Dashboard Data

							                                    St Michael’s Hospital
                        Division of Women’s & Children’s Services



                   Maternity Dashboard Data- January 2009
In order to reduce and manage risk, the Maternity Service within UH Bristol
NHS Foundation Trust has implemented a ‘Maternity Dashboard’. This is a
Performance and Governance score card which is reviewed on a monthly
basis at the Women’s Services Clinical Governance meeting and allows the
service to identify patient safety issues in advance so that timely and
appropriate action can be instituted to ensure woman centred, high-quality,
safe maternity care.

Areas of concern are currently:

Number of ethnic members on the labour ward forum

This dashboard item is included on recommendation of the RCOG following
the Healthcare Commission Report into the maternity services at Northwick
Park. At this hospital a large number of women were black and minority
ethnic (BME) and issues related to culture and language were thought to have
contributed to some of the maternal deaths that were investigated. At
UHBristol, one in four women giving birth are BME (Compared to 1 in 10 at
NBT and 1in 12 in Weston).

We are actively seeking BME representatives for the labour ward forum and
hope that we will achieve at least 2 members by July 2009. We do have a
member of the BME community on the antenatal working party and focus
groups are on-going with Somali representatives from the PCT.

Midwife to birth ratio:

The maternity dashboard demonstrates that the midwife to birth ratio within
the maternity services at UH Bristol for the past 12 months has been in the
region of 1:38/40. The benchmark used is a ratio of 1:28. Previous
benchmarking with the Healthcare Commission and Birthrate Plus – a
benchmarking tool from the Royal College of Midwives have also highlighted
that the midwifery staffing levels are very low. This has a high risk status on
the Divisional Risk Register. The challenge of recruitment and retention of
midwives within the maternity service is an ongoing priority and strategies
have been developed to attract and support both experienced and newly
qualified midwives. A recent bid for extra resources has been submitted to the
Primary Care Trust, which the service hopes will be successful.

In addition to establishing an adequate midwife to birth ratio, the maternity
service needs to ensure that there are adequate numbers of senior midwives

Authors: Janet Pollard Patient Safety Midwife
         Bryony Strachan Consultant Obstetrician

                                                                    UH Bristol March 2009
(Band 7) working on central delivery suite in order to ensure that the senior
midwife responsible for co-ordinating activity on each shift has supernumerary
status. This is key to driving performance improvement and maintaining safety
for mothers and babies.

Caesarean section rate

The increase seen in October and December has settled slightly. A ‘normal
birth’ group led by Belinda Cox, Practice Development Midwife has been set
up as a sub group of the labour ward forum and Belinda also leads a vaginal
birth after caesarean (VBAC) group.

In addition the supervisors of midwives have taken the lead on the re-launch
of the birthing suite within the central delivery suite to encourage normality
and increase the normal birth rate.


Blood transfusions (4 units of blood)

The increase in the number of transfusions of 4 units of blood or more has
been discussed in the Maternal Critical Care (MCC) Working Party meeting
and the Women’s Service Clinical Governance meeting.

Number of cases of hypoxic encephalopathy

Each individual case of hypoxic encephalopathy (HIE) is investigated and
presented at the monthly multi-professional neonatal morbidity and mortality
meetings. The number of HIE cases has risen in recent months. A full case
note review and root cause analysis (RCA) where applicable has been
organised. The action plans will be monitored by the relevant working parties
and then reported to the Women’s Service Clinical Governance Meeting.
Outstanding actions from the RCA will be presented to the Divisional Board in
April 2009.

Maternal Death

There has been one maternal death in January 2009. This is currently subject
to an inquest.

There were two peripartum hysterectomies in January 2009. Both were in
women with a placenta percreta (where the placenta imbeds abnormally into
the wall of the uterus) as a result of a low lying placenta and previous
Caesarean section scars. These were the only peripartum hysterectomies in
the previous 12 month period.




Authors: Janet Pollard Patient Safety Midwife
         Bryony Strachan Consultant Obstetrician

                                                               UH Bristol March 2009