LISA BACON

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• LISA BACON
• LSA MIDWIFERY OFFICER

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Themes from Midwife Investigations - 2011
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The North West Picture 2010/11

• 4,275 midwives
• 318 Supervisors of Midwives
• Approx 113 ratio
• April 2010 to March 2011 - 28 supervisory
  investigations (54 in 2010/2011)
• 10 programmes of supervised practice (16 year
  before)
• 7 Programmes successfully completed since April
  2011 to date.
• In vast majority system failures identified and
  fed back to service by Supervisors

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Key Trends from Supervisory Investigations

• Drug errors
• Lack of understanding of accountability
• Documentation and record keeping
• CTG interpretation
• Sphere of practice
• Communication, including calling for medical
  staff

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Themes from Supervised Practice

• Failure to adequately monitor fetal heart rate
  during labour
• Left woman at home in established labour on two
  occasions
• Failure to perform maternal observations during
  labour
• Failure to maintain adequate records
• Failure to adhere to hospital policy/guidelines
• Failure to act when became concerned regarding
  fetal well being

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Themes

• Failure to communicate concerns with colleagues
• Inappropriate administration of syntocinon
  infusion in the context of unknown fetal
  wellbeing.
• Poor record keeping
• Failed to maintain and develop competencies
• Unclear/lack of knowledge re standards for
  medicines management

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Most Frequent supervised practice programme
objectives

• To demonstrate a clear understanding of the full
  range of responsibilities accountability and
  sphere of practice of the midwife 
• To develop a clear understanding of the process
  of risk identification, particularly in respect
  of the identification and management of high risk
  mothers and the vulnerable/high risk fetus. 
• To be confident in recognising deviations from
  the normal and understanding the appropriate
  action to be taken by a midwife. 
• To demonstrate an appropriate understanding of
  clinical guidelines and the responsibility of the
  midwife to practise in accordance with same.
•  

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Programme objectives

• To demonstrate an understanding of the importance
  of good documentation and produce evidence of
  consistent high quality recording keeping. 
• Be able to define normality and be competent to
  work within the sphere of practice as defined
  within the Midwives Rules. To demonstrate
  knowledge of NMC publications in particular the
  Midwives rules and standards and The Code 
• Be aware of the processes involved in consulting
  other healthcare professionals when the woman and
  babys needs fall outside the scope of midwifery
  practice

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Summary of themes - clinical

• The most consistent DOCUMENTATION
• Failure to recognise deviations from the norm
• Inadequate care
• Failure to escalate concerns
• CTG interpretation
• Lack of understanding of accountability

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Summary of themes none clinical

• Unprofessional behaviour
• Poor communication
• Falsifying records or signatures
• Telling lies
• Poor Teamwork
• Lack of assertiveness

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Organisational themes

• Trust not understanding or valuing supervision
  and role of Supervisors of Midwives
• Labour ward co-ordinator NOT supernumerary
• Lack of time to support newly qualified midwives
  or those coming from other Trusts
• Culture of the unit not conducive to teamwork
• Inadequate staffing for activity

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Addressing the Issues

• Documentation auditing of records feedback to
  midwives - use local national tools, including
  peer audit
• CTG interpretation failure to recognise
  deviations skills drills, in house education,
  fresh eyes buddying approach, ACT ON WHAT
  IS SEEN
• Poor Care your practice should be based on the
  best available current evidence. You are
  accountable for your own practice and you cannot
  have that accountability taken from you by
  another registered practitioner, nor can you give
  that accountability to another registered
  practitioner (NMC Midwives rules and standards
  2004)

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• Failure to escalate know the normal well in
  order to recognise the abnormal
• Accountability awareness understanding of
  legislation - NMC publications
• Communication open and supportive environment,
  encourage communication at all levels
• Unprofessional behaviour generate a confident
  trusting culture in the workplace
• Teamwork build effective teams promote
  trusting relationships

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Supervision the key!

• Supervisory 1 to 1s with midwives
• Regular reflection on practice individual or
  group
• Encourage confidence, competence, honesty,
  trust
• Ensure upholding the reputation of the profession
  is vital
• Be a role model
• Collaborate educate about supervision
• Structured reflection following an incident or
  identified poor practice
• Developmental support in conjunction with
  employer
• Supervised practice in cases which would
  otherwise warrant referral to the NMC
• Referral to the LSA then NMC very last resort

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Conclusions

• Primary and secondary legislation supports
  Supervisors and the LSA in protecting the public
• Supervised practice and developmental support is
  very successful prevents referral of midwives
  to the NMC
• Supervisors are therefore providing leadership
  and guidance, supporting best practice
  facilitating midwives reflection on critical
  incidents
• Supervisors are also supporting midwives through
  dilemmas and giving advice on ethical issues
• And - empowering women and midwives by being
  confident advocates for mothers and babies