUs did not achieve staffing standards for NICUs or LNUs respectively. Conclusions A wide range of activity is undertaken by UK LNUs and SCUs, with moderate overlap of workload between unit types. These data should inform potential unit redesignation as part of the current national reviews. Current medical and ANNP staffing is a major barrier to implementing change. (Table Presented).

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Stabilisation and Transfer of Sick New-Borns Delivered in Stand-Alone Midwifery Led Units. (2014)

Type of publication:
Conference abstract

Author(s):
*Tyler, W, Philpott, A, Brown, S, Rhodes, J

Citation:
Archives of Disease in Childhood — Fetal & Neonatal Edition, 02 June 2014, vol./is. 99/(0-0), 13592998

Abstract:
BACKGROUND: Women should be offered the choice of delivering at home, in midwife-led units (MLU) or obstetric units.(1) 20% of Shropshire mothers choose delivery in an MLU which refer into Shrewsbury and Telford NHS Trust (SaTH) obstetric/neonatal unit for additional care. The West Midlands neonatal transfer service (WMNTS) is not commissioned to transfer babies from MLUs; any transfer required is performed by the MLU midwife and the West Midlands Ambulance Service (WMAS). These staff must be confident in recognising, stabilising and transferring babies requiring a higher level of care at or immediately after delivery. AIM: To develop an educational package for midwives and paramedics caring for sick newborns. PROJECT: Representatives from midwifery, neonatal care, WMAS and WMNTS met to develop a training package. They were informed by the Scottish Transport Team who deliver a course for their remote maternity units. Support for the project was given by SaTH, WMAS and WMNTS. A one day programme was delivered at Shrewsbury MLU in December 2013. FEEDBACK: 16 midwives and 4 paramedics attended the course. All lectures, workshops and simulations were rated as good (20%) or excellent (80%). The course was rated as excellent (95%) or good (5%). FURTHER DEVELOPMENTS: Dates are set for three additional courses. All staff supporting stand-alone MLUs will access this training on a two-yearly basis. This programme will be offered to other MLUs in the West Midlands. REFERENCE: National Institute for Clinical Excellence. Intrapartum care. 2007. http://www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf.