The National Maternity Hospital Holles Street

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					The National Maternity Hospital,
Holles Street




                      Annual Report 2006
  The Organisation’s Values, Mission and Vision Statements

                                                The Mission
   The Mission of The National Maternity Hospital is to achieve the highest attainable level of care for
                                      women, babies, families, and staff.


                             The purpose of the National Maternity Hospital
The purpose of the National Maternity Hospital is to provide a continuously improving health service and
     also to be respected by patients, by the mothers and families of babies we care for, by our staff,
                                      and by the community we serve.


                              The values of the National Maternity Hospital
 The values of the National Maternity Hospital are respect for people and their needs, closeness to our
        patients, a caring culture, service to the community, corporate and individual responsibility,
                       improved clinical governance, and protection of patient rights.


                             The strategy of the National Maternity Hospital
  The strategy of the National Maternity Hospital is to contribute to the delivery of the National Health
Service, to respond effectively to emerging strategic issues in health care for women, to develop staff skills,
            to motivate the delivery of a better health service, and to achieve value for money.


                 The corporate behaviour standards of the National Maternity Hospital
 The corporate behaviour standards of the National Maternity Hospital are openness, strong governance,
continuous improvement, acceptance of change, high ethical standards, team work and staff development.
  The National Maternity Hospital,
                               Holles Street




                             Annual Report 2006




                     Photographs by Denis Towel and David O’Toole

Project Managed for the National Maternity Hospital by Fionnuala Byrne, Information Officer

                    Design and Print by Printcomp Ltd. (01) 497 8511
                                                                                                          Contents




Contents                                                       Pharmacy Department                                37
                                                               Physiotherapy Department                           37
Governor’s Reports                                     4
                                                               Social Work Department                             38
    Deputy Chairman’s Report                           4
                                                               Chaplaincy Department                              39
Master’s Report                                        5       Practice Development Department                    40
Executive Committee Report                             7           Urodynamics                                    41
                                                                   Diabetes                                       43
Finance and General Purposes Committee Report          9
                                                                   Infection Control                              44
Secretary’s/Manager’s Report                          11

Director of Midwifery and Nursing Report              12   Education Reports                                      45
                                                               Royal College of Surgeons in Ireland               45
Board of Governors                                    13
                                                               University College Dublin                          45
    Governors Ex-Officio                              13
                                                               School of Midwifery                                45
    Nominated by the Minister for Health & Children   13
    Nominated by Dublin Corporation                   13
                                                           General Support Services Reports                       47
    Governors Elected                                 13
                                                               Arts Office Report                                 47
Executive Committee Members                           14
                                                               Backcare and Erogonomics Programme                 47
House Committee                                       15       Casemix Programme                                  48

Finance & General Purposes Committee                  15       Facilities Engineering Department                  49
                                                                   Engineering Department                         49
Ethics Committee                                      15
                                                                   Environmental Management                       49
Professional Advisors                                 16       General Services Department                        51
Resident and Visiting Medical Staff                   16           Laundry                                        51

Honorary Consulting Staff                             17           Portering Services                             52
                                                                   Telecommunications                             52
Senior Midwifery and Nursing Staff                    18
                                                                   Catering                                       52
Paramedical Staff                                     20       Health and Safety Department                       53
Senior Administration Staff                           21       Human Resources Department                         55
                                                               Information Department                             56
Medical and Midwifery Reports                         22
                                                               Information Technology Department                  56
    Neonatal Department                               22
                                                                   Hospital Inpatient Enquiry (HIPE) Department   57
         Neonatal Resuscitation                       23
                                                               Patient Services Department/
         Neonatal Liaison Service                     24
    Breastfeeding Support Services                    25         Freedom of Information                           58

    Community Midwifery Service                       27       Medical Records Department                         58

         Early Transfer Home                          29       Purchasing and Supplies Department                 59

    Clinical Governance                               29       Partnership                                        60

    Gynaecology Department                            30       Quality / Accreditation                            60
                                                               Patient Service User Panel                         61
Clinical Support Services Reports                     31
                                                               Staff Satisfaction Survey                          62
    Antenatal Education Departments                   31
         Pregnancy Yoga Classes                       31
                                                           Accounts and Statistics                                63
Clinical Engineering Department                       32
                                                               Accounts                                           64
    Clinical Nutrition and Dietetics                  33
                                                               Statistics for the National Maternity Hospital     66
    Occupational Health Department                    35
    Pathology and Laboratory Medicine                 36
                                                                                                                       3
    The National Maternity Hospital, Holles Street Annual Report 2006




    Governors’ Reports                                                 funding for very identifiable matters which continue to arise
                                                                       year after year. The sooner Irish hospitals move to a situation
    Deputy Chairman’s Report
                                                                       where an adequate budget is allocated at the start of the year
    I have great pleasure in presenting the report on the hospital     the better. In such a scenario we can be realistically held
    for the twelve months ended 31st December 2006.                    accountable for fiscal performance.


    This report outlines the main activities of the hospital during    There is no doubt that the level of activity at the hospital is in
    the year which saw 7,986 mothers delivering at the hospital.       excess of its designed capacity. In the longer term there is a
                                                                       need to re-locate the hospital to another site and our
    The hospital budgetary performance during 2006 is set out in       preferred option, having considered all options, would be St.
    detail in the report of the Finance & General Purposes             Vincent’s University Hospital.There is an urgent need for the
    Committee.                                                         HSE to address this important matter and agree the longer
                                                                       term strategy for this hospital. With regard to short term
    2006 was a year when activity at the hospital increased after a    needs the hospital appointed a design team during the year to
    self-inflicted short respite in 2005. We had more nurses and       progress an interim development utilising the €14.8m
    midwives available during the year which was a help in coping      allocated for this purpose by the HSE.
    with the increased activity. In addition, the hospital was
    selected as a pilot site for trialing new NCHD rosters in the      During 2006, we appointed Ms Mary Brosnan as our Director
    context of the European Working Time Directive. Additional         of Nursing and Midwifery and I wish her well in her new post.
    consultant posts were granted to the hospital in the specialties
    of anaesthetics, paediatrics and obstetrics/gynaecology. These     I would like, on behalf of the Board of Governors, to thank all
    posts will be available early next year and will reduce the        members of staff for their continuing dedication and excellent
    number of hours worked by our NCHDs.                               work during the year. It is through their dedication and
                                                                       excellence that the hospital continues to enjoy its reputation.
    On the subject of finance, 2006 was a normal year in that the
    hospital was allocated an inadequate budget at the start of the    J Brian Davy
    year. As usual, we spent the entire year negotiating additional    Deputy Chairman




4
                                                                        Governors’ Reports/Master’s Report



                                                                    Of the 8088 babies who weighed more than 500g, 60 were
                                                                    either stillborn or died during the first 7 days of life.The
                                                                    uncorrected perinatal mortality rate for the hospital was
                                                                    therefore 7.4 per thousand. If one excludes the 29 deaths that
                                                                    were due to congenital anomalies, the corrected perinatal
                                                                    mortality rate was 3.8 per thousand.
                           Michael Robson,
                           Master
                                                                    At the same time as this very satisfactory perinatal outcome
                                                                    we must acknowledge that our caesarean section rate rose for
Master’s Report                                                     the 10th consecutive year to 18.9%.This together with a high
This report marks the end of my second year as master and           induction rate remains a concern and continuously needs to
again I would like to start by thanking all staff for the support   be challenged. We must seek standards of excellence at both
they have given me. Our outcomes remain of a high standard          ends of the spectrum.
and represent a lot of hard work by everybody in the hospital.
                                                                    Our Fetal Assessment Unit and Special Care Baby Unit at
Last year I emphasised how important it is to recognise             both ends of the pregnancy journey have made a huge
everyone’s part in this and this year is no exception. It is hard   contribution to our results with the Fetal Assessment Unit
to achieve high standards, but it is even harder to maintain        continuing to see more women and more often then ever
them at the same time as improving and developing new               before, 20,222 attendances were recorded during the day not
forms of care. Ultimately we want to offer a service that           including emergencies at night, which average out at over
patients have confidence in and one that we are proud to            70/day.
provide.
                                                                    The Special Care Baby Unit also deserves further comment in
I would therefore like to acknowledge in particular                 a year when 1242 babies were admitted.This is a significant
everybody’s willingness to help each other when busy times          increase on previous years and is partly due to an increase in
occur.This unselfishness is the most important quality of a         our own numbers, but also due to admissions from all over
successful organisation and a true reflection of Holles Street.     Ireland including babies from the other Dublin maternity
Flexible and integrated working practices are going to be           hospitals. Extra space was created to cope with this and on
crucial in the future if we are to keep up with patient             that note I would like to acknowledge all the excellent work
expectations.                                                       that the Facilities Engineering department have carried out
                                                                    during the year.
In 2006 we lifted the cap on our deliveries which had been
imposed during the busy summer months.This decision was             Gynaecology remains busy despite limited resources. It also
carefully considered and resulted in the total number of            suffers when the numbers of deliveries are high because of
deliveries increasing back to our previous numbers. Last year       the lack of space, in particular theatre space and time. Despite
7986 women gave birth to 8088 infants. Certainly we had             these restrictions, 10,660 women were seen at our
more deliveries and we were busier but overall I feel we            gynaecological clinics during the year and 534 major
provided a valuable and safe service to the population of           gynaecological operations were performed.There is no doubt
Ireland within the available resources. Morale I feel was good      in my mind that in order to develop our gynaecology service
although I admit at times it did require all our staff to do that   we need to improve our infrastructure in the short term, and
                                                                    in the long term secure our future which we have for many
extra bit.
                                                                    years being told by the Department of Health is on the St
There is no cap planned for 2007 at the moment but we are           Vincent Hospital site.
continuously trying to improve our ability to predict the
number of deliveries expected.This should help us to manage         Clinical Governance which incorporates accountability, quality
the numbers better as well as managing any future caps if           improvement and the management of risk continues to
required.                                                           develop with weekly meetings.This is an area which will I feel

                                                                                                                                       5
    The National Maternity Hospital, Holles Street Annual Report 2006



    will pay back significant dividends in the future. Alongside this                 incorporate hygiene, decontamination and infection prevention
    the Information Governance Meetings looking at all aspects of                     and control .
    information collection and communication is also playing its
                                                                                      Training and working practices for nurses, midwives and
    role in setting up organisational structures which will support
                                                                                      doctors is another national issue which is going to see big
    future development.
                                                                                      changes in the near future. As a pilot site for the European
                                                                                      Working Time Directive, developments in Community
    During the year there continued to be new appointments in                         Midwifery and Nurse Prescribing, we are helping to lead those
    all departments. In particular though I would like to                             changes. It is essential to ensure that we look after both
    congratulate Mary Brosnan on her appointment to Director of                       patients and staff during these processes.
    Nursing and Midwifery and at the same time I would also like
    to thank Mary Boyd for her hard work as Director of Nursing                       However the most important issue is undoubtedly our long
    and Midwifery and wish her well in her new and challenging                        term future. In 2007 there will be a review of the maternity
    job in Cork.                                                                      services in Dublin. We believe this will confirm our view that
                                                                                      our future is on the St Vincent Hospital site. Our biggest
    So that brings me to the end of my second year and there are                      responsibility will be to make that happen and will require
    a number of issues I would like to highlight.                                     continued patience, a clear strategy and ultimately decisive
                                                                                      action. We all need to support that process.
    The whole subject of healthcare associated infection is going
    to remain an important national issue which we need to                            Dr. Michael Robson
    develop a strategy for.This is being carried out and will                         Master




    Midwives and doctors attending the International Active Management of Labour Course in February




6
                                                        Master’s Report / Executive Committee Report




Executive Committee Report
Executive Committee
At the Annual General Meeting the outgoing members of the
Executive Committee were proposed and seconded and were
elected as ordinary members of the Executive Committee for
the coming year.


New Governors
There were no new Governors elected during the year.


Charter Day
We had a very good attendance at Charter Day which was
                                                                 Mary Brosnan, Director of Midwifery and Nursing, and Gertie Cull,
held on the 26th January 2006 and was hosted by Dr Michael       Midwifery Tutor, who retired in 2006.

Robson to whom we are most grateful.
                                                                 Staff Retirements
                                                                 The following staff members retired during the year after
Staff Appointments
                                                                 many years of service.
New appointments during the year included Dr Colm
O’Donnell, Consultant Neonatologist, Ms Angela Gargan,           Ms Gertie Cull and Ms Cora McComish, Midwifery Tutors, Ms
Clinical Risk Manager and Mr Martin Creagh, Health and Safety    Helen Kearns, Pharmacy, Ms Ann O’Byrne and Ms Briget
Officer. Ms Maggie Walsh was appointed Chief Medical             Leahy,Telephonists, Ms Rosemary Reynolds and Ms Joan Barry
Scientist, Microbiology and Mr Joe Byrne Specialist Medical      Ward, Midwifery Staff and Ms Cecilia Foley, Chaplain. Dr Frank
Scientist. Ms Ann Delany was appointed Quality/Accreditation     McManus, Honorary Orthopaedic Surgeon, also retired during
Manager. Mr Damian McKeown was appointed Project Co-             the year.
ordinator and Ms Fionnuala Byrne was appointed Information
Officer. Other appointments included Mr Eoghan Hayden to         We wish them all a happy retirement.
the post of Senior Clinical Engineering Technician.

                                                                 Hospital Awards and Certificates
Ms Mary Brosnan was appointed to the post of Director of
                                                                 Awards for the year 2006 were as follows: The A. Edward
Midwifery and Nursing. Ms Nicola Clarke was appointed
                                                                 Smith Medal was awarded to Ms Sarah Hyde.The John F.
Assistant Director of Midwifery and Nursing. Ms Julie Higgins,
                                                                 Cunningham Medal was awarded to Dr Ferdia Bolster. The
Ms Ann Marie Sliney, Ms Fiona Roarty, Ms Bernie O’Callaghan,
                                                                 Kieran O’Driscoll prize was presented to Ms Sarah Hyde. The
Ms Niamh Cummins, Ms Orla Foley and Ms Katie Cuffe were
                                                                 Royal College of Surgeons/NMH medal was awarded to Ms
all appointed as Clinical Midwife Manager (CMM) 2 -
                                                                 Melissa Pendergrass.
Community Midwives. Ms Michaela Kinnear was appointed as
CMM2 in Unit 4, Ms Claire O’Rourke, CMM2 in Fetal
                                                                 Medals were also presented to student midwives as follows:
Assessment. Ms Orla Gavigan was appointed to CMM2 as
                                                                 The Hospital Gold Medal was presented to Ms. Sinead
Clinical Placement Co-Ordinator. Further appointments            O’Brien and Ms Bridget MacDaid who were joint winners of
included Ms Caitriona Cullen, CMM2 Allocations Liaison           the award. The Elizabeth O’Farrell Medal was presented to
Officer and Ms Ann Marie Dunne, CMM2 Clinical Placement          Ms. Pamela Johnston. The Director of Midwifery’s Award was
Co-ordinator.                                                    presented to Ms Louise McGrath and Ms Aoife O’Friel.

                                                                                                                                     7
    The National Maternity Hospital, Holles Street Annual Report 2006



    The Student Neonatal Intensive Care Nursing Medal, which       infrastructural deficits. Because of the necessity to phase any
    was donated by Dr N O’Brien, was awarded to Ms Shirley         development of the site, it has become clear that the long
    Moore. A Neonatal Medal for Neonatal Resuscitation was         term future of the hospital should be on another site – the
    awarded to Ms Brid O’Brien and a Neonatal Medal in             preferred option is St.Vincent’s University hospital.
    recognition of her dedication to improving neonatal nursing
    care was awarded to Ms Hilda Wall.                             Maternity Hospitals Joint Standing
                                                                   Committee
    A presentation was also made to the Specialist Registrar for
                                                                   The Committee, under the Chairmanship of Dr Miriam
    2006, Dr Vijay Hirenath.
                                                                   Hederman O’Brien, continued to meet on a monthly basis
                                                                   during the year. Issues of common interest were discussed
                                                                   which included staff shortages, opportunities for co-operation
                                                                   and medical indemnity insurance.


                                                                   Conclusion
                                                                   The Executive Committee has great pleasure in acknowledging
                                                                   the work and co-operation they received from all categories
                                                                   of staff; medical, paramedical, midwifery, administration,
                                                                   catering, maintenance, portering and household.


                                                                   Mr Gabriel Hogan
                                                                   Honorary Secretary

    Hospital Finances
    As can be seen from the report of the Finance and General
    Purposes Committee an accumulated deficit of €779k was
    carried forward at year-end. Gross expenditure for the year
    was €56,249k and this represents an increase of 7.1% over
    2005.


    Hospital Development
    The Design Team prepared a number of schemes for the
    interim development of the hospital. The budget of €14.8
    million allocated by the HSE is inadequate to undertake the
    type of development necessary to address the hospitals




8
                                                                     Executive Committee Report /
                                                    Finance and General Purposes Committee Report


Finance and General Purposes                                        self funding renovation project for the four Mount St. houses
                                                                    which will hopefully come to fruition during 2007. Irrespective
Committee Report
                                                                    of the interim development or the longer term plans, there
Gross expenditure for the year was €56,249k which                   remains a need for substantial ongoing capital investment to
represents an increase of 7.1% over 2005. This increase is          maintain activity on this site on a day to day basis. As in
relatively small when consideration is taken of the pay awards,
                                                                    previous years, the need for progress on long-term
of the increased number of midwifery and nursing staff during
                                                                    development solutions remain a major priority.
the year and of the overall levels of activity.The year-end
position was an accumulated deficit of €779k.                       During the year cost pressures were experienced in a number
                                                                    of areas. Medicines and bloods were significant cost drivers
Payroll costs accounted for 77.3% of the gross expenditure
                                                                    due to activity levels, patient diversity and the introduction of
and non-pay costs for the remaining 22.7%; this is a shift of
                                                                    new treatments and drugs. In addition, there were pressures
2.2% towards payroll from 2005 levels. Income for the year
                                                                    due to rising energy costs and also the ongoing costs of
increased to €10,427k - 18.5% of gross expenditure.The gross
                                                                    maintaining the increasing amount of information technology
expenditure was funded by an allocation from the HSE of
                                                                    hardware and software systems throughout the Hospital.
€45,417k and incomes of €10,427k.
                                                                    There has been sustained pressure on the staffing budget
The Finance and General Purposes Committee continued in             mainly due to increasing pressure from the HSE for the
its main role of monitoring and evaluating the use of the           Hospital to maintain our numbers within an ‘approved ceiling’
Hospitals resources on a monthly basis.This role is essential to    set by the HSE.
enable the Hospital to meet its targets in relations to finances,
staff numbers and service levels as agreed in our Provider          The year was very challenging from a financial perspective

Plans.                                                              with an initial projected deficit against allocation of over
                                                                    €2million. Additional funding totalling ~€2million was secured
During the year, Capital Funding of €1,741k was received            in the second half of the year; however, a certain amount of
which assisted in dealing with a number of critical areas           this was on a once off basis only. A number of funding issues
relating to maintenance, medical equipment, hygiene and             remaining unresolved and confirmation of certain additional
interim development planning.This included funding for a            funds was only received in the final weeks of the year. Activity
neonatal isolation area which was urgently required and also        levels need to be continuously monitored and many
some funding (€393k) to enable implementation of the initial        infrastructural issues continue unresolved and difficult to
steps of our hygiene program. Funding has been allocated over       progress in the absence of firm commitments regarding the
a number of years for an interim development and the interim        medium and longer term developments.These issues,
development team have spent considerable time discussing            combined with a lack of ongoing significant capital investment,
various options particularly with a view to our long term plans     continuous pressure on staffing numbers and a less favourable
to co-locate to the St.Vincents site. Substantial time and          overall financial position, indicate that the Committee and the
money has been devoted throughout the year to progress a            Hospital once again face a difficult year in 2007.




                                                                                                                                        9
     The National Maternity Hospital, Holles Street Annual Report 2006



                           2006 Pay Costs                                            2005 Pay Costs


                               6%                                                         7%
                                            19%                                                        18%
               10%                                                           11%



                                                       7%                                                     8%




                                                       11%
                 47%                                                                                         11%
                                                                              45%



                                         Consultants and NCHDs   Midwifery and Nursing
                                         Paramedical             Support Services
                                         Administration          Pensions and Lump Sums




                    2006 Non-Pay Costs                                            2005 Non-Pay Costs

                                                                                     12%
                         12%
                                                                             7%
               8%                                                                                            47%
                                                       46%             6%
          5%


                                                                       11%
           12%

                    4%                                                        4%
                                                                                     5%
                           7%                                                                  8%
                                    6%




                                          Medical                Utilities
                                          Maintenance            Training and Assoc. Costs
                                          Finance                Office Expenses
                                          Computer Expenses      Miscellaneous




10
                   Finance and General Purposes Committee/Secretary/Manager’s Report



                                                                   x-ray screening suite (€650k), emergency replacement of
                                                                   concrete banding on the outside of the hospital (€200k) and
                                                                   the provision of an extension of our NICU for isolation
                                                                   (€250k). In addition, €393k was made available to address
                                                                   infrastructural deficits from a hygiene perspective and
                                                                   significant improvements in bathrooms and kitchens were
                           Michael Lenihan                         implemented. I would like to thank our Facilities Engineering
                           Secretary Manager
                                                                   department who managed all of these projects in addition to
                                                                   the normal routine maintenance requirements of the hospital.
Secretary/Manager’s Report
Once again the year 2006 was a challenging year from a             During the year a hygiene audit was carried out and the
financial perspective. Activity levels at the hospital increased   hospital was categorised as fair to good and were rated in the

by 6.6% over 2005 and 7,986 deliveries took place.                 top third nationally. Whilst the €393k allocated by the HSE
                                                                   was welcome to address some of our infrastructural deficits,
                                                                   there is an urgent need to increase the frequencies of cleaning
With regard to the hospital’s interim development, the Design
                                                                   in a number of areas.There is also a need to provide staff out
Team prepared a number of options in relation to the
                                                                   of hours to undertake cleaning duties. The cost of these
development of the Holles Street site. The extent of any
                                                                   developments have been submitted to the HSE but
development will depend on the long term future of the
                                                                   regrettably no additional revenue funding has been provided.
hospital. The stated preference by the hospital is to re-locate
                                                                   These needs were also identified in 2005 in our Irish Health
on to the site of St.Vincent’s University Hospital as soon as
                                                                   Services Accreditation Board accreditation survey.
possible. Negotiations in this regard have been ongoing for
some years and St.Vincent’s University Hospital has confirmed
                                                                   The Partnership Committee established in 2004 continued to
its agreement in principle to the re-location. The HSE has
                                                                   work well during the year and I would like to thank the Joint
decided to conduct a maternity services review similar to the
                                                                   Chairs for their commitment to the work of this Committee.
paediatric review which is due to be completed by the
summer of 2007. The Executive Committee has agreed to              I would like to thank all of my administrative colleagues for
suspend any further consideration of on site options until this    their continued support during the year. They are a
review is completed. With regard to the development of our         committed group and work very well as a team.
Mount Street properties, a planning application was submitted
in the autumn and work is expected to take place in 2007           Finally, I would like to thank all of the staff of the hospital for
subject to licences being agreed with the various                  their continuing dedication to the hospital during another busy
potential users.                                                   year.


A number of major capital works were completed during the          Michael Lenihan
year. The HSE provided funding for the replacement of our          Secretary/Manager




                                                                                                                                         11
     The National Maternity Hospital, Holles Street Annual Report 2006



                                                                                 This year marked a historic change in midwifery education. In
                                                                                 September, four of the tutors from the School of Midwifery,
                                                                                 Ms. Anne Mc Mahon, Ms. Barbara Lloyd, Ms Denise O’Brien
                                                                                 and Ms. Sandra Atkinson transferred to lecturer posts in
                                                                                 University College Dublin.Two senior members of our
                                                                                 teaching staff chose to take early retirement, Ms Cora Mc
                                 Mary Brosnan
                                                                                 Comish and Ms Gertrude Cull.Their contribution to the
                                 Director of Midwifery and Nursing
                                                                                 education of student midwives has been invaluable and they
                                                                                 will be greatly missed.This hospital retains a satellite education
     Director of Midwifery and                                                   centre to support the ongoing educational need of the
     Nursing Report                                                              qualified staff. In September, 20 students commenced the pre
                                                                                 registration midwifery course and we look forward to
     The past year has heralded many developments in the
                                                                                 welcoming these students in January 2007 for their first clinical
     midwifery and nursing service and education. In my first year
                                                                                 placements.
     as Director of Midwifery and Nursing, I would like to thank all
     my colleagues throughout the hospital for their hard work and
                                                                                 I wish to congratulate Ms. Caroline Brophy on her
     support. I am particularly grateful to the senior midwifery
                                                                                 appointment as CMM2 for Unit 7, Ms. Orla Gavigan and Ms.
     management team and clinical midwifery managers, clinical
                                                                                 Anne Marie Dunne as Clinical Placement Co-ordinators for
     midwife and nurse specialists and each individual member of
                                                                                 the pre registration midwives,Ms. Catriona Cullen as
     the midwifery and nursing team in both the hospital and
                                                                                 Allocations Officer and Ms. Claire O’Rourke as CMM2 in the
     community settings, for their assistance.
                                                                                 Fetal Assessment Unit; I wish each of them success in their
                                                                                 new roles.
     In 2006, twenty three midwives graduated with awards of
     Higher Diploma in Midwifery from University College, Dublin. I
                                                                                 The deaths occurred of Ms. Biddy O’Reilly a former Matron
     offer my sincere congratulations and would like to thank them
                                                                                 and Ms. Una O’Gara, ward sister; we extend our sympathies
     for their commitment to the hospital. We are delighted to
                                                                                 to their families.
     report that 20 of the midwives who graduated in 2006 have
     accepted staffing posts in the hospital.The principal midwifery
                                                                                 Finally, I wish to thank my predecessor Ms. Mary Boyd for her
     tutor and all of the midwifery tutors deserve recognition for
                                                                                 support and wish her every success for the future.
     assisting these midwives to graduate from the programme.
     Many midwives and nurses also undertook BSc. and MSc.
                                                                                 Mary Brosnan
     programmes to enhance their professional qualifications and
                                                                                 Director of Midwifery and Nursing
     they are also to be congratulated.

     Former Director of Midwifery and Nursing Mary Boyd on Graduation day in March.




12
                              Director of Midwifery and Nursing Report/Board of Governors




Board of Governors                                              1976   *   Dr Declan Meagher
                                                                1976   *   Mrs Rosaleen Lynch
Governors Ex-Officio
                                                                1977   *   Mrs Laura MacDonald
Dr Diarmuid Martin (Archbishop of Dublin – Chairman)
                                                                1978   *   Mrs Una Crowley
Councillor Vincent Jackson (Lord Mayor – Vice Chairman)
                                                                1979   *   Dr Brendan Murphy
Dr Michael Robson (Master)
                                                                1980   *   Dr John R McCarthy
Very Rev. Patrick Finn (Parish Priest of the Parish of
                                                                1980   *   Dr Niall O’Brien
Haddington Road)
                                                                1981   *   Mr J. Brian Davy (Deputy Chairman)
The Rt. Rev. Monsignor Peter Briscoe (Parish Priest of the
                                                                1983   *   Mrs Maureen Spain
Parish of Sandymount)
                                                                1983   *   Mr Neil V McCann
Fr. Patrick Boyle (Administrator of the Parish of St. Andrew,
                                                                1983   *   Mrs Judith Meagher
Westland Row)
                                                                1983   *   Professor Sean Blake
                                                                1984   *   Dr Dermot MacDonald
Nominated by the Minister for Health & Children
                                                                1984   *   Mrs Stephanie Stronge
Ms Nuala Fennell (until August)
                                                                1985   *   Dr J.T. Gallagher
Ms Patricia O’Shea
                                                                1985   *   Dr. Reginald Jackson
                                                                1985   *   Mr Edward Bourke
Nominated by Dublin Corporation
                                                                1986   *   Mrs Maeve Hayes
Councillor Wendy Hederman
                                                                1986   *   Mr Gabriel Hogan (Honorary Secretary)
Councillor Eibhlin Byrne
                                                                1986   *   Mrs Monica Owens
                                                                1986   *   Dr Joseph Stanley
Governors Elected
                                                                1987   *   Professor Paddy Masterson
1952          Mrs Joan Duff
                                                                1989   *   Mrs Anne Davy
1956     *    Dr Jack G. Gallagher
                                                                1990   *   Ms Carmencita Hederman
1956     *    Mrs Bridget Malone
                                                                1990   *   Mrs Margaret Anderson
1957          Dr Garret Fitzgerald T.D.
                                                                1990   *   Mrs Kathleen O’Grady
1957     *    Mrs Sheila Geoghegan
                                                                1991   *   Dr John F. Murphy
1958          Dr Deirdre Pepper
                                                                1992   *   Dr Frances Meagher
1959     *    Professor Sheamus Dundon
                                                                1992   *   Mr Kevin Mays
1959     *    Professor E O’Dwyer
1962     *    Mr Alex J Spain                                   1995   *   Mr Peter Sutherland

1963     *    Mrs Robina O’Driscoll (deceased October)          1995       Dr Declan O’Keeffe

1964     *    Mr Patrick J Spain                                1995   *   Professor Colm O’Herlihy

1967     *    Mrs Katriona Maguire                              1996   *   Mr William Johnston

1968     *    Mr Joseph Derek Davy                              1997   *   Dr Peter Boylan
1968     *    Professor Eoin O’Malley                           1998   *   Mrs J Keane
1969     *    Professor Kieran O’Driscoll                       1998   *   Mrs A Murphy
1969     *    Dr Alan O’Grady                                   1998   *   Mr Nial Fennelly
1970     *    Mrs Emer Meagher                                  1998   *   Mr Frank Downey (Honorary Treasurer)
1971     *    Mrs Alice Finlay                                  1998   *   Mr Anthony Garry
1971     *    Mrs E O’Malley                                    1998   *   Mr C O’Briain
1974     *    Dr Joseph Alvey                                   2000   *   Mr John Spain
1974     *    Mr S. P. Boland                                   2000   *   Dr F Gorman
1975     *    Mrs Mary Ensor                                    2001   *   Mrs Helen Moe
1975     *    Mr Donal S. McAleese                              2001   *   Mrs Yvonne McEvoy
1976     *    Professor Enda Hession                            2001   *   Mrs Jane Collins

                                                                                                                   13
     The National Maternity Hospital, Holles Street Annual Report 2006



     2001    *   Ms Alexandra Spain
                                           Executive Committee Members
     2001    *   Mrs Margo McParland
     2001    *   Mrs Catherine Altman      Mrs Catherine Altman

     2001        Dr John Murphy, Paeds     Mrs Margaret Anderson

     2003        Mr Niall Doyle            Dr Peter Boylan

     2003    *   Mrs Sara Appleby          Fr Patrick Boyle

     2003    *   Ms Lydia Ensor            Councillor Eibhlin Byrne

     2005        Dr Declan Keane           Mr Brian Davy (Deputy Chairman)

     2005        Ms Caroline Simmons       Mr Frank Downey (Honorary Treasurer)

     2005        Dr Peter Lenehan          Mr Niall Doyle

     2005        Dr Orla Sheil             Ms Lydia Ensor

     2005        Ms Sheena Carton          Mrs Nuala Fennell (until August)

     2005        Ms Elaine Doyle           Ms Carmencita Hederman

     2005        Ms Maeve Dwyer            Councillor Wendy Hederman

     2005        Dr Peter McParland        Mr Gabriel Hogan (Honorary Secretary)

     * denotes life member                 Mr William Johnston
                                           Dr Declan Keane
                                           Lord Mayor of Dublin, (Vice Chairman), Cllr.Vincent Jackson
                                           Mrs Rosaleen Lynch
                                           Dr Diarmuid Martin (Archbishop of Dublin, Chairman)
                                           Mr Kevin Mays
                                           Dr John F. Murphy, Consultant Obstetrics/Gynaecology
                                           Dr John F. Murphy, Consultant Paediatrician
                                           Mrs Kathleen O’Grady
                                           Prof. Colm O’Herlihy
                                           Mrs Patricia O’Shea
                                           Mrs Monica Owens
                                           Dr Michael Robson (Master)
                                           Mr Alex Spain




14
                                Executive Committee Members/House Committee/Finance and
                                             General Purposes Committee/Ethics Committee


House Committee                                       Ethics Committee
Dr Michael Robson (Master)                            Dr John F. Murphy, Consultant Paediatrician (Chairperson)
Mrs Anne Murphy (Chairperson)                         Dr Michael Robson, Master (Vice Chairperson)
Mrs Monica Owens                                      Ms Mary Brosnan, Director of Midwifery and Nursing

Mrs Ann Davy                                          (Alternative Vice Chairperson)
                                                      Mr Michael Lenihan
Mrs Judith Meagher
                                                      Dr Declan Keane
Mrs Maureen Spain
                                                      Ms Denise O’Brien
Mrs Margaret Anderson
                                                      Mr Berchmans Gannon
Mrs Kathleen O’Grady
                                                      Ms Mary Moran
Mrs Carmencita Hederman (until May)
                                                      Ms Dorothy McCormack
Mrs Rosaleen Lynch
                                                      Ms Deirdre Soffe
Mrs Helen Moe                                         Ms Ann Rath
Mrs Margo McParland                                   Dr Edgar Mocanu
Mrs Jane Collins                                      Mr Pat Murphy
Mrs Catherine Altman                                  Mr Sean Alyward
Mrs Elaine Doyle                                      Mr Padraic Ingoldsby (until February)
                                                      Ms Clodagh Henehan
Finance and General Purposes                          Clinical Risk Manager

Committee                                             Ms Paula Reid
                                                      Ms Catherine Hayes
Mr Niall Doyle                                        Mr Eugene Murphy (Until June)
Dr Michael Robson (Master)
Mr J. Brian Davy (Deputy Chairman)
Mr Gabriel Hogan (Honorary Secretary)
Mr Frank Downey (Honorary Treasurer)
Mrs Kathleen O’Grady

Some members of Medical Staff




                                                                                                                  15
     The National Maternity Hospital, Holles Street Annual Report 2006




     Professional Advisors                                    Resident and Visting Medical
                                                              Staff
     Law Advisors                                             Master
     Beauchamps Solicitors, Dollard House, Wellington Quay,
                                                              Dr. Michael Robson, F.R.C.S., M.R.C.O.G., F.R.C.P.I.
     Dublin 2.

                                                              Department of Obstetrics and Gynaecology
     Bankers                                                  Dr Peter Boylan, M.A.O., F.R.C.P.I., F.R.C.O.G.
     The Bank of Ireland, 2 College Green, Dublin 2           Dr Stephen Carroll, M.D., M.R.C.O.G., M.R.C.P.I.
                                                              Dr Grainne Flannelly, M.D., M.R.C.O.G., M.R.C.P.I.
     Auditors                                                 Dr Michael Foley, M.A.O., F.R.C.P.I., F.R.C.O.G.
     Price Waterhouse Coopers. Chartered Accountants,         Dr Declan Keane, M.D., F.R.C.P.I, F.R.C.O.G.
     George’s Quay, Dublin 2.                                 Dr Peter Lenehan, F.R.C.P.I., F.R.C.S.I., M.R.C.O.G.
                                                              Dr Peter McParland, M.D., M.R.C.O.G., M.R.C.P.I.
                                                              Dr John Murphy, M.D., F.R.C.P.I., F.R.C.O.G.
                                                              Dr Orla Sheil, M.D., F.R.C.O.G., F.R.C.P.I.
                                                              Dr Mary Wingfield, M.D., M.R.C.O.G.


                                                              Department of Obstetrics and Gynaecology, University College
                                                              Dublin
                                                              Professor Colm O’Herlihy, M.D., F.R.C.P.I., F.R.C.O.G.,
                                                              F.R.A.C.O.G.
                                                              Professor Fionnuala McAuliffe, M.D, M.R.C.O.G., M.R.C.P.I.,
                                                              D.C.H.


                                                              Department of Obstetrics and Gynaecology, Royal College of
                                                              Surgeons
                                                              Professor Dermot MacDonald, M.B., M.A.O., F.R.C.O.G.,
                                                              F.R.C.P.I., F.A.C.O.G. (Hon).


                                                              Department of Pathology and Laboratory Medicine
                                                              Director: Dr Eoghan Mooney, M.B., M.R.C.P.I., M.R.C.Path.
                                                              Dr Peter Kelehan, MSc., F.R.C. Path.
                                                              Dr David Gibbons, F.C.A.P.,
                                                              Dr Karen Murphy, M.R.C.P.I., M.R.C.Path. (Haematology)
                                                              Dr Susan Knowles, M.D., M.R.C.Path., D.C.H. (Microbiology)


                                                              Department of Paediatrics and Neonatology
                                                              Director: Dr John F. Murphy, M.R.C.P.I.
                                                              Dr Anne Twomey, M.D., M.R.C.P.I., F.A.A.P
                                                              Dr Eleanor Molloy, MB, BCh, B.A.O., Ph.D, F.R.C.P.I., M.R.C.P.,
                                                              M.R.C.P.C.H.
                                                              Dr Colm O’Donnell, MB BCh, B.A.O., M.R.C.P.I., D.C.H.,
                                                              M.R.C.P.C.H., F.R.A.C.P., Ph.D.

16
                                         Professional Advisors/Resident and Visiting Medical Staff/
                                                                        Honorary Consulting Staff


Department of Anaesthetics
                                                                         Honorary Consulting Staff
Director: Dr Kevin T. McKeating, F.F.A.R.C.S.I.
Dr Breda O’Kelly, F.F.A.R.C.S.I., A.E.A., D.C.H., S.E.S.S. (Paris VII)   Physician
Dr Ingrid Browne, F.F.A.R.C.S.I.                                         Professor Muiris X. Fitzgerald, M.D., F.R.C.P.I., F.R.C.P.
Dr. Ola P. Rosaeg, M.B., FRCPC
                                                                         Surgeons
Respiratory Physician                                                    Mr Enda McDermott, M.Ch., F.R.C.S.I.
Dr Walter McNicholas, M.D., F.R.C.P.I., F.R.C.P. (C), F.C.C.P.           Professor Raymond J. Fitzgerald, F.R.C.S., F.R.C.S.I., F.R.A.C.S.
                                                                         (Paed. Surg.)
Cardiovascular Medicine                                                  Mr Martin Corbally, F.R.C.S.I., F.R.C.S. (Paed. Surg.)
Dr Desmond Fitzgerald, F.R.C.P.I.                                        Mr F. Quinn, F.R.C.S.I.

Psychiatrist                                                             Oto-Rhino-Laryngologist
Dr Anthony McCarthy M.R.C.P.I., M.R.C.Psych.                             Mr Alex Blayney, F.R.C.S., F.R.C.S.I.

Diabetic Physician/Endocrinologist
                                                                         Urological Surgeons
Dr Richard Firth, BSc., F.R.C.P.I., D.A.B.I.M. (Endo-Metab.)
                                                                         Mr David Mulvin, F.R.C.S.I.
Dr Brendan Kinsley, M.B., M.R.C.P.I.
                                                                         Mr David Quinlan, F.R.C.S.I.

Opthalmologist
                                                                         Consultant in Genitourinary Medicine
Dr Michael O’Keeffe, F.R.C.S.E.
                                                                         Dr Fiona Mulcahy, M.D., F.R.C.P.I.

Reproductive Endocrinologist
                                                                         Gastroenterologist
Professor David A. Powell, M.D., F.R.C.P.I.
                                                                         Dr John Crowe, Ph.D., F.R.C.P.I.

Physician in Chemotherapeutic Medicine
Dr David Fennelly, M.R.C.P.I.                                            Orthopaedic Surgeon
                                                                         Mr Frank McManus, F.R.C.P.I. (Retired in June 2006)
Department of Radiology                                                  Mr Damian McCormack, BSc, MCh, Orth.
Dr Brigid V. Donoghue, D.M.R.D. (London), F.R.C.R.
Dr Risteard O’Laoide, F.R.C.R.                                           Dermatologist
                                                                         Dr Frank Powell, F.R.C.P.I., F.R.C.P. Edin.
Renal/Metabolic Physician
Dr Alan Watson, M.D., F.R.C.P.I., F.A.C.P., F.R.C.P.                     Radiotherapist
                                                                         Dr Michael Moriarty, M.D., F.R.C.P.I., F.R.C.R.


                                                                         Paediatric Cardiologists
                                                                         Dr Desmond F. Duff, F.R.C.P.I., F.A.A.P., D.C.H.
                                                                         Dr Paul Oslizlok, F.R.C.P.I., D.C.H.
                                                                         Dr Colin McMahon, M.B, B.A.O, B.Ch, D.C.H., M.R.C.P.I,
                                                                         M.R.C.P. (UK), F.A.A.P.
                                                                         Dr David Coleman, M.B., Ch.B., D.C.H., F.R.A.C.P.


                                                                         General and Colorectol
                                                                         Dr P. Ronan O’Connell, M.D., F.R.C.S.I.

                                                                                                                                             17
     The National Maternity Hospital, Holles Street Annual Report 2006



     Paediatric Neurologists
                                                                          Senior Midwifery and Nursing
     Professor J. McMenamin, F.R.C.P.I.                                   Staff
     Dr Bryan Lynch, F.A.A.P.
                                                                          Director of Midwifery & Nursing (until March)
     Dr David Webb M.D., M.R.C.P.I., F.R.C.P.C.H.
                                                                          Mary Boyd, MA, Public Management, R.G.N., R.M., Dip F.P.
                                                                          HDipQ
     Neurologists
     Dr Conor O’Brien M.B., MSc., Ph.D., C.S.C.N. (Emg), F.R.C.P.I.       Director of Midwifery & Nursing (commenced April )
     Dr Janice Redmond, M.T., M.D., F.R.C.P.I., F.A.C.P., D.A.B. Psych.   Mary Brosnan MSc., R.G.N., R.M.,
     Neuro., D.A.B. Elec-Diag.Med.
                                                                          Assistant Directors of Midwifery & Nursing

     Paediatric Infectious Diseases                                       Nicola Clarke, MSc., R.S.C.N., R.G.N., R.M., IBCLC, FFNM RCSI
                                                                          Mary F. Moore, R.G.N., R.M. Dip Mgmt, HDip, H.C. Risk Mgmt,
     Dr Karina Butler, F.R.C.P.I.
                                                                          Rosa Mugan, R.S.C.N., R.G.N., R.M. Dip Social / Behavioural
                                                                          Science.
     Infectious Diseases
                                                                          Mary Purcell, R.G.N., R.M., FFNM RCSI
     Dr Colm Bergin F.R.C.P.I, M.R.C.P. (UK)
                                                                          Assistant Directors of Midwifery & Nursing – Night Duty
     Clinical Geneticist                                                  Josephine Reilly-Griffin, R.G.N., R.M. Dip Mgmt.
     Dr William Reardon, M.D., D.C.H., M.R.C.P.I., F.R.C.P.C.H.,          Martina Carden, R.G.N., R.M. Dip Mgmt.
     F.R.C.P., (London)                                                   Bernadette O’Brien, R.G.N, R.M. BMS (Hons)


                                                                          Assistant Director of Midwifery & Nursing – Neonatal Clinical
                                                                          Practice Development Coordinator
                                                                          Geraldine Duffy, BSc.(Hons), R.G.N., R.M., RNC, ANNP(UKCC)

     Community Midwifery Team




18
                              Honorary Consulting Staff/Senior Midwifery and Nursing Staff



Principal Midwifery Tutor                                         Niamh Dougan, R.G.N., R.M.                         Delivery Unit
Cora McComish, MTD, R.G.N., R.M. (retired September)              Tina Murphy, R.G.N., R.M. BSc. Nursing (Hons)      Delivery Unit
                                                                  Martina Cronin, R.G.N., R.M., BSc. Nursing Mgmt
Midwifery Tutors                                                   (Hons)                                            Delivery Unit
Sandra Atkinson, MSc., BNS, R.G.N., R.M., RNT                     Laurence Rousseill, R.G.N., R.M., BSc. Midwifery
Gertie Cull, R.G.N., R.M., FFNM RCSI (retired October)             (Hons)                                            Delivery Unit
Patricia Feeney, ,R.G.N, R.M., A075E.NB (HDU)                     Gillian Santry, R.G.N., R.M., BSc. Nursing Mgmt
Barbara Lloyd, MSc., R.G.N., R.M., HDip, BSc., RNT                 (Hons)                                            Delivery Unit
Anne McMahon, MA, M. PHIL., HDipEd, R.G.N., R.S.C.N, R.M.,        Breid O’Dea, R.G.N., R.M.
ADM, RNT                                                          Gynaecological Clinic
Denise O’Brien MSc. Midwifery Education, R.G.N., R.M., BNS,       Clare O’Dwyer, R.G.N., R.M., H Dip. HC             Delivery Unit
RNT                                                                 Risk Mgt
                                                                  Mary O’Connor, R.G.N., R.M.                        Unit 10
Clinical Instructor (Neonatology)                                 Marie O’Neill, B.A., R.P.N., R.G.N., R.M.,
Clare McCormick, R.G.N., R.M. BSc.N.                               HDip H.C. Risk Mgmt                               Unit 5
                                                                  Ciara Macken, R.G.N., R.M.                         Recovery
Clinical Midwife / Nurse Managers 3                               Maggie Bree, R.G.N., R.M.                          Theatre
Mary Moran, MA Healthcare Mgmt, R.G.N., R.M., HDDI, HDip          Karen Sherlock, R.G.N., R.M.                       Theatre
Public Admin.                                                     Breda Coronella, R.G.N., R.M.                      Unit 8
Mairead Hever, R.G.N.                                             Phyllis Doughty, R.S.C.N. R.G.N., R.M.             Unit 8
Ann Rath, R.G.N., R.M. BSc. Nursing Mgmt (Hons)                   Rachel Irwin, BSc. N.Mgt. R.G.N, R.M.              Unit 8
Margaret Hanahoe, R.G.N., R.M.                                    Sara Duff Rock, R.G.N., R.M.                       Unit 8
Hilda Wall, R.G.N., R.M. Dip Healthcare Management                Florrie Fee, R.G.N., R.M.                          Unit 8
Geraldine McGuire, R.G.N., R.M, Dip Nursing Mgmt.                 Maria O’Connell, R.G.N., R.M.                      Unit 8
                                                                  Joan Ward, R.G.N., R.M., IBCLC                     Unit 9
Clinical Midwife / Nurse Managers 2                               Caroline Brophy, R.G.N., R.M., BNS (Hons)          Unit 7
Myra Radcliff, R.G.N., R.M.                      Outpatients      Michaela Kinnear, R.G.N, R.M                       Unit 4
                                                 Department
Aileen Fox, R.G.N, R.M                           Early Transfer   Clinical Midwife/Nurse Specialists
                                                 Home Team        Mary Coffey, MSc., R.G.N., R.M., H.Dip.
Ann Fleming, R.G.N., R.M., HDDI                                   (CMS - Diabetes)
 (until May 06)                                  Fetal            Mary Jacob, MSc., BSc (Hons), R.G.N., RCN R.M., FFNM RCSI
                                                 Assessment       (CMS - Urodynamics)
Valerie Kinsella, R.G.N., R.M., HDDI             Fetal            Cecilia Mulcahy R.G.N., R.M., MSc. Diag. Imaging
                                                 Assessment       (CMS - Sonography)
Elizabeth Murphy, R.G.N., R.M., HDDI             Fetal            Teresa Sexton, R.G.N., R.M., HDip Infection Control, DipMgmt.
                                                 Assessment       (CMS - Infection Control)
Clare O’Rourke, R.G.N, R.M, HDDI                 Fetal            Imelda Keane, R.G.N, B.N.S., Dip Shww
                                                 Assessment       (CNS - Occupational Health)
Mary J. O’Brien, R.G.N., R.M., RSCN              Unit 9           Bridget O’Brien R.G.N., R.M., HDip Neonatal Studies
Mary Byrne, R.G.N., R.M. Dip Mgmt.               Merrion Wing     (CMS - Neonatal Resuscitation Officer)
Margaret Fanagan, R.G.N., R.M., Dip HA, IBCLC Antenatal           Caroline McCafferty, R.G.N., R.S.C.N., BSc. Nursing
                                                 Education        Management (CNS - Neonatal)
K O’Sullivan R.G.N., R.M., IBCLC                 Antenatal        Lorraine O’Hagan, BSc. Midwifery (Hons) R.G.N., R.M., Dip in
                                                 Education        Social Studies I.B.C.L.C. (CMS - Lactation)
Ann Calnan, R.G.N., R.M. BSc. Nursing Mgmt                        Helen Walsh, BSc. Nursing, R.G.N., ANNP.
 (Hons)                                          Unit 3           (CMS – Neonatology)

                                                                                                                                     19
     The National Maternity Hospital, Holles Street Annual Report 2006



     Community Midwives
                                                                      Paramedical Staff
     Coordinator: Margaret Hanahoe R.G.N., R.M., DipMgt
     Kate Casey, R.G.N., R.M.                                         Chief Medical Scientists
     Niamh Cummins, R.G.N, R.M.                                       Ms Marie Culliton, M.Sc., M.B.A., F.A.M.L.S.
     Orla Foley, R.G.N., R.M.                                         Ms Maggie Walsh. F.A.M.L.S.
     Julie Higgins, R.G.N., R.M.
     Clodagh Manning, R.G.N., R.M.                                    Specialist Medical Scientist
     Róisín McCormack, R.G.N., R.M.                                   Mr Joseph Byrne F.A.M.L.S.
     Teresa McCreery, R.G.N., R.M.
     Niamh Morrissey, R.G.N., R.M.                                    Senior Biochemist
     Beirne O’Callaghan, R.G.N, R.M.                                  Mr Austin Bourke, B.Sc.
     Fiona Roarty, R.G.N., R.M., P.H.N.
     Ann Marie Sliney, R.G.N, R.M                                     Senior Medical Scientists
     Sinead Thompson, R.G.N., R.M.                                    Mr Michele Amoruso, A.I.B.M.S., M.A.M.A.L.S.
                                                                      Mr Ray Collins M.A.M.L.S
     Haemovigilance Officer
                                                                      Ms Deirdre Fagan, F.A.M.L.S.
     Bridget Carew, R.G.N., R.M., HDip. Healthcare Risk Mgt., HDip.
     Quality in Healthcare                                            Mr Luke MacKeogh F.A.M.L.S.
                                                                      Ms Meriel Matheson M.A.M.L.S
     Clinical Skills Facilitator                                      Ms Eilish Reynolds M.A.M.L.S
     Lucille Sheehy, B.M.S, R.G.N, HDip R.M
                                                                      Pharmacists
     Nurse Colposcopist
                                                                      Dorothy McCormack, BSc. Pharm, M.P.S.I.
     Elaine Fahy, R.G.N. HDip Onc.
                                                                      Christina Lynham, BSc. Pharm, M.P.S.I.
                                                                      Aine Toher, BSc. Pharm, M.P.S.I
     Cancer Nurse Co-Ordinator
     Helen Frances Craig, R.G.N Onc.
                                                                      Clinical Pharmacist
     Clinical Placement Co-Ordinators                                 Noreen O’Callaghan, BSc. Pharm, M.P.S.I.
     Ann Marie Dunne, MSc. (Edu)., NICU, Grad Dip, R.G.N., R.M.
     Orla Gavigan, B.M.S. (Hons), R.G.N, R.M., DipMgmt,               Medical Social Workers:
                                                                      Loretto Reilly, Head Medical Social Worker, B.Soc.Sc., C.Q.S.W.
     Allocations Liaison Officer
                                                                      Áine Egan, Senior Practitioner, B.S.S., N.Q.S.W.
     Caitriona Cullen, R.G.N., R.M.
                                                                      Jane Farmer, B.S.S., C.Q.S.W., MSc. Applied Soc. Studies
                                                                      Laura Harrington, B.A., H.Dip Sp., N.Q.S.W.


                                                                      Radiographers
                                                                      Mary Corkery, D.C.R.
                                                                      Clara Nolan, D.C.R.
                                                                      Bernadette Ryan, D.C.R.


                                                                      Physiotherapists
                                                                      Judith Nalty, Physiotherapy Manager, BSc. (Physio), M.I.S.C.P
                                                                      Lesley-Anne Ross MSc. (Physio), M.I.S.C.P.
                                                                      Helen Power, BSc. (Physio), M.I.S.C.P


20
                                                Senior Midwifery and Nursing Staff/Paramedical Staff/
                                                                        Senior Administration Staff


Sue Cao, BSc. (Physio), M.I.S.C.P (until January)
                                                                Senior Administration Staff
Jo Egan, BSc. (Physio), M.I.S.C.P (from July)
                                                                Secretary Manager
Psychosexual Counsellor                                         Michael Lenihan Dip. H.A.
Meg Fitzgerald, B.Soc.Sc., M.S.W., N.Q.S.W., Dip P.S.T
                                                                Financial Controller
Dietician                                                       Ronan Gavin B.B.S. (Hons), ACA
Roberta McCarthy, BSc./DipHumNut&Diet, MINDI
Sinead Curran, BSc./DipHumNut&Diet, MINDI                       IT Manager
                                                                Ann O’Connor
Clinical Risk Manager
Grainne McCarthy H.Dip. Healthcare Risk Management (until       Human Resources Manager
May)                                                            Lauri Cryan, MSc., MCIPD
Joan Heffernan R.S.C.N., R.G.N, H.Dip. Quality in Healthcare,
H.Dip. Healthcare Risk Mgt.                                     General Services Manager
Geraldine Smith, R.N., R.M., M.B.A., C.P.H.Q. (until April)     Tony Thompson, Dip.HSM, Dip. SCM
Angela Gargan, BSc. Nursing, R.G.N, Dip. Health & Safety
Welfare, Dip. Nursing Mgt. (from Oct)                           Purchasing and Supplies Manager
                                                                Gerry Adams Dip.BM, CPPB, MIIPMM


                                                                Facilities Engineering Manager
                                                                Neil Farrington


                                                                Patient Services Manager
                                                                Sheila Broughan, Dip. H.A.


                                                                Information Officer
                                                                Fionnuala Byrne, MSc., B.A. (Mod) I.C.T.


                                                                Quality/Accreditation Manager
                                                                Ann Delany R.G.N, R.M., M.B.A. (Healthcare Mgt)




                                                                                                                  21
     The National Maternity Hospital, Holles Street Annual Report 2006




     Medical and Midwifery Reports                                        Infection is a major issue in Neonatology. It is an important
                                                                          cause of preventable morbidity and mortality among newborn
     Neonatal Department
                                                                          babies. Perinatal infection is quite unique in that it can make a
     In 2006, there were a total of 1241 admissions (including            previously well baby extremely sick in a matter of hours. In
     readmissions) to the Neonatal Unit.There were 116 infants
                                                                          2006, a new area called Unit 8A was commissioned.This
     weighing less than 1500g. Eighteen infants died.The total
                                                                          separate area allows infected infants to be isolated from non-
     number of bed days used was 10,482, with an overall average
                                                                          infected infants. This is an important measure in helping to
     length of stay of 8.7 days.
                                                                          control the spread of infection from one infant to another.
                                                                          During the year, 47 infants were treated for bacterial sepsis.
     Neonatology is a very procedure related speciality particularly
     in the case of the sick preterm infant. A hospital activity
                                                                          The admission of sick infants from other hospitals is an
     analysis carried out at the National Maternity Hospital in late
                                                                          important activity of the Unit. The transfer of these infants to
     2005 as part of a ‘hospital at night project’ showed that in
                                                                          Holles Street is facilitated by the availability of the Neonatal
     Neonatology, 92% of medical calls resulted in a procedure
                                                                          Transport Service (NTS). In 2006, a total of 54 infants
     being carried out. Activity remains high until 1am, after which it
                                                                          requiring intensive care were transferred to Holles Street from
     falls off. Activity increases again at 6am. The actual pattern of
                                                                          other neonatal units.
     recorded activity being: 8am-4pm 48%, 4pm-12mn 48%,
     12mn-8am 9%.
                                                                          In July 2006 Dr Colm O’Donnell joined the permanent staff as

     Providing support for infants with respiratory problems is the       a consultant Neonatologist. A UCD graduate, Colm returned
     cornerstone of what we do. A total of 161 admissions                 from Melbourne where he has trained in neonatology.
     required assisted ventilation and/or CPAP. One hundred and
     five infants were administered surfactant.Thirty three infants       The Unit continued its commitment to research and training
     developed pneumothoraces.The two commonly encountered                with the appointment of two research registrars for a period
     conditions were Respiratory Distress Syndrome (134 infants)          of two years. Both doctors are pursuing MD theses.
     and Transient Tachypnoea (TTN) (177 infants). The increased
     numbers of infants with TTN is related to the higher                 I’m grateful to all the staff who have done so much over the
     caesarean section rate.                                              past year to get through the large volume of work. In
                                                                          particular I want to thank my fellow medical colleagues, Hilda
     Patent Ductus Arteriosus (PDA) is another common problem.            Wall, Geraldine Duffy and their nursing staff, pharmacy,
     During the year, 48 infants developed a PDA. The ability to
                                                                          physiotherapy, radiology and dietetics.
     diagnosis the condition accurately has been helped by the
     greater availability of echocardiography.The infants were
                                                                          Dr. JFA Murphy
     managed in a number of ways depending on the degree of
                                                                          Director
     severity. Among the 48 infants- 6 were treated surgically, 23
     were treated medically and 19 did not require treatment.             Department of Neonatology




22
                                                                                Medical and Midwifery Reports



Neonatal Resuscitation                                              Audit and Research
The role of the Clinical Midwife Specialist (CMS) in Neonatal       The CMS continues to review neonatal care literature and to
Resuscitation ensures that the service continues to improve         develop protocols and guidelines in areas including Incubator
the quality of care for the Neonate and Parents.The Neonatal        Humidity and Neonatal Intubation.The CMS is the link person
Resuscitation service continues to develop through education,       for the Multicentre Heat Loss Prevention Trial (Polyethylene
research and communication in order to provide a high               Occlusive Wrap) and has been involved in the enrolment of
standard of care.                                                   five infants in this trial.


Education and Training                                              The CMS coordinated the Neonatal Services of two cases of
The Neonatal Resuscitation Providers program course (NRP)           Caesarean Section for Maternal Reasons in St.Vincent’s
continues to be provided on a monthly basis for the                 Hospital and Beaumont Hospital with a safe outcome for the
midwifery, nursing and paediatric staff working in the Neonatal     mothers and babies.
Unit, Delivery Unit and Theatre. Orientation and training
sessions are provided for new paediatric staff during their         New Developments for 2007
initial phase of attending Neonatal Resuscitation in the            The CMS will be involved next year in an education
Delivery Unit and Theatre.The CMS also attends high risk            programme for neonatal staff.
deliveries. Informal training sessions are provided for Midwifery   Baby Cardio Resuscitation service will be expanded to provide
and Nursing staff.The 5th Edition Textbook on Neonatal              training to parents of infants <34 weeks gestation.
Resuscitation Programme was launched in September; this
introduced the use of the Neopuff, Oxygen Blenders,                 The CMS in Neonatal Resuscitation would like to take this
Saturation Monitors and the use of Occlusive Wrap for               opportunity to thank the Midwifery/Nursing, Medical,
Premature infants. Reviewing research and evidence-based            Paramedical and Ancillary Staff for all their support throughout
best practice changes had already been incorporated into our        the year.
care of the infant during Neonatal Resuscitation.
                                                                    Brid O’Brien
Complementing the NRP course is the education and training          CMS – Neonatal Resuscitation
in resuscitation of the Infant on the Postnatal Unit that
continues to be provided at the Mandatory In-service Study
Day for Midwives and Nurses working in this area. Intubation
equipment will be provided in 2007 for all Neonatal
Resuscitation areas in the Postnatal Units.


Baby Cardio Resuscitation prior to discharge home from the
Neonatal Unit continues to be taught to parents of infants
who are <1.5kg, have required ventilator support, have a
history of Apnoeic Episodes or Sudden Infant Death
Syndrome within the family or by parental request. An audit
on the response of parents to this programme will be
conducted next year.


Education and Training Breakdown
Midwifery/Nursing Staff: 44
Paediatric Staff: 14
Postnatal Resuscitation for Midwifery/Nursing Staff: 88
Baby C.P.R. given to Parents: 61


                                                                                                                                       23
     The National Maternity Hospital, Holles Street Annual Report 2006



     Neonatal Liaison Service                                            for neonates.The CNS is involved in teaching structured and
     The Neonatal Clinical Nurse Specialist (CNS) continues to           impromptu sessions with Midwifery/Nursing staff and
     ensure effective community liaison and discharge planning of        Midwifery students in Neonatal Unit.The CNS also continues
     babies from the Neonatal Unit; by improving overall discharge       to update new Neonatal Nursing and Medical staff on an
     planning, the care and education to parents and their babies in     ongoing basis.
     the Neonatal Unit is improved.These babies require extensive
     input from the CNS; liaising with other staff members,              The CNS contributes to the following hospital committees-
     parents/carers, other referral centres and local services in the    Neonatology Accreditation Team,
     community. Parents are met on a daily basis in the Neonatal         Baby Friendly Hospital Initiative Committee, Hospital
     Unit or by telephone until discharge. Follow up via telephone       Community Network, Joint NMH/UCD Research Network,
     is continued for a period of time.                                  General Practitioner Liaison Committee.

                                                                         Research Involvement
     The Neonatal Liaison Service is provided to preterm Infants
                                                                         The CNS keeps abreast of new developments in Neonatal
     <1.5 kgs or <32 weeks Gestation and infants with: Neonatal
                                                                         Care through published specialist neonatal care literature and
     Abstinence Syndrome, a long term illness, a life limiting
                                                                         disseminates this knowledge to other nursing staff.The CNS
     condition, neurological problems, complex social
                                                                         applies the significance and implications of the research
     circumstances, congenital anomalies, palliative care
                                                                         findings for patient care through developing new protocols
     requirements and those discharged home on tube feeding,
                                                                         including intra-gastric tube feeding in the Neonatal Intensive
     oxygen or a suction machine.
                                                                         Care Unit and with Discharge and Discharge planning.

     Training and Education
                                                                         Audit of Activities
     All parents receive information on car safety, positioning,
                                                                         Total Discharges Neonatal Unit: 1230
     bathing, and preparing formula feeds.
                                                                         Discharges CNS extensively involved in: 195 (16%)
     Other issues discussed with parents include safety at home
                                                                         Phone Contacts post discharge: 410
     and advice on feeding. Individualised training sessions are given
                                                                         Discharged home on nasogastric tube feeding: 5
     to parents whose babies are discharged home on medications,
     tube feeding or with a suction machine.
                                                                         Phone calls to the Neonatal Unit, Baby Clinic and Out of
     The CNS attends a number of meetings and conferences on             Hours service were audited for three months to ascertain
     the subject of Neonates and continues to act as a resource          parental concerns.The result of this audit raised awareness of




24
                                                                             Medical and Midwifery Reports



the information that parents require prior to discharge home      Breastfeeding Support Services
and the consistency of the information given.                     Breastfeeding Support Services continue to develop; the drop
                                                                  in clinic on Friday mornings is well attended and the service is
The new Public Health Nurse referral forms in the Neonatal        now extended to the baby clinic during the week. We
Unit were evaluated and the feedback given was positive.          welcome all mothers to avail of the service before and after
Parent questionnaires were distributed over a 3 month period      the birth of their babies with infant feeding concerns.
to evaluate the service provided by this post; 92% returned
                                                                  Education for staff continues with 260 hours of education
‘Excellent’ and the remaining 8% felt the service was ‘Good’.
                                                                  commitments completed in 2006.Tutorials are given to various
                                                                  staff groups; these range from short orientation sessions given
Community Projects
                                                                  to most staff, to the 3 day Breastfeeding Management Course
A new relationship with the other Maternity and Paediatric
                                                                  for all midwives, nurses and local Public Health Nurses.This
Hospitals in Dublin called The Neonatal Nursing Inter-hospital    year we facilitated three 20 hour breastfeeding management
Group was established in July 2006 to improve communication       courses for new staff and Public Health Nurses.There was
and compare practices thus improving patient care in this area.   also a one day refresher course for experienced midwifery
                                                                  staff and a one day course for nursing/midwifery staff in the
The CNS continues to work with The Road Safety Authority          Special Care Baby Unit focusing on breastfeeding the ill and
to produce a leaflet for parents on car safety for premature      premature baby.
infants.
                                                                  The Antenatal drop-in breastfeeding class held monthly in the
New Developments for 2007                                         antenatal education department continues to be well
                                                                  attended. It provides pregnant women with the opportunity to
The establishment of a post discharge parent support group
                                                                  meet with the breastfeeding support staff and facilitates a
for the neonatal unit will be addressed.The CNS will also be
                                                                  group discussion on management of breastfeeding in particular
involved in an educational programme for Neonatal Staff.
                                                                  on the first 14 days following delivery while breastfeeding is
                                                                  being established.
Thanks to the Midwifery/Nursing, Medical, Paramedical and
Ancillary Staff for all their support throughout the year.        To celebrate national breastfeeding week in October we
                                                                  hosted a reception. Many breastfeeding mothers and babies
Caroline McCafferty                                               who delivered in 2006 met with expectant mothers.
CNS - Neonatal Liaison Service                                    Representatives of La Leche League and Cuidiú also attended
                                                                  along with many midwifery staff.


                                                                  We continue to work with the Human Milk Bank in
                                                                  Fermanagh by providing a freezer facility for storing breast
                                                                  milk that has being donated to the Human Milk Bank.This
                                                                  programme has been very successful, with the Human Milk
                                                                  Bank facilitating the collection on a regular basis of frozen
                                                                  breast milk.


                                                                  Plans for 2007 include introducing an appointment system at
                                                                  the breastfeeding clinic and extending it to include Monday
                                                                  and Wednesday morning as well as Friday morning.
                                                                  Educationally, we plan to facilitate four refresher courses for
                                                                  experienced staff and four courses for unit 8 staff along with
                                                                  two 20 hour breastfeeding management courses for new
                                                                  midwifery and nursing staff to the hospital.

                                                                                                                                     25
     The National Maternity Hospital, Holles Street Annual Report 2006



                                   As the Breastfeeding Support Services continue to expand and develop
                                            so too do the activity levels as is evident from the table.

      Audit Of Patient Consultations

                                                            2006*          2005          2004             2003        2002          2001
      Total Consultations (Clinics/Wards)                    1655          1741          1690             1395        1029           977
      Total New Breastfeeding Clinic Referrals                394            253          240              166         162           191
      Total return visits                                     124             80            75              40          41            37
      Total phone contacts                                   1807          1824          2080             1670        1467          1143
      Follow-up complex cases                                  50             50            70              48           46           41


      Clinic Case Load Reviews
      General breastfeeding support                           193             63            28              16            9             2
      Weight issues                                           195            102            77              62          46            29
      Sore nipples                                             37             18            10               8          26              1
      Sore breasts Mastitis                                    38             20            20              12            9             3
                      Thrush                                   24             30            40               3            7             1
                      Engorgement                                4             0             2               2            3


      Prematurity                                              10             11            18               8            6             0
      Jaundice                                                   7             6            12               4            6             0
      Other                                                      7             3             5               7            7             3
      Antenatal concerns                                         3             0            12               6            8
      Total                                                   518            253          240              166         162            41


     *2006 figures refer to visits not cases as in previous years


      The Breastfeeding Initiative Team met 4 times in 2006. We successfully renewed our Baby Friendly Hospital certificate of
      commitment in December 2006 following a site visit by the assessment team for the baby friendly hospital initiative.


      Hospital Breastfeeding Rates*              2006         2005           2004          2003           2002       2001         2000

      Initiation                                 61.8%        58.9%         56.6%           60%            58%        55%           54%
      Discharge (excl/partial )                  58.6%        55.6%         53.2%           55%            55%        52%           50%


     *Approximately 8% of Initiation and Discharge Breastfeeding information unknown- unknowns projected according to percentage of rates
     known. The issue of unknowns is being addressed.


     Lorraine O’Hagan
     CMS - Lactation




26
                                                                               Medical and Midwifery Reports



Community Midwives                                                Aims of the Community Midwifery Service

The community midwifery service has been established in           - To provide continuity of care and choice to low risk women
Dublin for eight years and has delivered a total of 1,861          throughout pregnancy, labour and puerperium.
women, 166 homebirths and 1693 ‘domino’ births.The long           - Provide 24-hour cover midwifery care for all women booked
awaited expansion of the Community Midwives team to                with the scheme.
North Wicklow was welcome news in 2006.The Community              - That a community midwife known to the woman conducts
Midwives and midwifery management from the hospital had            her care.
many comprehensive meetings with the local community              - To provide continuity of information in pregnancy, labour and
Public Health Nurses to get the process established.The            postnatal period.
feedback from the mothers and families availing of the service    - To provide early discharge without affecting postnatal care.
has been very positive.The relationship between the
Community Midwives and the Public Health Nurse’s is               Antenatal Care
excellent and everyone is benefiting.                             All women are encouraged to have combined care with their
                                                                  GP's. We feel this is important, as the GP will be doing the 6-
A lot of time was put into preparing a booklet and leaflet for    week postnatal check on all mothers and babies.The antenatal
the service which will be published in early 2007. Once           clinic in the Ballinteer Health Centre has continued to
published, we will carry out a recruitment drive among the        successfully look after both hospital and ‘domino’ women. We

GP’s in the North Wicklow area. We have attempted to              have a good working relationship with our community

create a uniform system of booking and discharge so that all      partners and we refer women to antenatal classes,
                                                                  physiotherapy or social worker in the Ballinteer clinic, as the
hospital reporting is similar and so all the community midwives
                                                                  need arises.The community midwives run an antenatal clinic in
can work in any area in any capacity.To assist with the
                                                                  St. Michael's Hospital in Dun Laoighaire for women requesting
introduction of this service and to also support women who
                                                                  ‘domino’ care.The hours of the clinic were extended to
are not eligible for the scheme, the Community Midwives are
                                                                  accommodate more appointments as it is proving to be an
now assisting at all community antenatal clinics in the Wicklow
                                                                  increasingly busy clinic. Women requesting hospital care can
area. Unfortunately, it is not yet envisaged to have an Early
                                                                  attend the ETH programme in St. Michaels. 870 visits were
Transfer Home (ETH) programme in the Arklow area;
                                                                  attended in our external clinics throughout this year.The team
however, the clients do get the opportunity to meet the
                                                                  had 1380 antenatal visits in the Community Midwives clinic in
Community Midwives at the antenatal clinics.
                                                                  the National Maternity Hospital. If an obstetric opinion was
                                                                  requested, women were reviewed by Dr Declan Keane in the
The recruitment process for the ‘domino’ and ETH service
                                                                  outpatient clinic. If a woman requires an urgent medical
have been made easy for the Community Midwives; the
                                                                  opinion, the registrar or assistant master on duty will review
women meet with Dr. Grainne Flannelly in the Bray clinic and
                                                                  the woman.
with Dr. Stephen Carroll the Greystones clinic. With the quick
expansion of the area, both the Consultant and the                Antenatal Classes
Community Midwives clinics become fully booked.                   The antenatal classes have continued successfully with almost
                                                                  every woman attending with their birthing partners,
The six midwives who provide the service in North Wicklow         irrespective of their choice of place of birth. One of the aims
run two midwives ‘domino’ clinics and three antenatal             of antenatal education provided by the team is to offer classes
consultant led clinics.They also provide labour ward cover and    in a small group setting to promote optimum communication
postnatal visits for both the ‘domino’ and ETH service as well    between the midwife, women and birth partners.
as recruiting women in the hospital for the ETH service.
Women are looked after by the community midwife on duty,          Transfer of Care
although women having homebirths are cared for by the             In cases of women where complications arose, the care was
Dublin team.                                                      carried out by the Community Midwives in conjunction with


                                                                                                                                    27
     The National Maternity Hospital, Holles Street Annual Report 2006



     our medical colleagues. It should be noted that the figures         Special Care Baby Unit
     presented in this report include all women irrespective of          A total of 16 babies (5.5%) were admitted to the Special Care
     pregnancy complications or outcomes.                                Baby Unit. We continue to offer these women support and
                                                                         assistance while their babies are in the unit and complete their
     Total Deliveries:               292                                 postnatal care at home.
     Caesarean Sections:             21 (7.1%)
     Instrumental                    23 (7.9%)
                                                                         Discharge
     Normal delivery:                248 (85%)
                                                                         15% of women were discharged home directly from delivery
                                                                         ward after 6-8 hours. Most mothers went home within 12
     Homebirths
                                                                         hours; many stayed overnight if delivered in the evening. Most
     2006 had the largest amount of women booking Homebirths
                                                                         of our women who had a caesarean section were discharged
     since the beginning of the scheme.The women in our care
                                                                         home on day three and were then seen by the Community
     understand and sign two consent forms for Homebirth.This
                                                                         Midwives at home.The main reason that women remained in
     includes the reasons for transfer, expected date of delivery,
                                                                         hospital was Group B strep. where women did not receive
     date of post dates scan which are some of the main
                                                                         enough antibiotics in labour. All mothers and babies were seen
     complications of homebirth.The women feel confident in the
     knowledge that transfer means they become 'domino' and are          at home for at least 5 days. Most women were visited for 7-10

     looked after by the same team of midwives whom they know.           days, especially if there experiencing problems including
                                                                         breastfeeding difficulties, painful perineum, infection, or post
                                                                         caesarian section.The PKU's and follow up care were
      Booked for Homebirth:         Primigravida                   14    completed at home by the Community Midwives.The GP's
                                    Multigravida                   31    and Public Health Nurses were all informed of booking,
                                    Total                          45    delivery and discharge. In the case of Homebirth, a small
                                                                         portion of GP's have carried out the Day 2 paediatric physical
      Delivered at home:            Primigravida                     5   check on the baby, but most infants were brought to the
                                    Multigravida                   27    hospital for this examination.
                                    Total                          32
                                                                         Breastfeeding
     Domino                                                              The initiation rate for breastfeeding is 95.5% primigravida,
     The majority of GP's in the catchment area show their               88.9% multigravida.The team actively promotes breastfeeding
     support of the service by encouraging their women to come           but respect each individual choice.The success rate for those
     to us. We have found that all of our recruits have heard about      who initiated is approximately 90%. We attribute this success
     the scheme through friends, family or work colleagues. Due to       to the self-motivation of the women and also to the
     the increasing number of women now requesting                       continued support of the midwives for long periods of time
     domino/homebirth we have had to limit our numbers which             both physically and psychologically in person and by phone.
     required us having to turn away some women who requested            The team has consistency of information, which avoids
     our service. Women that we are unable to accommodate                confusion.
     were advised to attend the ETH program.

                                                                         Future
      Delivered as Domino:                                               The postnatal support group continues to be a great success.
      Primigravida                                              108      We hope to recruit more women for the Bray domino/ETH
      (incl. 9 transferred Homebirth)                                    scheme that commenced in 2006. As we are assisting at the
      Multigravida                                              152      Arklow clinic the midwives are considering a proposal to run a
      (incl. 4 transferred Homebirths)                                   midwives clinic in tandem with Dr. Stephen Carroll. We will be
      Total Domino                                              260      starting antenatal classes in the Bray area in early 2007. We


28
                                                                                Medical and Midwifery Reports



hope to increase the staffing levels of the Early Transfer Home     Clinical Governance
programme in Dublin so more women who request the
                                                                    Clinical Governance is a framework through which healthcare
service can be facilitated. At present the clinic in Dunlaoghaire
                                                                    organisations are accountable for continuously improving the
is fully booked and if a new midwife commences a second
                                                                    quality of their services and safeguarding high standards of
clinic or booking clinic could be commence.The Community
                                                                    care, by creating an environment in which excellence in clinical
Midwives are hoping to commence a study of postnatal
                                                                    care will flourish.
women who are readmitted to the hospital.
                                                                    The key components of Clinical Governance are:
Early Transfer Home                                                 -    Clinical effectiveness by ensuring clear lines of
The Early Transfer Home (ETH) program is now in it’s fifth               responsibility for overall quality of clinical care
year and is increasing in popularity.                               -    Comprehensive programme of quality improvement
                                                                         initiatives
Early Transfer Home Total                                  801      -    Patient focus – review of all patient feedback
 Primagravida                                              34%      -    Risk management with clear guidelines aimed at managing
 Multigravida                                              66%           risk
 Home on Day 1                                             18%      -    Professional and staff development
 Home Day 3 (Caesarean Section)                            14%
                                                                    A Clinical Governance Committee was formed in the hospital
                                                                    early in 2005.This Committee was established to continuously
                                                                    monitor the quality of services and ensure high standards of
The 801 women were seen in the South Dublin Area in 2006.
                                                                    care by developing a culture of excellence.The committee
This is a 10% increase when compared to 2005.The increased
                                                                    meets weekly and the core members are the Master, Director
workload brings additional pressure on the midwives running
                                                                    of Midwifery/Nursing, Secretary Manager, Patient Services
the service and demonstrates the need for further staff to
                                                                    Manager, Clinical Risk Manager and Quality and Accreditation
maintain or increase the service.
                                                                    Manager.

Evaluation forms are distributed to all service users and result
are audited; 99% of the women responding to the evaluation
forms record the care being received as either ‘Excellent’ or
‘Good’. ETH remains the most cost effective way of managing
postnatal care while offering a superb service to women who
choose to retire home early.The Early Transfer Home
programme helps reduce the addition of extra beds to a
ward.


In the last quarter of 2006, 52 women were seen on the ETH
program in the Wicklow area.This service was introduced in
2006 and will take some time for the women and GPs of
Wicklow to understand and embrace the service.The
feedback to date from the women, their families and the
Public Health Nurses has been very positive.




                                                                                                                                       29
     The National Maternity Hospital, Holles Street Annual Report 2006



     Gynaecology Department
     During 2006 gynaecology services at the NMH continued to deliver high standards of care despite another very busy year. A wide
     range of services are offered including specialist services in colposcopy, oncology, urogynaecology, reproductive medicine and
     adolescent services. The figures for the number of attendances at the outpatient clinic speak for themselves (Table 1) with 4,465
     new patient and 6,195 return patients delivered in 1488 sessions.This included 1391 new colposcopy patients seen in 500 sessions.
     In the operating theatre there were 1,509 caesarean section operations performed as well as 534 major gynaecological procedures.

      Clinics                                        Sessions               New                   Return                       Total
                                                                                                                        Attendances

      Gynaecology                                         392               1085                    2193                        3278
      Colposcopy                                          500               1391                    2529                        3920
      Urodynamics                                          70                137                       1                         138
      Perineal                                             40                274                      84                         358
      Endometriosis                                        11                 27                      75                         102
      DES                                                   6                  6                      44                          50
      Neuro Physiology                                      4                  9                       0                           9
      Trophoblast                                          10                 26                      66                          92
      Infertility                                          39                174                     323                         497
      Miscarriage                                          19                  0                     105                         105
      Special Infertility                                  28                 67                     155                         222
      Psychiatric                                          35                 79                      94                         173
      Unbooked Gynae*                                     218                802                     111                         913
      Stillbirth Counselling                               19                  0                      28                          28
      Anaesthetic                                          51                176                       0                         176
      Adolescent                                           34                197                     349                         546
      Endocrine                                            12                 15                      38                          53
      Total Speciality                                   1488               4465                    6195                       10660

     Quality Assurance                                                  - Establishment of an IT infrastructure to facilitate audit to
     The key objective of the gynaecology team is the delivery of           evaluate outcome
     high standards of care for gynaecology patients at the NMH             •   Continued development of the mediscan colposcopy
     using the four key cornerstones of quality assurance;                      management system with the implementation of
     guidelines, training, risk management and audit. A theatre users           failsafes for data entry and risk management
     group has been established to provide ongoing management               •   Implementation of the web based regional cancer
     of issues related to policies and equipment.The colposcopy                 management system with integration with the Patient
     quality assurance group continues and during 2006                          administration system, Laboratory and colposcopy
     cooperated with the ICSP in the development of a DVD for a                 systems
     national smear taker training programme.                               •   Design and implementation of a surgical procedure
                                                                                database to incorporate an integrated module for
     In addition during 2006 the team’s focus has been                          infection control as well as the facility to generate
     - Definition of evidence based best practice for gynaecology               automated discharge letters to the community
        •   Collating evidence of best practice                                 (Designed in house by IT department)
        •   Documenting clinical pathways of care                           •   Definition of structured reports to report on activity
        •   Development of Management Guidelines for specific                   levels and waiting times for other gynaecological
            problems which are available to the team                            activities
        •   Development of integrated pathways of care (must be
            based on guideline – plan to pilot one or two in the        Dr. Grainne Flannelly
            next few months)                                            Consultant Gynaecologist

30
                        Medical and Midwifery Reports/Clinical Support Services Reports




Clinical Support Services Reports                                  classes for multigravidae and one class a month for mothers
                                                                   who have had a caesarean birth. There is a teenage class and
Antenatal Education
                                                                   a class for mothers expecting twins. Mothers and their
Childbirth education has sought to give women a more active
                                                                   partners are also taken on a one to one basis if necessary.
role in the birth experience, while at the same time helps
women to understand the physiology of childbirth and the
                                                                   We are also involved with providing post natal baby care
appropriate interventions that may be necessary during the
                                                                   classes and in the education of midwifery students, medical
process of labour and delivery. It promotes confidence in
                                                                   students and visiting midwives and registrars to the hospital.
mothers and their partners to meet the challenge of childbirth
and early parenting.
                                                                   It is important to assess the level of satisfaction with the
                                                                   preparation for labour and with their childbirth experience.
In the hospital courses of classes are run as a team effort with
                                                                   An important aspect of antenatal education is to see mothers
the specialised knowledge and skills of the midwife,
                                                                   post delivery, their feedback in imperative and very helpful to
physiotherapist and dietitian coming together to offer a
                                                                   us. Questionnaires are carried out at regular intervals.
comprehensive structured education to the mother and her
partner. Kathleen O’Sullivan and I share a midwifery post in
                                                                   Ms Margaret Fanagan
the department.
                                                                   Clinical Midwife Manager 2

There is a great demand for classes, particularly couples
                                                                   Pregnancy Yoga Classes
classes and evening classes. It is difficult to meet the demand
for evening classes with the limited number of staff. There are    Yoga is now an integral part of the antenatal education

thirteen courses running each week, eleven of which include        programme. It is now in its 7th year and going from strength
partners with two classes in the evening. In 2006, there was a     to strength. It gives women an added opportunity to prepare
total of 106 courses, with an attendance rate of 51%.              for their labour and delivery experience in a very practical and
                                                                   holistic way; it helps them to withdraw from the busy and
The course of classes consists of five classes covering all        often hectic lifestyles to focus within and observe how they
aspects of labour in detail. There are also two refresher          are feeling in both body and mind.




                                                                                                                                      31
     The National Maternity Hospital, Holles Street Annual Report 2006



     Many women come to yoga during pregnancy for the first            Clinical Engineering
     time looking for a way to stay strong and healthy.This is done    2006 was a difficult year for the Clinical Engineering service in
     in a relaxed and non-competitive way. It helps address any        the National Maternity Hospital. This was mainly prompted by
     imbalances through physical activity and mental attention.Yoga    the resignation of our Senior Engineer,Tom Murphy, early on in
     teaches women how to focus inside themselves rather than          the year.This was a great loss of experience and expertise to
                                                                       the department effectively reducing the staff by a third.This
     what is happening around them.This is achieved by proper
                                                                       loss of resource was not replaced and unfortunately required
     breath awareness focusing on the exhalation.
                                                                       that certain activities be curtailed in order to maintain our
                                                                       high standards of service to critical areas.
     Gentle stretching will counteract tiredness and tone the
     muscles without straining them, promote healthy blood flow,       Throughout 2006, the department continued it’s commitment
     combat fatigue, stabilise emotions and reduce stress. It also     to developing it’s own standard of operations.To date, the
                                                                       department is approximately 70% paperless and it is hoped to
     improves stamina for labour.
                                                                       increase this in 2007 by the use of online forms and digital
                                                                       signatures. Members of the department also took part in
     A deep relaxation and visualisation at the end of the class
                                                                       external talks and conferences; these include attendances at
     helps to develop a greater sense of strength, peace and           the highly successful infusion study day held by the Irish
     security around the whole process of giving birth.                Medicines Board, the triennial World Congress on Medical
                                                                       Physics and Biomedical Engineering, and a presentation at the
     Whatever happens during labour and delivery, even if              annual IEI Biomedical Engineering scientific seminar.
     complications arise, practising yoga throughout pregnancy is
                                                                       Clinical Engineering continued it’s support for the National
     the best way to prepare for a speedy recovery and return to
                                                                       Neonatal Transport Programme, undertaking transports to
     normal.
                                                                       various hospitals nationally when patients required nitric oxide
                                                                       therapy.
     There are 4 classes weekly, 2 lunchtime and 2 evening class.
     Each course is 6 weeks and booking is essential. Postnatally, a   The Neonatal Intensive Care Department (NICU) welcomed
     qualitative and quantitative questionnaire is sent to all         the start of Dr. Eleanor Molloy, whose interest in research
     attendees with very positive results.                             matched Clinical Engineering’s ongoing commitment to this
                                                                       area. We set up a study into the efficacy of Neopuff
                                                                       resuscitation, which is still on-going. We also continued our
     I believe yoga reveals the transformative powers of pregnancy
                                                                       support for the new SPR research posts in their projects.
     and is the catalyst by which we build a firmer, happier and       Due to the extensive use of cutting edge medical technologies
     healthier future for our children- ‘from within’.                 in these projects, Clinical Engineering plays a vital role in the
                                                                       setup, support, data collection and data evaluation.
     Carmel Flaherty
     Midwife/ Yoga Instructor                                          There is an increasing need for broadening the Clinical
                                                                       Engineering service within the hospital. Unfortunately, it has
                                                                       become increasingly difficult to support all those areas that
                                                                       require assistance and expertise, outside of the core Clinical
                                                                       Engineering duties, due to the chronic staff situation. It has long
                                                                       been identified that there is a significant need for augmenting
                                                                       the department’s staff numbers; this is essential in order to
                                                                       better provide services and in particular to meet IMB
                                                                       guidelines with particular respect to staff training. It is hoped
                                                                       that this will be addressed in 2007 and that we may see the
                                                                       department return to a more normal level of operation.

                                                                       Karl Bergin
                                                                       Clinical Engineering Manager

32
                                                                            Clinical Support Services Reports



Department of Clinical Nutrition and                                The Autumn/Winter Meeting of the Neonatal Nutrition
Dietetics                                                           Interest Group of the UK and Ireland took place at the NMH.

The Department of Clinical Nutrition and Dietetics consists of      This was the first time the meeting was held outside the UK
                                                                    and was very well attended by dietitians from both the UK
2 dietetic specialities:
                                                                    and Ireland.
Part-time (0.7WTE) senior dietitian (Sinéad Curran)
specialising in women’s health.
                                                                    An article on infant nutrition was prepared for Maternity
Full-time (1.0WTE) senior dietitian (Roberta McCarthy)
specialising in neonatal nutrition.                                 Magazine on behalf of the NMH.


Neonatal Nutrition and Dietetics                                    Women’s Health
This post is linked to the Neonatal Unit.The service is             The service is part time, delivered over 24 hours on
available for any baby attending the hospital as an inpatient or    Wednesday,Thursday and Friday only.There is no dietetic
outpatient for whom there is a concern regarding nutrition.         cover on Mondays or Tuesdays.The decision was taken to
The majority of babies seen were those born preterm, in             withdraw from active participation in various hospital
particular those less than 2kg (n = 192). However, the main         committees due to prioritisation of the clinical workload.
focus was for babies born less than 1.5kg (n = 97).These            Locum cover in 2006 was provided by Pauline Gibney and
babies often require intensive nutritional input including both     Rita O’Carroll.
parenteral and enteral nutrition support and regular growth
monitoring.


The total number of patient contacts was as follows:

                              New                 Review

     Inpatient:                343                3769
     Outpatient:               41                 391


Input involved liaising with other members of the Neonatal
Multi-disciplinary team, parents / carers, other referral centres
and local services etc.


A computerised Parenteral Nutrition (PN) program was
developed during the year which facilitated more efficient PN
ordering and recording. In October, the contract for Neonatal
PN compounding was awarded to an Irish based company
which has resulted in an improved PN service.
                                                                    Antenatal Education

Evidence-based guidelines for best practice were reviewed and       The dietitian is involved in 2 multidisciplinary antenatal classes.
developed including revised enteral feeding guidelines.             At the ‘Early Pregnancy Class’, held every Wednesday
                                                                    lunchtime, first-time parents are given advice on good nutrition
Efforts continued to be made to encourage increased use of          for a healthy pregnancy, as well as information from the
breast milk for preterm / VLBW babies and this is reflected in      physiotherapist and the Antenatal Education midwife.The
an increase to 73% in the number of babies £1.5kg who               ‘Video’ class, held on the first Thursday of every month,
received breast milk in the Neonatal Unit (according to             addresses late pregnancy issues, breastfeeding, early infant
dietetic records).                                                  nutrition and weaning.

                                                                                                                                          33
     The National Maternity Hospital, Holles Street Annual Report 2006



     General Obstetrics                                                  Neonatal Nutrition - British Dietetic Association Advanced
     Women were seen by the dietitian antenatally for assessment         Neonatal Nutrition Course, London, Mar 2006 (RMC)
     and advice for a wide variety of reasons including excessive        Vitamin D Supplementation in Pregnancy and in Neonates -
     weight gain, hyperemesis and anaemia. Outpatients are seen at       Clinicopath Conference, National Maternity Hospital, Mar
     booked appointments at a Thursday clinic managed by the             2006 (SC and RMC)
     Patient Administration System (PAS)                                 Vitamin D - Maternal Issues –Nutricia Paediatric Symposium,
                                                                         Dublin, May 2006 (SC)
     Diabetes                                                            Vitamin D Supplementation for Babies - National Maternity
     In view of the increasing incidence of Gestational Diabetes         Hospital Neonatal Nurses Study Day, Dublin, Jun 2006 (RMC)
     (GDM) and advances in the management of existing diabetes
     in pregnancy, a review of the dietetic service requirement for      IPOKRaTES Neonatal Nutrition and Gastroenterology
     diabetes in pregnancy was conducted. Growing numbers of             Conference Feedback – UKNDIG - UK and Ireland meeting,
     women attending the diabetes service at the hospital and            NMH, Nov 2006 (RMC)
     advances in insulin delivery systems (insulin pumps) create a       Value of Breast Milk in NICU – National Maternity Hospital
     significantly increased demand for dietetic input. A group
                                                                         Breastfeeding Courses, NMH (RMC)
     information session for newly diagnosed GDM was developed
     and this is now held every Friday. Women attending the
                                                                         Hospital Committee Membership
     diabetes clinic continue to be advised individually as needed or
                                                                         Neonatology Accreditation Team (RMC)
     during the course of an admission for stabilisation, but there is
                                                                         Baby Friendly Hospital Initiative Committee (RMC)
     no post-partum review.
                                                                         Hospital Community Network (RMC)

     Gynaecology                                                         Allied Health Professionals Group (SC and RMC)
     The number of outpatient hours for gynaecology referrals was
     reduced to accommodate the growing demands of the                   Professional Membership
     diabetes service and to prioritise antenatal referrals.             Member of the Irish Nutrition and Dietetic Institute (INDI)
     Unfortunately, there is now only 1 dietetic clinic per month for    (SC and RMC)
     women referred from the gynaecology clinics.                        Members of Paediatric Interest Group of the INDI (SC and
                                                                         RMC)
     Education and Training                                              Member of the Neonatal Dietitians Interest Group – UK and
     Participation in the education of medical, midwifery, nursing       Ireland (RMC)
     and dietetic students (SC and RMC)
                                                                         Member of the Diabetes Interest Group of the INDI (SC)
     Delivered the Healthy Eating module of the FETAC Care
     Assistant course (SC)
                                                                         Robert McCarthy,
     Attended education sessions and professional training as part
                                                                         Senior Dietition, Neonatal Nutrition
     of continuous professional development (SC and RMC)
     Attended relevant International Conferences:
     British Dietetic Association Advanced Neonatal Nutrition            Sinéad Curran,
     Course – England, Mar 2006 (RMC)                                    Senior Dietition,Women’s Health
     IPOKRaTES Neonatal Nutrition and Gastroenterology
     Conference – Poland, Nov 2006 (RMC)
     AED 2006 International Conference on Eating Disorders –
     Spain, Jun 2006 (SC)

     Presentations
     Neonatal Nutrition – Abbott Laboratories Neonatal Nurse
     Study Day, Dublin, Feb 2006 (RMC)

34
                                                                             Clinical Support Services Reports



Occupational Health                                                  figures for 2005 which totalled 42 reported exposures; this
Occupational Health in the National Maternity Hospital is a          reduction may be attributed to the use of safety technology
service available to all staff. The service is run by Dr. Sheelagh   recently introduced in the form of a safety cannula. 2006 saw
O’Brien, Consultant Occupational Physician and Imelda Keane,         the second OBE/ Hand hygiene awareness campaign which
Clinical Nurse Specialist, Occupational Health and this year we      involved education stands from a number of our sharps and
welcomed on to the team Dr. Riitta Holthofer, Locum                  safety devices providers. This was indeed a successful event
Occupational Physician.                                              with a high attendance from staff. Use of Sharps bin audit was
                                                                     also carried out and the findings communicated back to the

The Occupational Health programme in the National                    relevant parties. This work remains ongoing throughout the

Maternity Hospital aims to maintain and promote workers              year.

health and working capacity by promoting:
-   An improved working environment and making work                  Priority areas emerging in 2006 included the development of a
    more conducive to safety and health                              Pandemic Planning Committee between Occupational Health,
-   Development of work organisation and the working                 Infection Control and Consultant Microbiologist. In light of the
    culture to support health and safety and promote a               emergence of the H5N1 bird flu virus, action points were
    positive social climate                                          highlighted and the relevant areas advised of how best to
                                                                     prepare for a pandemic in terms of human resources, supplies
2006 was yet again an industrious year in the department with        and stock piling etc. Education on the correct fitting of Masks
consultations on the increase on previous years. The main            to be used in the event of a pandemic was carried out by
activities included pre employment medicals for all new              company suppliers. Influenza vaccination was again offered to
starters and all staff who were promoted during the year.
                                                                     all staff this year with a marginal increase in the uptake of
The total number of assessments carried out in the
                                                                     vaccine.
department totalled 194. The Management of Occupational
Blood/Bodily Fluid Exposures (OBEs) and management of
                                                                     Key services continue; sickness absence review, ergonomic
Occupational Injuries and Ill health also generated increased
                                                                     assessment etc. Health promotion activities carried out during
consultations and referrals to the department.
                                                                     the year included Blood Pressure awareness, Urodynamics

Occupational Health guidelines continue to be developed and          awareness was carried out by Mary Jacob, CMS Urodynamics
reviewed based on a local requirements and national and              and Diabetic Screening was continued again this year under
international best practice. New guidance from the                   the direction of Mary Coffey, CMS Diabetes.
Department of Health and Children relating to the Prevention
of Transmission of Blood Borne Diseases in the Healthcare            As per Health and Safety legislation, we are obliged to provide
settings has had an impact on the pre employment process.            Manual Handling Training for all staff. This department works
2006 saw the implementation of this guidance. All workers            closely with Carmel Flaherty in the provision of training along
who carry out Exposure Prone Procedures are subject to a             with Ciara Macken, Damien McKeown and Lucille Sheehy. We
test for Hepatitis B surface antigen and Hepatitis B core            welcome Orla Gavigan to the team who is a newly trained
antibody. All healthcare workers who carry out Exposure
                                                                     instructor.
Prone Procedures must be immunised against Hepatitis B
virus. In relation to Hepatitis C, new starters in the system
                                                                     I would like to take this opportunity to thank all those who
and new entrants or return entrants into the Irish system
                                                                     contributed to the development and running of the service
should be tested initially for the virus.
                                                                     through out the year.

Reported Occupational Blood/Bodily Fluid exposures totalled
34 for 2006. This figure includes needle stick, eye splash and       Imelda Keane
contact with bodily fluids. This indicates a decrease in the         CNS – Occupational Health

                                                                                                                                        35
     The National Maternity Hospital, Holles Street Annual Report 2006




     Pathology and Laboratory Medicine                                    combination of increased workload, insufficient staff and
                                                                          inadequate space is creating an intolerable situation.This must
     2006 was a period of change for the Department of
                                                                          remain a priority for action in the coming year.
     Pathology and Laboratory Medicine with many developments
     and improvements in services offered.
                                                                          Members of the department participated in Team Based
                                                                          Performance Management Training during the latter period of
     In January, Suzanne Deithrick joined the Cytology Department
                                                                          the year and 2 teams have been identified to achieve defined
     and in February Paula Whyte joined Histology. Maggie Walsh
                                                                          objectives in 2007.These teams will concentrate on preparing
     returned to the hospital as Chief Medical Scientist in
                                                                          the Transfusion laboratory for accreditation and developing a
     Microbiology. Damien McKeown took up his post as hospital
                                                                          system for ensuring competence of staff providing a ‘multi
     development Project Coordinator and has been replaced in
                                                                          disciplinary on call’ service.
     the laboratory by Mary Moriarty. In October, Joe Byrne took
     up his new role as Specialist Medical Scientist in Histology.
                                                                          The governance structures in the department continue to
     Approval was granted to re-grade the scientific staff in
                                                                          support the quality management system. All incidents are
     accordance with the 2001 Expert Group report.
                                                                          recorded in a customised database and investigated to
                                                                          minimise error and improve the quality of patient care.
     Service developments included the provision of ‘in house’
                                                                          Reports are made to the hospital Clinical Governance group
     tumour marker service for CA125 and development of our
                                                                          on a regular basis.
     endocrinology service. A new more sensitive and cost effective
     method was introduced for the detection of Group B                   The reconfiguration of our laboratory information system
     Streptococcal infections in urine.This work was undertaken by        commenced and this work will continue over the coming year
     Aoife O’Reilly for her Biomedical Science graduate thesis. Anya
     Curry is working on a sensitive method for the early detection       Members of the Scientific Staff are currently undertaking
     of MRSA infection.The Microbiology Department has                    Masters Programmes in Biomedical Science and Healthcare
     continued to work in close cooperation with the infection            Management. As part of these studies collaborative research
     control team to introduce a system for surveillance of               projects with the Department of Paediatrics and others are
     infection.                                                           being undertaken. During the year, members of staff attended
                                                                          scientific conferences and participated in Continuous
     While the Pathology Department continues to prepare for              Professional Development. Ms Marie Culliton was the Plenary
     laboratory accreditation the major focus this year was the           Lecturer at the European Professions in Biomedical Science
     preparation of the Blood Transfusion Department for ISO              meeting in Rome. Ms Aoife O’Reilly presented her work on
     15189 accreditation. A temperature monitoring system was             detection of Group B Streptococcus at the Academy of
     installed to assure that all blood products and reagents are         Medical Laboratory Science Annual Conference.
     maintained within agreed limits and this system was expanded
     to cover the entire laboratory and pharmacy.The Point of             Once again, the staff in Pathology have responded with
     Care portfolio was expanded with the arrival of new Glucose          enthusiasm to all changes and incorporated many
     Monitors and the addition of New Blood Gas Analysers for             developments during the past year. I would like to
     Clinical Areas.These instruments are currently being validated       acknowledge their level of commitment to setting and
     and staff are undergoing training.Their introduction is              maintaining the highest standards.
     expected in the 1st quarter 2007.
                                                                          Marie Culliton
     The poor cramped and unsatisfactory working conditions               Chief Medical Scientist
     continue in the laboratories. It was recommended by the
     hospital accreditation inspection team that this area receive
     attention as a priority.The workload continues to rise and this
     is particularly evident during the ‘on call’ period of the day.The

36
                                                                           Clinical Support Services Reports



Pharmacy                                                            Physiotherapy Department
The year 2006 was yet another busy year for Pharmacy and            The Physiotherapy Department was staffed by 3 fulltime
its team of 5 people; the Chief Pharmacist is Dorothy Mc            Physiotherapists in 2006; Judith Nalty, Physiotherapy Manager,
                                                                    Helen Power, Physiotherapist, Leslie-Ann Ross, Senior
Cormack is assisted by Noreen O’Callaghan, Senior Clinical
                                                                    Physiotherapist (part-time), Sue Cao, Senior Physiotherapist
Pharmacist, Christina Lynam part-time Pharmacist and Linda
                                                                    (part-time, until January), Jo Egan, Senior Physiotherapist (part-
Simpson, part-time Senior Technician. During 2006, Aine Toher       time, until July)
joined the department as a Senior Clinical Pharmacist.
                                                                    The Department was kept running with the wonderful help of
As hospital pharmacists we prepare, dispense and supply             locum physiotherapists Ananda Babineau and Caragh Crowley
medicines. We also provide clinical services and medication         and was, as ever, coordinated by our brilliant administrator
information. In addition to supplying the wards, we dispense to     Nicola Jordan.

outpatients, to patients on discharge and to the staff of the
                                                                    The department had another busy year in 2006 with 1882
hospital. We also counsel patients on the dosage, route of
                                                                    new patient contacts and 4935 treatments in total. I would like
administration and possible side-effects of their drug              to thank everybody involved for all of the hard work that they
treatments, especially those who require complex drug               contributed towards keeping the department running
therapy.The department also highlights harmful interactions         smoothly.
with other drugs and the suitability of treatments for patients
with particular health conditions which is important.               Physiotherapy Services include:
                                                                    - A full-time house Physiotherapist that is available to all
Medication-related queries from within the hospital, from
                                                                        hospital units both adult and paediatric with a weekend
other hospitals, GPs, community pharmacies, other healthcare
                                                                        on-call service
professionals and indeed the patients themselves are also
                                                                    - A busy outpatient clinic offering appointments Monday-
answered.To help ensure the delivery of safe and effective              Friday for musculoskeletal conditions and pelvic floor
drug treatment we work closely with the doctors and nurses.             dysfunction
We are continually involved in formulating guidelines for drug      - A paediatric outpatient clinic 4 days weekly,
preparation and administration.The pharmacists seek to              - Contribution towards the delivery of the Hospital
minimise medication errors by participating in lectures to          Antenatal and Postnatal Education Programmes including
clinical staff.The department also liaises with the Clinical Risk   Infant Massage Classes
Department to highlight and enhance medication safety issues        - Physiotherapy input into lecture programmes for
                                                                         midwifery and medical students (RCSI and UCD)
as appropriate. Controlling expenditure is always an issue and
                                                                    - Clinical training for UCD physiotherapy students
we provide detailed information on all aspects of the
pharmacy budget to the Drugs and Therapeutics Committee.            Continuing Professional Development
                                                                    Staff Member          Course Title
Considerable time is spent in keeping up-to-date with new
                                                                    Leslie-Ann Ross       Introduction to Alberta Infant Motor
technologies and developments in drug treatments. Choosing                                Scale
the most appropriate drug for use during pregnancy and for          Helen Power           Basic Urinary Incontinence
breast feeding mothers can be a challenge as choices are            Ananda Babineau       Basic Urinary Incontinence
limited.                                                            Helen Power           Infant Massage Instructor Training
                                                                    Helen Power           Pregnancy Massage Course
We report any unusual adverse effects to the Irish medicines        Jo Egan               Association of Chartered Physiotherapists
                                                                                          in Paediatrics Conference
Board to increase the databank of information available.
                                                                    Judith Nalty          Kari Bo Study Morning

Dorothy Mc Cormack                                                  Judith Nalty,
Chief Pharmacist                                                    Physiotherapy Manager

                                                                                                                                         37
     The National Maternity Hospital, Holles Street Annual Report 2006



     Social Work                                                         discharge planning. Particular support was given to parents
     The Social Work Department offers a direct service to               who have babies with identified special needs and links were
     maternity, gynaecological patients and their families and also to   made with the relevant services e.g. Jack & Jill Foundation,
     parents whose babies were admitted to the Neonatal Unit.            Nurse for Daniel. In addition, the Medical Social Worker
     Medical Social Workers work as part of the hospital multi-          supported parents and siblings when it was known baby
     disciplinary team and as a bridge to services in the community,     would not survive and when baby subsequently died.
     both statutory and voluntary.This year, the Medical Social
     Workers endeavoured to see patients earlier in their                Bereavement and Loss
     pregnancies to better assess needs and thus help prevent a          The Medical Social Workers met with 111 parents who had
     crisis before it happens.                                           experienced a miscarriage, stillbirth or neonatal death. The
                                                                         Hospital was represented at the Remembrance Service of the
     The Social Work Department is staffed by five Medical Social        Miscarriage Association and the Irish Stillbirth and Neonatal
     Workers: Head Medical Social Worker, Senior Practitioner and        Death Society. There are continuing links with these groups
     three Medical Social Workers. One of these posts will be            who provide support to our patients who have experienced
     upgraded to a senior position in 2007. There is one                 the death of a baby.There is a representative from the Medical
     administrator who manages the main office.                          Social Work Department on the Bereavement Committee
                                                                         within the Hospital. The Department was involved in the
     The Medical Social Worker provided counselling and practical        organisation of the Service of Remembrance with the
     support where patients experienced: relationship difficulties,      Chaplaincy Department and other Hospital staff.
     unplanned pregnancies, miscarriage, stillbirth or neonatal death,
     the birth of a baby with special needs, child care/protection       Adoption, Search and Reunion
     issues, domestic violence, and addiction issues.                    The Medical Social Workers met with patients who were
                                                                         considering the option of adoption.They liaised with the
     We provide information on entitlements including housing,           relevant adoption agencies and in four cases patients placed
     community service, maternity protection and issues in relation      their babies in foster care with a view to considering their
     to guardianship. In 2006, the Medical Social Workers had direct     options. Two of these babies have returned to the care of
     patient contact with 1,094 patients.
                                                                         their mothers.There was one reunion of a birth parent and
                                                                         her son. The initial contact was made through the Adoption
     Child Care
                                                                         Contact Register and facilitated by Barnardos Reunion Service.
     There was one child taken in to care by the Health Service
     Executive on a court order.
                                                                         Training and Development
                                                                         The Medical Social Workers gave lectures to medical and
     Teenage Pregnancies
                                                                         nursing students during the year. Information on the Social
     There were 122 teenagers aged 18 and under referred and
                                                                         Work Department was presented on the Induction
     seen in the Social Work Department.The Medical Social
                                                                         Programme for new staff members of the Hospital.
     Worker worked with the staff in the Antenatal Education
                                                                         Representatives from the voluntary groups who support our
     Department and Physiotherapy Department in the provision
     of a special antenatal class for teenagers.                         patients who have special needs gave talks on their services to
                                                                         the social work team. The representatives were from Ruhama,
     Domestic Violence                                                   ISANDS, Down Syndrome Association, Parentline and a Public
     Following the highlighting of this issue in 2005, Women’s Aid       Health Nurse specialising in post-natal depression.These
     staff gave a presentation to the Hospitals Clinical Conference.     meetings enhance our contact with voluntary support services
     A multi-disciplinary team met and worked on the                     and help forge better links with the community.
     development of guidelines for the Hospital; these guidelines
     will be completed in 2007.                                          A student from the Trinity Bachelors Degree in Social Work
                                                                         completed her third year placement here. A Medical Social
     Unit 8 – Neonatal Unit                                              Worker completed the practice teacher training.
     The Medical Social Worker allocated to the Special Care Baby
     Unit met with 245 parents who had babies on the Unit. She           Loretto Reilly
     continued to link with the multi-disciplinary team in relation to   Head Social Worker

38
                                                                              Clinical Support Services Reports



Chaplaincy Department                                                 something that the Chaplains are aware of. Much of the
The Chaplaincy department work with other professionals to            Chaplains time is spent ensuring that the time, space and
provide holistic care and ministry to patients, relatives and staff   support, both spiritual and practical, is available for the grieving
throughout the hospital.                                              parents to help them express their sadness and loss in a
                                                                      healing way.The role of Midwife Specialist in Bereavement will
Chaplaincy Team: All patients and relatives have access to a          be taken up by Ms. Sheila Power in January.This will greatly
minister of their own religion. Clergy and Ministers of all           enhance our present service to the bereaved and we look
Denominations are available to the hospital at all times by           forward to working with Sheila.
request. We bid farewell to Sr. Cecilia Foley at the end of the
year and welcomed Ms Teresa Ruxton on the staff.The                   Annual Remembrance Service:The Annual Remembrance
parishes of Westland Row and City Quay provide an                     Service was held in September in Andrew’s Church, Westland
invaluable on call service at night and at the week ends.The          Row. It recalls the short lives of the babies who died in the
Church of Ireland Ministers,Very Rev Tom Haskins and Rev.             last year and also recognises the major impact these short
Joyce Rankin visit the hospital regularly.                            lives have had on so many.The attendance was higher than
                                                                      usual and the event was well supported by hospital staff
Spiritual Care and Support:The ministry of the Chaplain               members. It demonstrates the importance that so many attach
includes accompanying parents, family and friends in their            to this commemorative event
celebration of the joy at the birth of a new baby or the
sadness or anxiety that may accompany their stay in hospital.         The Remembrance Book: Parents are invited to have their
Both sacramental and spiritual support is readily available.          babies names entered in this book which is on view in the
Spiritual Support is available to hospital staff and sometimes        hospital oratory. It is an ever present reminder to the memory
takes the form of providing liturgies for various occasions, or       of these little ones.
on a one to one basis as the need arises.
                                                                      I would like to thank the staff throughout the hospital for
Bereavement Support: While much joy and happiness                     liaising so generously with us and for referring patients at an
accompanies the birth of a child, the great emptiness that is         early stage.This enables us to form relationships that
present at the loss of a baby through miscarriage or stillbirth is    eventually benefit the parents. The ongoing support of
                                                                      management and staff in all departments is very much
                                                                      appreciated.


                                                                      My grateful thanks to Fr. Paddy Boyle and Fr. Paul St. John for
                                                                      their availability and support over the last year.


                                                                      Sr. Eliza Hopkins
                                                                      Chaplain




                                                                                                                                             39
     The National Maternity Hospital, Holles Street Annual Report 2006



     Practice Development Department                                     Hospital during the year. We hope to appoint an additional

     During 2006, the department continued to act as an                  Clinical Skills Facilitator for the Neonatal Department in early

     educational and practice support service for midwifery and          2007.

     nursing staff, the wider multidisciplinary team and our
                                                                         The ‘Preceptorship’ programme continued to be presented in
     community partners.The Department has incorporated
                                                                         the National Maternity Hospital. In 2006, six courses were
     elements of the School of Midwifery and education links with
                                                                         facilitated by the Practice Development team and our
     UCD following the introduction of the Pre-Registration (direct
                                                                         midwifery link tutors/lecturers from UCD. The course has
     entry) Midwifery Degree Programme in September 2006.To
                                                                         been refined to two days following evaluation and review.
     prepare for this, two new Clinical Placement Coordinators
     (Anne-Marie Dunne and Orla Gavigan) were appointed in July.
                                                                         Health Care Assistants’ training continued in 2006 with 2
     Catriona Cullen was appointed Allocations Officer (part-time)
                                                                         FETAC programmes being completed, in conjunction with St.
     to support the students further during their clinical
                                                                         Vincent’s University Hospital.
     placements in the National Maternity Hospital and selected
     outlying clinical placement sites.
                                                                         The Clinical Practice Development Coordinators further
                                                                         developed community links with regional and national practice
     As part of this new educational development, the Practice
                                                                         development groups and our community colleagues in the
     Development Department coordinated the An Bord Altranais
                                                                         local Public Health Nursing services in Dublin.The Hospital-
     Audit/Review which is required every five years. All Clinical
                                                                         Community Network continues to build communication
     placement areas were consulted and a full report was
                                                                         bridges, sharing knowledge and concerns, and enhancing local
     furnished to UCD and An Bord Altranais following their site
                                                                         best practice principles.
     visit.


     The Department is actively involved in site preparation for         The Practice Development Interest Group in conjunction with

     Advanced Nursing/Midwifery practitioners and hopes to have          the Clinical Midwife/Nurse Specialists facilitated some Journal

     practitioners in post in the near future.                           Club reviews in 2006. However attendance has waned and
                                                                         new ways of presenting research and sharing of knowledge

     The department has continued to support and assist staff in         are being considered for next year.

     programmes of mandatory training and educational
     workshops covering issues relevant to practice and                  This department is actively involved in ensuring that our

     professional development. Increasing numbers of staff (29)          Midwifery/Nursing practice is evidence based. With this aim in
     were supported and facilitated in further post-graduate third       mind, we continue to promote, review and develop guidelines,
     level professional educational programmes and a number of           policies and procedures that underpin our practice. Although
     staff (4) were facilitated and supported in advanced                the department has been involved in significant changes within
     educational programmes specific to their area of practice. We       the Education and Support Services to Midwives, Nurses and
     continue to be committed to ensuring that staff attend              Health Care Assistants during 2006, it has only been possible
     workshops/study days relevant to their area of practice thus        by the combined efforts of all staff to support improvements
     enhancing the care given to our clients.                            and advance practices.


     The Clinical Skills Facilitator, in conjunction with the Practice   Nicola Clarke ADOM/N
     Development Department, organised and accommodated                  Clinical Practice Development Coordinator
     supervised practice, orientation, induction and adaptation
     programmes for all the newly qualified and newly recruited          Geraldine Duffy ADOM/N
     international Midwifery and Nursing staff who joined the            Neonatal Practice Development Coordinator


40
                                                                           Clinical Support Services Reports



Urodynamics                                                             urinary retention in relation to clinical practice and
The Clinical Midwife Specialist (CMS), Urodynamic Studies,              documentation with recommendation for future practice.
provides an expert urodynamic service in the South East of
Dublin for the diagnosis of lower urinary tract symptoms or         -   identifies patient healthcare needs for the purpose of
urinary incontinence; to investigate bladder filling and voiding        promotion of self-care through ongoing patient education

function, to define bladder storage disorders accurately and to         towards a better understanding of their condition where
                                                                        necessary.
assess the severity of voiding dysfunction objectively. In
addition to providing expert urodynamic studies for the whole
                                                                    -   provides follow-up assessment and risk reduction to
of South Dublin, the CMS service acts as a national referral
                                                                        patients discharged from the Urodynamics Department.
centre for the rest of the country.

                                                                    Referral Sources
Assessment of urinary incontinence includes full
                                                                    Patients presenting to the CMS, Urodynamic Studies, with
gynaecological, medical, surgical and drug history. Non-
                                                                    lower urinary tract symptoms or urinary incontinence may be
specialist investigations include urine testing, completion of a
                                                                    referred in the following ways: from consultant Obstetricians
bladder symptom score, pad testing, measurement of residual
                                                                    and Gynaecologists within the hospital, the catchment area
urine volume. Specialist investigations include urodynamic          (Dublin, Meath, Kildare and Wicklow) and nationally for the
studies (conventional and ambulatory), ultrasonography and          management of complex cases.There are also self-referrals
video-urodynamics (Bristow and Hilton, 2000). Conventional          and those from General Practitioners.
urodynamic studies include the procedures of uroflowmetry,
urethral pressure profilometry and cystometry.                      Training and Education
                                                                    Lectures are given to Student Midwives, at Nursing/Midwifery
Role of the CMS, Urodynamic Studies:                                orientation, on Bladder Scanning/Continence Awareness
-   conducts a comprehensive health assessment for lower            updates, to Medical Students and externally to Public Health
    urinary tract symptoms or urinary incontinence, plans and       Nurses, HSE. Informal education sessions at ward level are
    initiates care and treatment modalities to achieve patient      given on an ongoing basis.
    centred outcomes and evaluates their effectiveness,
    initiating and terminating a care episode within the agreed     Poster Presentation
    scope of clinical practice guidelines.                          Irish Nurse and Midwifery Nursing Practice Development
                                                                    Association Conference 2006 “Value for Money: Learning
                                                                    through Evaluation.” Title of Poster - Change Management:
-   refers the patient for specialist physiotherapy services for
                                                                    Making and Sustaining a Difference.
    treatment of lower urinary tract symptoms or urinary
    incontinence.
                                                                    Continence Awareness and Risk Assessment for Staff
                                                                    Staff members were screened by completion of a
-   organises specialised clinics within the remit of the
                                                                    questionnaire with recommendations for continence
    urogynaecology clinic e.g. flow studies clinics and
                                                                    promotion and prevention of incontinence to mark
    instruction of intermittent self-catheterisation for patients
                                                                    Continence Awareness Week.
    with incomplete bladder emptying or with postnatal and
    postoperative urinary retention.                                Ongoing Education/Personal Development
                                                                    Presentation of MSc Research “Women’s Experiences of
-   provides follow-up and assessment for patients with             Urodynamic Studies” at University of Dublin,Trinity College,
    antenatal, postnatal urinary retention and postoperative        Dublin in November and at the International Continence
    urinary retention.                                              Society Annual Meeting, New Zealand in November.


-   actively participates in reviewing clinical incident report     Obtained Fellowship from Faculty of Nursing and Midwifery,
    forms for the Clinical Governance team for patients with        Royal College of Surgeons in Ireland.


                                                                                                                                    41
     The National Maternity Hospital, Holles Street Annual Report 2006



     The CMS is actively involved in the Gynaecological                   New Developments
     Accreditation process.                                               An application was made to The National Council for the
                                                                          Professional Development of Nursing and Midwifery to
     Colposcopy Clinical Governance Team                                  establish the position of Advanced Midwife Practitioner
     The CMS is a member of the Colposcopy Clinical Governance            (Women’s Health) for 2006. The development of Advanced
     Team with the objective of improving gynaecology and                 Midwife/Nurse Practitioner roles is a significant part of the
     colposcopy services.                                                 Health Service Reform Programme. The establishment of this
                                                                          clinical career pathway is a function vested in the National
     Audit and Research                                                   Council for the Professional Development of Nursing and
     -   Ongoing audit of clinical incident report forms on patients      Midwifery. Approval for this post, in accordance with agreed
         with postnatal urinary retention with recommendations.           standards is a lengthy process with all key stakeholders
     -   Dissemination of research findings pertinent to areas of         involved. The development of this career pathway serves to
         urogynaecology and urodynamic studies and incorporation          develop clinical midwifery expertise in the interests of holism
         of relevant research findings into clinical practice to ensure   and excellence in patient care.
         that practice remains evidence-based.
                                                                          M. Jacob
     Publications: Articles in Irish Practice Nurses Association.         CMS Urodynamic Studies




42
                                                                              Clinical Support Services Reports



Diabetes
The Diabetes Clinical Midwife Specialist (CMS) works as part of a multidisciplinary team that has responsibility for all women with
Gestational,Type 1 and Type 2 Diabetes as well as women who are hypothyroid and hyperthyroid throughout pregnancy until they
are discharged at 6 weeks postnatal.



                                         Overall Clinic Total Attendances 2000-2006
                               1000                                                                                       165
                                800                                                                                       160
                 Attendances
                 Number of




                                                                                                                                No. of Sessions
                                                                                                                          150
                                600
                                                                                                                          145
                                400
                                                                                                                          140
                                200                                                                                       135
                                  0                                                                                       130
                                       2000      2001           2002      2003           2004      2005          2006
                  Diabetic             684       551            807        892           908        810           931
                  Gestational          156       165            194        258           449        448           506
                  Thyroid              236       165            265        365           449        452           409
                  Total Sessions       142       143            150        151           155        153           160




Lectures given throughout the year to many disciplines                 its inception. Advice was given on healthy eating, the benefit of
including: Student Midwives, Nurse/Midwife Orientation,                moderate exercise and weight reduction, if relevant.
Medical Students (RCSI and UCD) and internal lectures.
Workshops have been initiated at ward level to provide                 Published: Article published in The World of Irish Nursing on
continuing education sessions to midwifery and nursing staff.          Gestational Diabetes.


Pre conceptual counseling sessions for women with Diabetes             Future Developments: In 2007, there will be a
– some self-referred, others referred from Diabetes centres            commencement of service to initiate and support the use of
throughout the country.                                                Continuous Subcutaneous Insulin Infusion Pumps. Approval
                                                                       has been received along with a commitment to collaborate
Ongoing Education/ Personal Development                                the generation of a new leaflet - ‘Diabetes and Pregnancy’
Attended study days at the National Council for Professional           from ‘Aventis’.
Development of Nurses and Midwifery, MSc. Midwifery plus
Advanced Practice Module in UCD completed.                             Mary Coffey
                                                                       CMS Diabetes
Community: Provided diabetes screening and general advice
on diabetes management and pregnancy planning at National
Medical Laboratory educational meeting, external lecture on
Gestational diabetes in May to Diabetes Nurse Specialists.


Staff Risk Assessment and Screening for Diabetes
Diabetes screening was available to all staff members. 169 staff
members were screened by means of a questionnaire and a
random Glucose level.This has been the best response since

                                                                                                                                                  43
     The National Maternity Hospital, Holles Street Annual Report 2006



     Infection Control                                                   attention (environment, ward kitchens and hand hygiene)
     The Infection Control service is provided by the Infection          which were either in the fair or poor category individually. In
     Control Team (ICT): Dr Susan Knowles, Consultant                    March the Hospital participated in the Hospital Infection
     Microbiologist and Ms Teresa Sexton, Clinical Midwife Specialist    Society’s third prevalence survey of healthcare associated
     (CMS), Infection Control.The ICT reports to the multi-              infection in acute hospitals. All paediatric patients were
     disciplinary Infection Control Committee (ICC) on a quarterly       excluded. No healthcare associated infections were detected
     basis. Surveillance and outbreak reports, audits, occupational      on the day of the survey.
     blood and body fluid exposures, new or revised guidelines and
     other infection control issues are discussed. Surveillance of       Education is the cornerstone of infection control. Guidelines
     healthcare-associated infection includes alert organisms and        and policies are available on the hospital intranet and in each
     conditions such as MRSA,VRE, Clsotridium difficile, norovirus,      ward’s Infection Control Manual.The team contributed to the
     other antibiotic resistant organisms, surgical site infections,     education of all groups of staff, from ad hoc education sessions
     bacteraemia, gastroenteritis, tuberculosis etc.There is             at ward level to induction and in-service mandatory education
     mandatory reporting of all ‘Notifiable Diseases’ to the Director    for clinical practitioners and students. A number of
     of Public Health and voluntary reporting of certain                 nurses/midwifes in various units are beginning to work as
     infections/conditions to the European Antimicrobial Resistance      Infection Control Link nurses.The aim of the Infection Control
     Surveillance System, the RCOG, the Health Protection                Link Nurse is to heighten awareness on practical issues in
     Surveillance Centre and the BPSU. In 2006, audits were              infection prevention and control in their area. This is an
     performed of the environment, sharps awareness, kitchen             important resource and one we hope will improve best
     hygiene, sluices, waste and hand hygiene. Clinical practices such   practice techniques and create an ‘infection prevention culture’
     as care of peripheral lines and use of personal protective          at ward level. Finally, we would like to thank all staff in the
     equipment were also audited.The second National Hygiene             hospital who maintain good infection control practices, whilst
     Audit of Acute Hospitals was carried out by the Health              delivering excellent healthcare to our patients.
     Service Executive (HSE) in spring 2006. It revealed significant
     improvements in hospital hygiene standards since the first          Dr Susan Knowles,
     audit in 2005, with an overall hospital score of 85%. Certain       Consultant Microbiologist
     areas faired particularly well (handling and disposal of linen,
     waste management and management of patient equipment),              Ms Teresa Sexton,
     although there were also areas that require significant             CMS Infection Control




44
                                               Clinical Support Services Reports/Education Reports




Education Reports                                                   School of Midwifery
                                                                    2006 was a historic year for the education of midwives in
Royal College of Surgeons
                                                                    Ireland; in September, a four year honours degree level
Undergraduate students from the Royal College of Surgeons           midwifery programme commenced throughout the country.
attended the National Maternity Hospital for their six week         This programme enables candidates without a previous
rotation in Obstetrics, Gynaecology and Neonatology in              nursing qualification to study midwifery. On successful
January/February and November/December 2006. Eighteen               completion of the course, students graduate with a B.Sc.
students attended in the each group. Again, the students have       Midwifery degree awarded at Honours degree level, which
responded very well to their time and teaching in the hospital.     also enables them to register as midwives with An Bord
                                                                    Altranais. Direct entry midwifery education and training has
The programme for the January/February group was co-                not been available in Ireland since the 1950s.The National
ordinated by Professor Dermot Mac Donald, Dr. Carmel                Maternity Hospital, in conjunction with its partner third level
Sheridan,Tutor (Obstetrics and Gynaecology), and Dr. John           institution, UCD, provides 20 places annually on this
Murphy (Neonatology). Dr. Karen Flood replaced Dr. Carmel           programme.
Sheridan for the November/December programme.
                                                                    The School of Midwifery continued to provide the Higher
Seven students achieved first class honours in their final          Diploma in Midwifery programme in partnership with
                                                                    University College Dublin and the School of Midwifery at the
obstetrics and gynaecology examination at the R.C.S.I. Ms.
                                                                    Coombe Women’s Hospital. Students commencing this
Melissa Pendergrass was awarded the N.M.H./R.C.S.I. medal
                                                                    programme are registered nurses who wish to qualify and
for achieving the highest marks amongst the R.C.S.I. students
                                                                    practice as midwives.There are two intakes every year.Twenty
who attended the National Maternity Hospital. This excellent
                                                                    four students successfully completed the programme in 2006,
performance reflects the enthusiasm of all those taking part in
                                                                    enabling them to register as midwives with An Bord Altranais
the teaching programme. Mr. R.F.Tad Gunkelman expressed his
                                                                    and to receive the award of the Higher Diploma in Midwifery
reflections in poetry on his experience of attending his first
                                                                    from the National University of Ireland. However, due to the
delivery and was published in Obstetrics and Gynecology,
                                                                    major changes occurring in midwifery education, there was a
2006; 108:427.                                                      realignment of the partnership arrangements for the delivery
                                                                    of registration programmes from September, with the
Professor Dermot Mac Donald                                         Coombe Women’s Hospital leaving the partnership which had
                                                                    existed since 1995, to form new academic and clinical
University College Dublin                                           relationships with the University of Dublin (Trinity College)
                                                                    and the Rotunda Hospital.
Undergraduate students attend the hospital for a period of
eight weeks during their final year. The Programme is
                                                                    The changes occurring in the educational landscape had major
coordinated with university lectures to provide a
                                                                    implications for the School of Midwifery. Four midwifery tutors
comprehensive grounding in all aspects of reproductive
                                                                    transferred to lecturer posts in University College Dublin, with
medicine.
                                                                    the option available to return to the Centre of Midwifery
                                                                    Education (CME) for the Dublin region within one year of
This year, the John F. Cunningham medal was awarded to Dr           transfer.Two members of staff availed of the opportunity for
Ferdia Bolster; the John F. Cunningham medal is awarded             early retirement, after very many years of dedicated service to
annually to the student who graduates with the highest first        midwifery education in Ireland. Ms. Patricia Feeney took up her
class honours mark in Obstetrics and Gynaecology together           position as midwifery tutor during the year, and is welcomed
with overall honours in the final examination. The Kieran           to the department.
O'Driscoll prize is also awarded each year to the student who
attains first place in the subject.This year it was awarded to Ms   Since 2001, the School of Midwifery has been involved in a
Sarah Hyde.                                                         partnership with the Faculty of Nursing and Midwifery, Royal
                                                                    College of Surgeons in Ireland, the Coombe Women’s
Professor Colm O’Herlihy                                            Hospital and the Rotunda Hospital to provide a one year

                                                                                                                                       45
     The National Maternity Hospital, Holles Street Annual Report 2006



     Higher Diploma in Nursing (Neonatal Intensive Care)                   Midwifery tutors are involved in the provision of continuing
     programme. Students from the three hospitals jointly                  education for qualified midwives, and facilitate the
     participate in the course. Curriculum development, teaching           preceptorship programme.They also contribute to the
     and assessing of the three specialist modules is shared               WHO/UNICEF breastfeeding course for qualified midwives. A
     between the midwifery tutors and neonatal intensive care staff        member of the staff provides relaxation sessions for hospital
     in the three hospitals.                                               staff and a reflexology service for patients.

     Due to the major changes occurring in midwifery education, it         Midwifery tutors provide midwife-led antenatal care in the
     was not possible for the School of Midwifery to provide the           Midwives Clinic.The School of Midwifery is also represented
     annual Return to Midwifery Practice course, much to the               on 11 hospital committees.
     disappointment of many interested applicants.This course,
     along with other continuing midwifery education courses, will         The year was an eventful one for the School of Midwifery,
     in future be provided by the Centre for Midwifery Education,          with significant demands being made on all members of staff.
     due to be set up in 2006 - 2007.The hospital made a                   Good teamwork, close co-operation and dedication to the
     submission to the HSE to be considered the ‘hub’ site for the
                                                                           education of midwives enabled the midwifery tutors to meet
     CME. However, it was decided that the ‘hub’ would be located
                                                                           the challenges posed by this period of intense change. The
     in the Coombe Women’s Hospital, due to the greater
                                                                           support of clinical midwifery colleagues and the student
     availability of classroom and car parking facilities, with both the
                                                                           midwives was also much appreciated, and is acknowledged
     Rotunda and the NMH designated ‘satellite’ centres.
                                                                           with gratitude.

     Midwifery tutors taught on the maternity care module for the
                                                                           Cora McComish
     BSc. (General) Nursing and coordinated the placements for
                                                                           Principal Midwifery Tutor
     these students in the hospital.They also contribute to the
     Higher Diploma in Nursing (Peri-Anaesthesia).These courses
     are provided by the School of Nursing, Midwifery and Health           Anne McMahon
     Systems, University College Dublin.                                   Midwifery Tutor




46
                                              Education Reports/General Support Services Reports




General Support Services Reports                                  Backcare and Ergonomics
                                                                  This programme has been running in the hospital since
Arts Office                                                       November 1993. It is now an integral part of the many
This year, many art works were rearranged around the              mandatory study days at the National Maternity Hospital. Our
hospital; postnatal ward Unit 7, the new Antenatal Day Ward       team is made up of staff members; Carmel Flaherty, Ciara
                                                                  Macken, Lucille Sheehy, Imelda Keane and Damien McKeown.
and the Bereavement Office benefited from this ‘recycling’.
                                                                  Orla Gavigan just completed her training and we welcome her
Many works were successfully reframed and updated.
                                                                  on board.

The Communications Committee coordinated an art                   We run both full patient and non-patient lifting and handling
competition to select designs for the National Maternity          courses. All categories of staff are obliged to do this training
Hospital charity Christmas cards in aid of the Neonatal and       with a refresher after two-three years. We run monthly
Gynaecology units. Members of staff and children from their       courses for new staff members and refresher staff. Extra
families took part. We had a prize giving for the children that   courses are provided for student midwives commencing post
took part at the lighting of the Christmas tree. We intend to     registration training. Our Manual Handling policy is in place in
                                                                  all departments.
repeat it for Christmas 2007 and hope to discover more
talent. Staff member Francis Hogan, whose painting was
                                                                  We are now almost up to our full complement of high-low
selected for the hospitals corporate card, let us buy her
                                                                  beds. We will purchase electronic beds with our allocated
painting, the proceeds of which she kindly donated to the         budget. We have purchased mechanical aids e.g. roller-boards,
Neonatal Unit.The painting is hanging in the Midwifery and        rope ladders, sliding boards, sliding sheets and a hoist to
Nursing Management office.                                        protect staff from injury.


Tove O’Flanagan                                                   We endeavour to improve best practice at all times.
Arts Officer
                                                                  Carmel Flaherty
                                                                  Midwife/Backcare co-ordinator




                                                                                                                                     47
     The National Maternity Hospital, Holles Street Annual Report 2006



     Casemix Programme                                                     Specialty Costing
                                                                           Specialty Costing involves a process of analysing and
     The National Maternity Hospital continued to participate in
                                                                           reallocating Hospital costs firstly to individual departments
     the National Casemix Programme and was once again
                                                                           within the hospital and then further analysed to allocate the
     grouped with the other two Dublin maternity hospitals for
                                                                           costs to the individual specialities (and eventually to individual
     Casemix related funding purposes by the Department of
                                                                           procedures within Casemix).
     Health and Children in 2006.
                                                                           This area of cost allocation requires extensive detail and much
     Casemix is the Comparison of Activity and Costs between               liaising with many departments to assess the analysis of their
     hospitals by measuring individual hospital output.This data is        provision of service to each of the specialties. Many thanks to
     then used to compare the average costs for each type of case          all departments who so willingly provided the required
     to the average costs of all other Hospitals in the group for the      information.The total amount of Casemix budget adjustment

     same case.The more cost efficient hospitals will benefit within       among the Maternity Hospitals for 2005 was €174,515.The
                                                                           National Maternity Hospital had a negative budget adjustment
     the Casemix budget funding programme whilst those who are
                                                                           of €22,046 and the Rotunda had a negative budget
     less than cost effective by comparison with others within their
                                                                           adjustment of €152,469.The Coombe on the other hand had
     group will lose out. Casemix combines two areas of Hospital
                                                                           a positive adjustment of €174,515.To date the National
     activity (HIPE) and costs (Specialty Costing).                        Maternity has an accumulated negative outcome under the
                                                                           Casemix Programme of €15,201.
     HIPE (Hospital Inpatient Enquiry)
     HIPE deals with the coding and classification of the Hospitals        There are challenging times ahead. Costs are ever rising and
     activity using internationally designed and recognised coding         activity levels are likely to peak. Cost per treatment episode
     models that have been in use in this hospital for some years          could rise and our cost competitiveness may be compromised
     now.The source data for HIPE is the patient chart.                    as a result. As always, funding will be based on the quality of
                                                                           the data that we provide and the Hospital continues to attach
     Inpatient, Daycase, Outpatient and Accident and Emergency
                                                                           great emphasis and importance to the HIPE/Specialty Costing
     episodes are all currently treated differently in Casemix and
                                                                           Program and to which the cooperation of all is essential and
     therefore it is important to separately identify these and
                                                                           appreciated.Thanks to All.
     classify them accordingly. It is vitally important that all patient
     care episodes are described and coded at clinician level in           Tommy Hayden
     order that they might be captured in HIPE.                            Management Accountant




48
                                                                             General Support Services Reports



Facilities Engineering Department                                    2006 was an ambitious year for engineering projects at the

The Facilities Engineering Department comprises of Clinical          hospital. Developments and works were conducted costing

Engineering and of the Environmental and Engineering                 €1.2M. Projects included the €200K Neonatal isolation area

Departments. The prime responsibility of the department is           with full NICU facilities, over €500K in internal refurbishments

to maintain the fabric and structure of the hospital buildings       to patient and support areas and €300K on essential repairs.
together with the mechanical, electrical and equipment
services contained within. Such services include Power, Light,       We undertook a maintenance survey of all wards, units and
Heating, Water, Medical Gases, Drainage, Lifts, Waste, Energy,       departments; the results of which were tabulated and
Electro-Medical devices, Environmental Management and                submitted for budget approval to the Executive Management
Emissions. Despite the ageing infrastructure, the demands of         Team.
these services have grown greatly over the years.The Facilities
Engineering Department strive to maintain the highest                Fredrick Byrne
standards of facilities and services regardless of infrastructural   Engineering Supervisor
restraints in order to sustain a hospital environment in which
                                                                     Environmental Management
patients can be treated effectively.There are currently over
€10M in essential Engineering Projects for the current               The Environmental Management section of the Facilities

buildings awaiting HSE approval. We hope that 2007 will see          Engineering Department is responsible for the development

the commencement of these projects.                                  and implementation of the Hospital’s Environmental
                                                                     Management System.This includes developing environmental

I would like to take this opportunity to thank the staff and         procedures, conducting training, recycling initiatives and

managers of the Facilities Engineering Department for their          awareness campaigns, compiling the environmental legislation

tireless hard work and assistance during the year and look           register, ensuring that monitoring is carried out, conducting

forward to the challenges of 2007. I would also take this            internal and external audits, compiling reports and plans and

opportunity to thank the staff of associated departments             maintaining data records in the following areas: waste
                                                                     management, energy management, water consumption and
within the hospital for their assistance and support during
                                                                     discharges to drain management, pollution to atmosphere, land
2006.The hospital Facilities Engineering Department uses
                                                                     management and contamination.
many third party companies who contribute significant and
irreplaceable expertise to the on-going works within the
                                                                     The objectives are to decrease as far as is reasonably
National Maternity Hospital and I thank them for their help
                                                                     practicable, the possible negative impacts the hospital has on
and assistance in making the substantial building and
                                                                     it’s environment.
engineering processes happen in a seamless way.

                                                                     In 2006, the National Maternity Hospital continued a program
Neil Farrington
                                                                     of staff training on Waste/Environmental Management.
Facilities Engineering Manager
                                                                     Environmental standard operating procedures and the
                                                                     environmental policy and plan were revised and are available
Engineering Department
                                                                     to all staff on the intranet of the hospital.
In 2006, the Engineering department responded to
requisitions for works including plumbing, electrical, mechanical    Discharges to drain monitoring was conducted in June and
and carpentry services. Workloads have increased again this          September 2006 and the results were forwarded to Dublin
year; the increase in works can be attributed to the aging           City Council as per licence requirements. New treatment and
fabric and structure of the building, a rise in staff and patient    control measures were introduced in 2006 along with more
expectation, and the rising expectations on services and             frequent monitoring in order to improve the quality of
facilities driven by changing standards in healthcare.               discharges to drain. Spill training was also conducted.

                                                                                                                                        49
     The National Maternity Hospital, Holles Street Annual Report 2006



     Recycling of waste has increased again in 2006 with 78% more       The success of the Environmental Department depends on
     dry recycling and 54% more glass recycling taking place than in    each employee’s cooperation and the assistance of all is greatly
     2005.The hospital again participated in Energy Awareness           appreciated.
     Week and Rehab Recycling Week. Water Consumption
     decreased by 4% to 23,058 m3 and a Water Conservation              Loretta Joyce
     awareness campaign took place. Both electricity and gas            Environmental Officer
     consumption decreased in 2006 and new energy reduction
     measures were introduced at the end of 2006.




     Waste Management Data

      Waste Type                                                  Quantity disposed/recycled             % change on Quantity
                                                                           in 2006                             for 2005

       General Healthcare Risk Waste                                        94 tons                                  0%
       Special Healthcare Risk Waste                                        7.5 tons                               +25%
       Chemical Waste                                                        3.25 L                                  -2%
       Fluorescent tubes and waste containing mercury                      0.11 tons                               +22%
       Healthcare Non Risk Waste                                           204 tons                                  -2%
       Building Skip Waste (partially recycled)                             45 tons                                +7%
       ‘Dry Recycling’ (paper, cardboard, plastic, cans)                   356,100 L                               +78%
       Glass Recycling                                                      2.2 tons                               +54%
       WEEE (waste electrical and electronic
        waste) Recycling                                                   1.97 tons                               +4%
       Cooking Oil Recycling                                                 850 L                                 -11%




     Energy Management Data

      Energy Consumption                                                    2006                           % change on 2005
                                                                                                             consumption

      Electricity consumption in kWh                                      2,792,810                                 -5%
      Natural gas consumption in kWh                                      2,500,023                                 -4%




50
                                                                             General Support Services Reports



General Services Department                                         level on Units 7 and 10. Feedback has been very positive with
                                                                    commendations received for the higher standards of
The General Services Manager is responsible for the provision
                                                                    environmental hygiene and catering service being achieved
and development of Support Services in the Hospital. 2006
                                                                    from Ward Managers and others on behalf of our service
was another record year in terms of activity for the National
                                                                    users.
Maternity Hospital. However, despite the less than ideal
infrastructural facilities, Support Services, as with other         In late 2006, we were notified that that the HSE appointed the
Departments, continued to work hard to ensure a quality             Irish Health Service Accreditation Board (IHSAB) to conduct
service for our service users.                                      Hygiene Audits for all publicly funded hospitals in the country
                                                                    and that these would take place in 2007.The IHSAB Hygiene
Hygiene has become a very topical and important issue in
                                                                    Services Assessment Scheme will be similar to the Hospital
hospitals in recent years. I am pleased to report that the
                                                                    Accreditation process and will involve a period of self
National Maternity Hospital improved from fair to good in the
                                                                    assessment followed by Audit. However, unlike Accreditation,
recent National Hygiene Audit results.This placed us in the
                                                                    Hygiene Audits are mandatory and unannounced.The Audits
top third of all institutions audited. In advance of the National
                                                                    will be more detailed with a team of auditors spending up to
Hygiene Audits, the hospital compiled and submitted renewed
                                                                    2 days on site and more areas will be visited including
funding requests to the HSE to address identified                   Catering Department, Delivery Wards and Theatre. Multi-
infrastructural deficits and to improve cleaning frequencies. In    disciplinary teams began meeting in 2006 to discuss how we
late 2006, after the hygiene audits had taken place, some           could further improve our Hygiene standards within the given
funding was received to assist with enhancing our identified        resource/infrastructural constraints, for the benefit of Patients
infrastructural deficits. However, no funding was received to       and Staff.
improve cleaning frequencies e.g. to provide 24/7
Housekeeping cover, to segregate cleaning and catering              2007 promises to be a demanding but exciting year for the
                                                                    development of support service provision in the health
functions at Ward level, to provide an Infection Control
                                                                    service and I would like to take this opportunity to thank
Response Team.
                                                                    everyone involved in the provision of Support Services for
To ensure maximum return from funds received, a Hygiene             their continued hard work and dedication throughout 2006
Committee comprising of a multidisciplinary team of staff,          and commitment to service developments for 2007
considered and prioritised a works programme for our
                                                                    Tony Thompson
Engineering department.This programme of works included
                                                                    General Services Manager
the upgrading of Ward kitchens, new flooring and painting in
selected Wards some additional storage for Household
                                                                    Laundry
materials, refurbished sluice rooms, additional and refurbished
                                                                    The Laundry Department is one of the smallest departments
wash hand basins, refurbished laundry storage facilities and
                                                                    in the National Maternity Hospital. We dealt with over one
some new ward furniture.The works programme was agreed
                                                                    million pieces of linen in 2006. Over 630,000 pieces of clean
and completed within a tight time frame thanks to the
                                                                    linen was delivered to the hospital and distributed to the
dedication and cooperation of the many categories of staff
                                                                    various departments.
involved that all worked together in a positive inclusive
partnership way.                                                    With the week on week, month on month and year on year
                                                                    stock use system, we can give each department a record of
With regard to outstanding identified Hygiene deficits, we have
                                                                    the linen they have used and the costs involved.
resubmitted our requests to the HSE for funding and are
hopeful more funding will be allocated in 2007.To strengthen        The Laundry Department has developed into a most effective,
our business case to the HSE for the funding required to            efficient, cost control and reliable department for the hospital.
address identified operational concerns, we have commenced          It is proactive in changing to meet the highest standards that
a trial segregation of catering and housekeeping duties at ward     are demanded by both the public and the hospital.

                                                                                                                                        51
     The National Maternity Hospital, Holles Street Annual Report 2006



     Laundry Services were provided by Springrove Services; the         The portering staff had a memorable year at the fund raising
     Laundry Department ensure that they continue to maintain           Golf Classic in aid of much needed funds for Unit 8; we have
     the high standard that every one has come to expect.               been taking part for the past 14 years and this year we finally
                                                                        won!
     We were fortunate to have our Laundry Press renovated in
     2006.                                                              We look forward to the challenges of 2007 and aim to
                                                                        provide the best possible service to our service users.
     I would like to take this opportunity to thank Stephen Tone
     (Laundry Porter), Midwifery and Nursing Staff and all other
                                                                        Ken Ray
     Staff for their cooperation and help over the last year in
                                                                        Portering Services Manager
     ensuring the Laundry Department reach its objectives and
     goals in providing an effective, efficient and proactive Laundry
                                                                        Telecommunications
     Services for the National Maternity Hospital.
                                                                        There were a few changes at the switchboard during the
     Joe Staunton                                                       past year with the retirement of Bridget Leahy, telephonist,
     Laundry Services Manager                                           after 17yrs and the recruitment of Betty Hyland. We wish
                                                                        Bridget many happy years to enjoy her leisure time, and we
     Portering Services                                                 extend a warm welcome to Betty and hope she will be
     2006 was another busy year for the National Maternity              happy here at the National Maternity Hospital
     Hospital and subsequently for the Porters of the hospital.The
     portering staff cover the whole hospital.                          We have recently been provided with two new
                                                                        switchboards and a general upgrade of the system is taking
     During the year the new wheelchair ramp was installed which
                                                                        place.The number of bleeps is increasing and we keep
     was much needed.
                                                                        them in working order and send them out for repair when
                                                                        required. We do ‘tests’ on the adult and neonatal
                                                                        emergency bleeps at specified times each day.The staff
                                                                        here availed of the supplemented introductory European
                                                                        Computer Driving License (ECDL) course which was most
                                                                        helpful as much of our work is now computer based.


                                                                        In 2006, the Telecommunications team undertook a
                                                                        ’Customer Service Training’ course which was run
                                                                        externally.The feedback was very positive and highlighted
                                                                        many problems and situations relevant to our work here at
                                                                        the switchboard.


                                                                        We look forward to the challenges of the year ahead, and I
                                                                        thank my colleagues for their hard work and support.


                                                                        Kitty O’Connor
                                                                        Senior Telephonist


                                                                        Catering Department
                                                                        The Catering Department of the National Maternity Hospital
                                                                        has had another demanding but productive year. We continue
                                                                        to receive very positive feedback from patients, visitors and

52
                                                                               General Support Services Reports



staff who have visited our catering facilities.This has proved to       Health and Safety
be very welcoming to all staff involved with this success.
                                                                        The National Maternity Hospital management is dedicated to
                                                                        ensuring the safety and well being of the National Maternity
The Department has continued to support education and
                                                                        Hospital staff, service users, community and environment.This
training programs. Courses undertaken have involved areas of
                                                                        is achieved by promoting and facilitating a safe place of work
Customer Service, Cashier Skills, Manual Handling and Primary
                                                                        in line with the requirements of the Safety, Health and Welfare
Food Hygiene.
                                                                        at Work Act 2005.The National Maternity Hospital ensures
Jackie Larkin and Donna Blake, members of the Catering                  the management of safe systems of work, safe plant and safe
Department, have participated in an organised Securing                  equipment.The hospital is committed to the provision of
Knowledge Intra Lifelong Learning (SKILL) Course.The                    training and policies are designed to provide competent and
program was established to oversee education, training and              safety conscious staff that plan, organise, perform, maintain and,
development of Support Staff employed within the Irish                  when appropriate, revise systems of work so that they are
Health Service.                                                         safe and without risk to health.


The Catering Department was involved with the promotion                 The main legislative changes in 2006 were:
of the National Cultural Diversity week in November.The                 S.I. No. 318 of 2006 Safety, Health and Welfare at Work
Catering Department contributed to this week by providing               (Work at Height) Regulations 2006
multi-cultural dishes in the staff canteen throughout the week          S.I. No. 370 of 2006 Safety, Health and Welfare at Work
consisting of Irish, Indian, Latvian, Filipino and Italian food. Some   (Control of Vibration at Work) Regulations 2006
of our multi-cultural staff contributed their ideas which added         S.I. No. 386 of 2006 Safety, Health and Welfare at Work
to its success.                                                         (Exposure to Asbestos) Regulations 2006
                                                                        S.I. No. 504 of 2006 Safety, Health and Welfare at Work
Finally I wish to thank all the Catering Department personnel
                                                                        (Construction) Regulations 2006
for their continued support and hard work that consistently
ensures the Department’s success.                                       In 2007 the Safety, Health and Welfare at Work (General
                                                                        Application) Regulations 1993 are due to be revised which will
Margaret King                                                           further enhance the hospitals safety management systems.
Catering Manager
                                                                        The overall employee participation, awareness and culture
                                                                        toward safety, health and welfare in general, remains at a high
                                                                        level.This makes the work of the Health and Safety
                                                                        department more varied, rewarding and beneficial for all.The
                                                                        enthusiasm and interest shown by the Safety Representatives
                                                                        and Safety Committee demonstrate the commitment and
                                                                        dedication among hospital staff; this ensures that our place of
                                                                        work is as safe as possible within the constraints imposed by
                                                                        the resources, age and physical footprint of the listed buildings
                                                                        we share.

                                                                        Thanks to all those who attended the Health and Safety
                                                                        induction and mandatory Fire Safety Training program in 2006.
                                                                        The corporate induction program for both NCHD and staff is
                                                                        further complemented by the mandatory study days that run

                                                                                                                                             53
     The National Maternity Hospital, Holles Street Annual Report 2006



     throughout the year; these ensure all staff have an opportunity    executive management and the Deputy Chair of the Executive
     to refresh their Health and Safety and emergency procedures        Committee.This information is available to all via the intranet
     awareness.                                                         and copies are held in the library. It is the responsibility of
                                                                        department managers to ensure that their staff comply with
     The Dublin Fire Brigade (DFB) training staff provided excellent    and follow safety, health and welfare instruction onsite.The
     instruction to our fire wardens. Further training with the DFB     Health and Safety Manual contains all updated and reviewed
     is scheduled for 2007 and managers are reminded of their           health and safety information for staff, contractors, consultants,
     duty to ensure their staff are aware of the emergency              patients and visitors, including;
     procedures throughout the hospital.The hospital has liaised
     closely with the DFB in drawing up emergency plans and             The National Maternity Hospitals’ Health and Safety Plan
     providing them with the detailed information required to           Fire Policy and Evacuation Procedures
     safely deal with any incidents at our site.Training was also       NMH Safety Statement
     provided to members of the management team by IBEC to              NMH Emergency Contingency Policy
     ensure staff are aware of statutory obligations and to further     Hazard Control – Safe Work Practice Guidelines
     enhance the safety management system within the hospital           Violence Prevention in the Workplace Policy
     and its environs. First Aid training was provided to our team of   Manual Handling Policy
     First Aiders. They respond to any incident in the hospital and
     our grateful thanks to them for their efforts.Training was also    The foundations of an effective health and safety management
     provided to our chemical spill response team and abrasive          system have been set and it is planned to build on this in
     wheels training was provided to ensure compliance with             2007.The pursuit of a quality management system in line with
     legislative requirements.                                          the internationally recognised OHSAS 18001 specification for
                                                                        our safety management system is the goal.To achieve this, the
     The Hospital Watch program initiated in 2005 with the Garda        Health and Safety department will work with individual
     Liaison Officer from Pearse St Garda station is ongoing.The        departments to enhance their health and safety management
     purpose of this initiative is to improve hospital                  systems to develop and implement the required pre-requisite
     communications with the local community partners and to            elements.
     explore practical Emergency Contingencies with the Gardai.
     The Security awareness within the hospital has been raised as      Sincere thanks to all employees proactively working to
     a result of this initiative and our thanks goes to Garda Brian     improve the safety culture within the hospital.Thanks also to
     Farrell and Garda Aoife Cullen for their attendance, patience      all members of the Health and Safety Committee and the
     and advice.                                                        Safety Representatives.

     The Health and Safety programme for the “Prevention of             Finally I would like to express a special thanks to all the staff
     Violence in the Workplace” which was established in 2005 has       that have made me feel very welcome and I look forward to
     proven to be a success in providing staff with the tools to deal   working with you all in the coming year.
     with situations before they escalate into a crisis.The National
     Maternity Hospital, in conjunction with the Rotunda Hospital,      Martin Creagh
     Coombe Women’s Hospital and the Mater Hospital provide a
                                                                        Health and Safety Officer
     number of full one day “Non Violent Crisis Intervention”
     training programmes throughout the year.Those wishing to
     attend any of the above training programmes should consult
     their manager and contact the Health and Safety department.


     The hospital ‘Health and Safety Manual’ has been distributed
     to all line managers, department heads, senior management,

54
                                                                            General Support Services Reports



Human Resources Department                                          In examining some HR key performance indicators, it was
                                                                    encouraging to see that voluntary turnover at the hospital fell
Human Resources (HR) plays an important role in any
                                                                    from 9% to 7%. However, the level of sick absences recorded
environment where people are at the core of all activities. It is
                                                                    continues to be a challenge for many departments.To tackle
not surprising then to report that HR was busy in the hospital
                                                                    the issue of sick leave, a multidisciplinary working group was
during 2006.The HR Accreditation report issued by the
                                                                    setup.This group has designed a staff presentation /
Hospital surveyors identified a number of areas where further
                                                                    consultation road show and plan to roll it out across the
improvements could be made.This has helped shape some of
                                                                    hospital during quarters 2 and 3 of 2007.
the HR activities implemented during 2006.

                                                                    The Partnership committee continued its good work with a
The hospital’s investment in staff training and development
                                                                    number of activities; a “Return to Learning” programme was
continued in 2006. A number of development programmes
                                                                    organised where literacy and computer training classes were
were implemented; Customer Service training was given to
                                                                    made available to staff.The committee also organised
147 frontline staff, training on handling Dignity at Work issues
                                                                    “Partnership in Action” awards where teams were invited to
and poor employee performance was provided to 62
                                                                    submit proposals aimed at improving the working lives of staff
managers, every 6 weeks all new employees in the hospital
                                                                    or the service to patients.
received 1.5 days corporate induction training. Further training
that took place during the year included fire safety training,
                                                                    To help further improve communications and promote greater
Non-Violent Crisis Intervention training and first aid training.
                                                                    staff interaction, the Communications Committee organised
The hospital also participated in the National Team Based
                                                                    some social events.These included a staff table quiz, a treasure
Performance Management initiative. Four teams received
                                                                    hunt, a competition for the child relatives of staff to design the
training providing them with the skills to work with their own      charity Christmas Cards and a competition for Adults to
teams in identifying and delivering on a number of important        design the official hospital Christmas cards. In November, the
objectives.                                                         hospital celebrated the rich multi-cultural mix that exists
                                                                    amongst staff by participating in the national Cultural Diversity
In 2006 the hospital was allocated 11 places on the national        Week. Events organised included welcome banners in various
Securing Knowledge Intra Lifelong Learning (SKILL)                  languages, national dishes in the staff canteen and talks from
programme.The aim of the one year programme is to                   representatives of different ethnic minority groups.
educate, develop and train support staff and supervisors to
enhance their role and the quality of service provided to           The quantity and quality of work produced in the HR
patients. It is envisaged that this programme will take place       Department only happens by having the right people in place.
again in 2007.                                                      This applies to the great HR team that resides in the National
                                                                    Maternity Hospital.The service provided is only possible
The year also saw the introduction of a new Information and         through the dedication and professionalism each member of
Consultation Agreement.The Pre-Existing Agreement, which            the team has shown throughout the year and for this I am
sets out a framework for how the hospital proposed to               enormously thankful.
inform and consult with staff, was voted in by staff in a secret
postal ballot co-ordinated by the hospital auditors, Price          Lauri Cryan
Waterhouse Coopers.                                                 Human Resources Manager




                                                                                                                                         55
     The National Maternity Hospital, Holles Street Annual Report 2006



     Information Department                                             Information Technology Department
     Information and knowledge is a key organisational resource.        The Information Technology service is now a key factor in the
     Meaningful Information can be used in quality management,          functioning of the National Maternity Hospital and so the
     continuous quality improvement and peer review. By                 ongoing functioning of these systems is ever-increasingly
                                                                        important.The importance of IT systems in the hospital has
     improving the quality of information, core data can be
                                                                        grown exponentially with activity and personnel levels over
     provided for randomised clinical trials, outcomes research and
                                                                        the past 10 years. Functions are always expanding but include:
     epidemiological studies. High quality data can form the
     foundations for policy makers, families of high-risk infants and
                                                                        -   Operation, support, maintenance and enhancement of
     the public.
                                                                            existing computer systems
                                                                        -   Management, enhancement and support of the Hospital’s
     The Information Officer works closely with IT and Patient              local networking infrastructure
     Services Departments along with administrative and medical         -   Maintenance of electronic communications with external
     staff in the hospital. The prime areas of the role are:                organisations
     -   Extracting and analysing information from hospital             -   Develop and Implementation a Hospital Information
         information systems to assist management decisions and             Technology stragegy and constantly review same -
         to highlight changing / emerging trends                            Implementation of hospital communication initiatives
                                                                        -   Procurement of all I.T. hardware, software and
     -   Coordinating HSE and Department of Health and
                                                                            consumables required by the Hospital
         Children Activity returns and Parliamentary Questions as
                                                                        -   Sourcing and implementation of new software systems
         they arise
                                                                            with other appropriate personnel and 3rd party suppliers.
     -   Producing internal hospital activity reports                   -   Supporting all existing hospital information systems
     -   Publication of the hospitals Annual Report and Annual          -   Providing user support to Hospital staff including relevant
         Clinical report                                                    system documentation and access to I.T. Helpdesk.
     -   Developing and designing internal information systems in       -   Assistance with multimedia presentations
         conjunction with relevant hospital stakeholders                -   Maintenance and enhancement of Hospital’s
                                                                            Intranet/Internet Website
     -   Providing an information service for the dissemination of
                                                                        -   Maintenance of I.T. Asset Register
         hospital information internally and also providing
         information to external agencies e.g. Media, other
                                                                        Developments during 2006 include
         hospitals/medical agencies.
                                                                        McKesson: All of the maternity hospitals now have the
                                                                        McKesson Hospital Information System (HIS).The Obstetric
     The Information Officer works closely with Clinical                Management System (OMS) and Neonatal Information System
     Information Analyst, Tracy O’Carroll, who is involved in the       (NIS) for both Rotunda and NMH will be discontinued from
     verification, validation and presentation of all neonatal          June 2007.
     information captured in the Neonatal Unit. The Clinical
     Systems Officer is also responsible for the collection and         Intra Maternity Hospital Projects: There was a joint strategy
     submission of data to the Vermont Oxford Database (VOD).           document issued in 2006 which was a result of an initiation by
                                                                        the Joint Standing Committee of the Dublin Maternity
     The VOD is a world wide network that allows anonymous
                                                                        Hospitals. This document will be a road map for the next 3 to
     clinical data to be compared with other institutions to improve
                                                                        5 years. A project has been initiated arising from the strategy
     effectiveness and efficiency of medical care for newborn
                                                                        to find replacement systems for the existing Obstetric
     infants.
                                                                        Management and Neonatal Information systems. Cork
                                                                        University Hospital is also part of this project as they have no
     Fionnuala Byrne                                                    system currently and it is envisaged that the project will
     Information Officer                                                become a National Project.

56
                                                                           General Support Services Reports



Additional Projects Implemented in 2006                            Hospital In-Patient Enquiry
We work closely with Patient Services, the Information             There was an increase in total discharges in 2006 when
Department and the Obstetric and Neonatal staff to examine         compared with 2005 as the capping of deliveries in 2005
ways of improving the systems in order to provide a better         resulted in a decrease in hospital activity.The increase was
service to our patients.                                           seen in obstetric discharges and episodes and in neonatal
-   Complete upgrade of the windows domain to embrace              activity cases. Gynaecology and oncology inpatient activity
    the latest technology.                                         declined slightly.
-   Continuing to upgrade and implement new IT initiatives
    throughout the hospital                                        A totally new classification system, the ICD10AM
-   Continue to implement a project with the 5 east coast          (International Classification of Diseases 10 Australian
    hospitals; a comprehensive oncology system where               Modification) was introduced in 2006.The regular training
    patients use a unique number and whose care can be             schedules supplied by the HIPE unit in the ESRI helped make
    processed in any of those hospitals.                           the changeover of the coding system almost seamless.
-   The IT department is the first point of contact for the
    maintenance of the network infrastructure; there are           HIPE is one of the cornerstones of the Casemix program; of
    approximately 300 pieces of hardware including server          the 2008 allocation 20% will be allocated through casemix. It is
    maintenance printer and PC maintenance throughout the          vital that all activity is recognised, captured and coded; this
    hospital.                                                      requires all patient charts routed to us in a timely manner.
-   The department provides first line maintenance on all
    software systems within the hospital including McKesson        Belinda McCarthy
    Patient Administration System (PAS) and OMS/NIS,               HIPE co-ordinator

    Finance and Materials management, HR, Mediscan
    Colposcopy System and Pharmacy


Students Projects
It is our policy to encourage and facilitate IT students as much
as possible; we have in previous years made it possible for
students to undertake final year projects in the hospital and
we have provided students with work experience.This year
was no exception. In addition we were in a position to offer
one such student a short term contract to work on some
application development projects.


The HIPE and IT departments have excellent dedicated and
hardworking people. I would like to take this opportunity to
thank them for their efforts and loyalty during the year. We
enjoy an excellent working relationship with all other
departments in the hospital. I look forward to maintaining this
relationship for the years to come.


Ann O’Connor
IT Manager

                                                                                                                                      57
     The National Maternity Hospital, Holles Street Annual Report 2006



     Patient Services Department/Freedom of                        Medical Records Department
     Information                                                   2006 was very busy but rewarding year for the Medical
     The Patient Services Department continues to manage and       Records Department. We have increased our administrative
     develop:                                                      support service in Dictation, Notification of Births and Deaths,
                                                                   Satellite Clinics and General Medical Records and Retrieval
     • Administrative support staff assigned to Medical Records,
                                                                   areas.
         Admissions, Outpatients and Clinical Departments.
     • Patient services areas within the hospital
                                                                   Medical Records is always changing and developing; we are
     • A patient services focus for the hospital with particular
                                                                   constantly reviewing new Document Management Systems.
         emphasis on communications and improving patient
                                                                   We have researched projects into micrographic scanning of
         facilities
                                                                   charts onto optical disc storage. We have also looked at
     •   The requirements of the Freedom of Information Act
                                                                   varying and different elements of Electronic Patient Records.
     • Improved standards of records management in the hospital

                                                                   In September, the National Hospitals Office set up a steering
     Sheila Broughan
                                                                   group to review standards and recommended practices for
     Patient Services Manager
                                                                   Medical Records Management. It is expected that these
                                                                   standards will become Policy and be implemented nationally
                                                                   by the 53 Hospitals in March 2007.


                                                                   There were 959 routine access written requests received in
                                                                   2006.These included copies of Medical Charts for Patients,
                                                                   general queries and copies of reports for other Healthcare
                                                                   Agencies.


                                                                   The Medical Records Team has been selected to participate in
                                                                   the Team Based Performance Management initiative.The
                                                                   project we have selected is based on “Missing Charts” and will
                                                                   run for 12 months.


                                                                   All the team participated in the Joint Maternity Hospitals
                                                                   course on Customer Care which received a lot of positive
                                                                   feedback.


                                                                   Congratulations to Carol Cloak on her appointment to
                                                                   Supervisor in Chart Retrieval.


                                                                   Finally, I would like to thank all the Medical Records Team for
                                                                   hard work and dedication and look forward to a challenging
                                                                   2007.


                                                                   Alan Mc Namara
                                                                   Medical Records Manager

58
                                                                          General Support Services Reports



Purchasing and Supplies Department                                range of cleaning products driven mainly by infection control

There was an increased throughput of work in the Purchasing       and colour coding has increased significantly.

and Supplies Department in 2006. Apart from IT,
                                                                  The hospital is getting busier with additional departments,
Bioengineering and Maintenance orders generated from the
                                                                  additional products, expanding client base, changing
Purchasing Department, the number of stock orders has
                                                                  operational requirements and additional and changing
increased by 40% in the past four years.There has also been
                                                                  legislation; the increased hospital activity increases our
an increase in the number of trolley loads of stock distributed
                                                                  challenge of meeting all our user requirements making them
around the hospital in the same period - by 100 %!
                                                                  more demanding and more complex. Working with the same
                                                                  staffing compliment to meet these additional requirements
Two large consumable contracts were processed during the
                                                                  means we have had to work smarter and encourage our
year and contracts awarded to suppliers as part of the Dublin
                                                                  suppliers to work smarter. Challenging times ahead! The Team
Maternity Hospitals Joint Tendering programme. Cost savings
                                                                  Based Performance Management programme which was
accrued in both competitions (Stationery and Household)
                                                                  piloted in the hospital last year was found to have been
mainly due to the inclusion of product alternatives and a
                                                                  successful. As part of this initiative going forward, we have
significant change in the Supplier base.                          formed a Central Supplies team to focus on these challenges
                                                                  and have set four objectives for the coming year. It will be
The accreditation process in 2005 refocused our thinking on       interesting to reflect at the end of the year to see how we
systems and procedures and provided a natural impetus for us      have progressed.
to achieve our objective - Getting it right first time… Right
Goods, Right Suppliers, Right Quality, Right Quantity, Right      Again, I would like to thank a hard working staff for their
Place, Right Time, Right Price.The accreditation process also     commitment and dedication to the work they do for the
kept us busy managing all the queries and associated              hospital.
paperwork that governs the procurement and supply chain
cycles; the Hygiene Audit and imminent quality improvements       Gerry Adams
has impacted on the work undertaken in the Department.The         Purchasing & Supplies Manager




           Purchase Orders (stock) volume                                            Trolley Numbers throughput


3500                                                               2500
                                                                                                                               2457
                                             3374       3404
3300                                                               2250

3100                                                               2000                                          2075


2900                             2938                              1750
                                                                                                    1618
2700                                                               1500
                     2663
                                                                                          1409
2500                                                               1250
                                                                              1227
         2439
2300                                                               1000

2100                                                                750

1900                                                                500

1700                                                                250

1500                                                                  0
         2002        2003        2004       2005        2006                  2002        2003      2004        2005           2006




                                                                                                                                      59
     The National Maternity Hospital, Holles Street Annual Report 2006



     Partnership                                                        Quality and Accreditation Department
     Partnership can be described as a relationship between             According to the current health strategy- ‘Quality and Fairness:
     management, unions and staff aimed at improving the hospital       A Health System for You’ (Department of Health and
     as a workplace and the quality of service we provide to our        Children, 2001), gaining people’s trust in the health system is
     service users.                                                     about guaranteeing quality.Trust requires that deficiencies in
                                                                        the system are identified, corrective actions taken and future
     The success of Partnership is evident in the National              progress monitored.
     Maternity Hospital with the enhanced communications and
     inclusive multidisciplinary approach being adopted as we go        In applying for accreditation the National Maternity Hospital
     about our daily business.The Communications Committee (a           has undertaken to continue to develop a quality system that
     sub group of Partnership) has played a key role in this cultural   assists healthcare professionals in providing the best possible
     shift and are to be commended for their work which includes        level of care for our service users.This is accomplished by:
     the “Special Delivery” staff newsletter.
                                                                        -    Identifying and acting on the key areas relating to
     The Partnership Committee consists of an equal number of                patient/client safety
     management and union nominees.The hospital management              -    Utilising a framework (accreditation standards) to help
     nominated Mary Brosnan, Lauri Cryan, Marie Culliton, Michael            evaluate and improve the key aspects of care/service
     Lenihan, and Tony Thompson. Margaret Cooke and Bronwyn                  delivery
     Redmond were nominated by the INO, Shay Higginbotham by            -    Self-assessing the service provided on a regular basis and
     the Crafts Union, Mary Hunter by the MLSA, Belinda                      implementing improvements where identified
     McCarthy by IMPACT and Pat Tobin by SIPTU.                         -    Inviting independent external surveyors to validate the
                                                                             service being provided
     We were nominated as co-chairs by management and unions            -    Utilising the findings of independent surveyors to
     respectively. In addition, the expertise and services of Seosamh        continuously improve
     O'Maolalai, Partnership facilitator from the National Health
     Service Partnership Forum, have been extremely beneficial in       The main theme of the quality improvement programme in
     guiding us on the path to true Partnership.                        the hospital is to continue to nurture an environment
                                                                        whereby all staff are focussed on the need to ensure that the
     Partnership has become an integral part of the hospital’s          quality of services being delivered are of the highest standard
     operations and will be centrally involved in the future            and that the women and babies attending our services are our
     challenges facing us all in the evolving healthcare environment.   priority.
     We look forward to 2007 and beyond and, through
     Partnership, are better positioned to meet any challenges the      2006 continued to be a very busy year as each of the seven
     future may hold.                                                   accreditation teams progressed their identified quality
                                                                        improvement plans. A progress report was submitted to the
     Finally, we would like to take this opportunity to thank
                                                                        Irish Health Services Accreditation Board in November 2006.
     everyone involved for embracing the Partnership approach
                                                                        Two of the peer review surveyors are due to do an on-site
     which benefits everyone.
                                                                        visit in May 2007.

     Tony Thompson, General Services Manager
                                                                        Working with an evolving clinical governance structure, the
     Belinda McCarthy, IMPACT Representative
                                                                        primary function of the Quality/Accreditation Manager relates
     Partnership Co-Chairs
                                                                        to accreditation and actively promoting a culture of
                                                                        continuous quality improvement with the patient at its centre.
                                                                        Collaboration with those responsible for risk management,
                                                                        health and safety and patient complaints and involvement in
                                                                        the patient service user forum is an integral part of this


60
                                                                          General Support Services Reports



function. Attendance at the 2006 International Society for         Patient Service User Panel
Quality in Healthcare conference has enhanced the facilitation     This group is composed of interested members of the public,
of quality initiatives.
                                                                   including some past patients, from a diverse range of
                                                                   backgrounds who, together with hospital staff, meet on a
The National Maternity Hospital participated in the HSE
                                                                   monthly basis to consider and recommend improvements to
Quality and Safety week from the 23rd – 27th October 2006
                                                                   the services offered by the hospital to its patients.
and received a “Highly Recommended” Certificate as we
demonstrated outstanding work in the acute services sector.
                                                                   Following recruitment of new members towards the end of
The hospital was particularly commended for its safety
                                                                   2005, the expanded group had its first meeting in February
statement, quality initiatives, and communication skills and for
                                                                   2006 and is going from strength to strength.      The group
an enormous effort made during HSE quality and safety week.
                                                                   work in close liaison with staff members by examining ways in
Over two hundred staff attended the various sessions and
                                                                   which service delivery can be improved.
daily prizes were awarded.The overall competition prize
winner’s slogan was:
                                                                   Successful initiatives to date include the audit and revision of

‘Safety is everybody’s business and if we’re safe - you’re safe’   patient satisfaction survey questionnaires and the introduction
                                                                   of a new hospital visiting policy.
Ann Delany
Quality/Accreditation Manager                                      The Patient Service User Panel are currently reviewing the
                                                                   hospital’s internet site and are involved in developing ideas to
                                                                   improve the facilities in the hospital’s reception area.


                                                                   This highly progressive panel is consumer-driven, progressive
                                                                   and pro-active and the hospital is benefiting greatly from their
                                                                   impartial advice.

Baby Neasa on her mother’s shoulder, photo taken by her dad.




                                                                                                                                      61
     The National Maternity Hospital, Holles Street Annual Report 2006



     Staff Satisfaction Survey
     A number of sessions took place to inform and consult with staff following publication of the main findings from the 2006 staff
     satisfaction survey.The results were also compared with the findings of the 2005 survey.The confidential questionnaire invited staff
     to air their views across 9 categories ranging from job satisfaction to communications to hospital facilities. Whilst the number of
     completed questionnaires was down (2006 = 250, 2005 = 145) and some of the results were disappointing the vast majority were
     positive with some showing an increase in the positive rating (or a decrease in the negative rating!). Below is a flavour of some of
     the results:


     Statement:         I like my job
     Result:            88% responded positively (same in 2005)


     Statement:         I am satisfied with the level of stress in my job
     Result:            42% responded negatively (44% in 2005)


     Statement:         I receive adequate support from my manager
     Result:            66% responded positively (58% in 2005)


     Statement:         The level of staff in my area is adequate
     Result:            62% responded negatively (64% in 2005)


     Statement:         I am satisfied with the methods used by hospital management to communicate with me
     Result:            61% responded positively (39% in 2005)


     A copy of the presentation made at the staff sessions was made available on the hospital intranet site.




62
                                 Accounts and Statistics




The National Maternity Hospital 2006




Accounts and Statistics




                                                           63
     The National Maternity Hospital, Holles Street Annual Report 2006




     Accounts
     Income and Expenditure
     Extracts from the Hospital Income and Expenditure Account for the Year Ended 31 December 2006

                                                                                          2006        2005
                                                                                         €’000       €’000
     Ordinary Income
     Miscellaneous                                                                        2,232        2,058
     Treatment Charges                                                                    8.194        6,890
                                                                                        ––––––       ––––––
                                                                                         10,426        8,948
                                                                                        ––––––       ––––––
     Ordinary Expenditure - Pay
     Medical NCHD’s                                                                       3,859        3,584
     Consultants                                                                          4,334        3,552
     Nursing                                                                             19,832       17,844
     Para-Medical                                                                         3,255        3,058
     Housekeeping                                                                         2,288        1,985
     Catering                                                                             1,046        1,036
     Porters                                                                                958          925
     Maintenance                                                                            243          227
     Administration                                                                       4,941        4,538
     Pensions                                                                             2,273        2,147
     VHSS Lump Sums                                                                         421          658
     VHSS Refunds                                                                            45           44
                                                                                        ––––––       ––––––
                                                                                         43,495       39,598
                                                                                        ––––––       ––––––
     Ordinary Expenditure - Non Pay
     Medicines, Blood & Gases                                                             2,032        1,911
     Laboratory Expenses                                                                  1,071        1,018
     Medical and Surgical Appliances                                                      2,581        3,024
     X-Ray Expenses                                                                          61           64
     Provisions                                                                             486          461
     Heat, Power and Light                                                                  330          269
     Cleaning and Washing                                                                   692          651
     Furniture, Hardware and Crockery                                                       152          204
     Bedding and Clothing                                                                    78           85
     Maintenance                                                                            598          731
     Transport and Travel                                                                   232          259
     Finance                                                                                936          701
     Office Expenses                                                                      1,004          917
     Education,Training                                                                     442          462
     Computer Expenses                                                                      534          564
     Miscellaneous                                                                        1,525        1,606
                                                                                        ––––––       ––––––
                                                                                         12,754       12,926
                                                                                        ––––––       ––––––

     Deficit for Year
     Excess of Expenditure over income                                                   45,823       43,576
     Less: Annual Allocation                                                             45,417       40,478
                                                                                        ––––––       ––––––
     Deficit                                                                              - 406      - 3,098
                                                                                        ––––––
                                                                                        ––––––       ––––––
                                                                                                     ––––––

64
                                                                                      Accounts and Statistics



Cumulative Figures
Extracts from the Hospitals Income and Expenditure Account For the Year Ended 31 December 2006


                                                                                     2006                   2005
                                                                                    €’000                  €’000
Deficit Brought Forward                                                              - 373                    - 35
Deficit Transferred from Income & Expendiiture                                       - 406                   - 339
                                                                                   ––––––                  ––––––
Deficit Carried Forward                                                              - 779                   - 373
                                                                                   ––––––                  ––––––



Balance Sheet
Extracts from the Hospitals Balance Sheet as at 31st December 2006



                                                                       2006          2006         2005      2005
                                                                      €’000         €’000        €’000     €’000


Fixed Assets                                                                        62,497                 62,734


Current Assets
Stock                                                                    579                        561
Debtors                                                                8,045                      7,874
Cash & Bank                                                               17                          17
                                                                     ––––––                      ––––––
                                                                       8,641                       8,435
                                                                     ––––––                      ––––––


Current Liabilities
Bank Overdraft                                                         3,287                      3,010
Creditors                                                              6,091                       5,757
                                                                     ––––––                      ––––––
                                                                       9,378                       8,766
                                                                     ––––––                      ––––––


Net Current Assets                                                                   - 737                   - 331


Non Current Liabilities/Assets
Trust Fund Loan                                                                      - 282                   - 282

                                                                                   ––––––                  ––––––
Net Assets                                                                          61,478                  62,121
                                                                                   ––––––                  ––––––


Represented by:
Capitalisation Account                                                              62,215                 62,452
Accumulated (Deficit)                                                                - 779                   - 373
Other Funds                                                                             42                      42
                                                                                   ––––––                  ––––––
                                                                                    61,478                  62,121
                                                                                   ––––––
                                                                                   ––––––                  ––––––
                                                                                                           ––––––




                                                                                                                     65
     The National Maternity Hospital, Holles Street Annual Report 2006



     Statistics for the National Maternity Hospital
     See page (72) for Definitions

     Mothers Delivered                     1997       1998         1999       2000         2001     2002   2003     2004       2005         2006


      Primip                               3336           3572     3469       3427         3551     3646   3747     3740          3268      3579
      Multip                               4210           4242     4065       4295         4429     4376   4508     4578          4225      4407
      Total                                7546           7814     7534       7722         7980     8022   8255     8318          7493      7986

      % Primip                             44.2%      45.7%        46.0%      44.4%        44.5%   45.5%   45.4%    45.0%     43.6%         44.8%



          8500                                                             Mothers Delivered
                                                                                                            8318
                                                                                                    8255

          8000                                                               7980
                                                                                           8022
                                                                                                                                     7986
                                    7814
                                                                 7722

          7500        7546                         7534                                                                7493



          7000


          6500


          6000
                      1997          1998       1999              2000        2001          2002     2003    2004       2005          2006

         Community Midwives                                 2000           2001           2002      2003     2004       2005             2006

         Deliveries                                          167            235            263       284      268           297           292


               350                                                Community Midwives Deliveries


               290                                                                                            297             292
                                                                                    284
                                                                                                   268
                                                                   263

               230                             235




               170           167



               110


                 50
                             2000             2001                2002              2003           2004      2005             2006



66
                                                                                 Accounts and Statistics




Emergency Room Attendance          2000          2001            2002     2003    2004     2005       2006

Obstretic/Gynaecology              3534          3935            4237     4306     4566    4698       5491
Paediatric                          750           547             608      741      892     747         823
Total                              4284          4482            4845     5047     5458    5445        6314




                                    Emergency Room Attendances

        6500
        6250                                                                                   6314

        6000
        5750
        5500
                                                                         5458       5445
        5250
        5000                                              5047

                                          4845
        4750
        4500                4482

        4250     4284

        4000
                2000        2001       2002              2003           2004       2005       2006



Fetal Asessment                    2000          2001            2002     2003    2004     2005       2006

Attendances                        18034         17192       17784       19224    20673    20257      20848


                                    Fetal Assessment Attendances
   21500
   21000
                                                                                              20848
                                                                        20673
   20500
                                                                                   20257
   20000
   19500
                                                         19224
   19000
   18500
   18000       18034
                                      17784
   17500
                        17192
   17000
   16500
               2000     2001          2002               2003           2004       2005       2006




                                                                                                              67
     The National Maternity Hospital, Holles Street Annual Report 2006




      Theatre Activity                     2000            2001           2002    2003    2004      2005        2006

       Major Operations                    1562             1671          1775     1921    1958      1947       2043
       Minor Operations                    1972             1808          1885     1782    1735      1890       2020
       Total                               3534             3479          3660     3703    3693      3837       4063




                                                     Major Operations                                  2043
           2000
                                                                                 1958      1947
                                                                   1921

           1850

                                               1775

           1700
                                  1671


           1550        1562




           1400


           1250
                       2000       2001         2002                2003          2004      2005        2006


       Inpatient Discharges                2000            2001       2002        2003    2004      2005        2006

       Obstetric                           11878           12113      12621       12986   13547     13207       13924
       Gynaecology                          1122            1380          1303     1195    1064      1108         973
       Paediatrics                           854             917          1061     1067    1057      1042        1225
       Total                               13854           14410      14985       15248   15668     15357       16122

                                                    Inpatient Discharges                                16122
               16000

                                                                                  15668
               15500
                                                                                            15357
                                                                    15248

               15000                               14985



               14500
                                   14410


               14000
                          13854


               13500
                          2000     2001            2002             2003          2004      2005        2006



68
                                                                           Accounts and Statistics




ALOS                          2000        2001            2002     2003     2004    2005       2006

Obstetric                      2.92        2.89           2.80      2.69     2.63    2.58       2.63
Gynaecology                    3.35        3.12           2.95      2.98     3.35    2.93       3.19
Paediatrics                   12.10       10.38           9.68      9.10    10.11    9.87       8.55
Total                          3.52        3.39           3.30      3.16     3.18    3.10       3.11




        4.0                       Overall Average Length of Stay



        3.5   3.52
                      3.39
                                  3.30
                                                  3.16           3.18
                                                                             3.10      3.11
        3.0



        2.5



        2.0
              2000    2001        2002            2003           2004       2005      2006


Outpatient Activity           2000        2001           2002      2003     2004    2005       2006

Obstetrics                    36079       32967       34797       36271    36256    34435      34884
Gynaecology                    9064        8649           9278     9341     9512    9462       9747
Paediatric                     4305        3969           4325     4335     4155     4123       4244
Total                         49448       45585       48400       49947    49923    48020      48875


                                      Out Patient Attendances
   52500

   51000

                                                  49947          49923
   49500      49448
                                                                                       48875
                                  48400
   48000                                                                    48020


   46500
                      45585
   45000

   43500

   42000
              2000    2001        2002            2003           2004       2005       2006



                                                                                                       69
     The National Maternity Hospital, Holles Street Annual Report 2006




                            2006: Inpatient and Daycare Admissions by Speciality


                                         7%
                                                                                   Obstetric

                             10                                                    Gynaecology

                                                                                   Paediatric




                                                                      83%




       Bed Days Used                 2000       2001      2002       2003      2004             2005    2006

       Obstetric                     34627     35061      35313     34900     35594             34095   36562
       Gynaecology                    3756       4304      3846      3567      3560              3249    3108
       Paediatrics                   10333       9518     10275      9707     10682             10282   10476
       Total                         48716     48883      49434     48174     49836             47626   50146




       IP + DC Admissions            2000       2001      2002       2003      2004             2005    2006

       Obstretic                     11873     12117      12629     12968     13572             13192   13924
       Gynaecology                    1766       1829      1757      1669      1986              1490    1705
       Paediatrics                     865        908      1063      1061      1057              1042    1225
       Total                         14504     14854      15449     15698     16615             15724   16854




70
                                                                                        Accounts and Statistics



                                       2006 Caesarean Sections Analysis: 10 Groups

                                                                                   Caesarean      All        Caesarean
                                                                                    Sections   Deliveries   Section Rate


All Deliveries                                                                       1509        7986          18.3%


Nulliparous women with a single cephalic pregnancy, at greater than or equal to
                                                                                      143        2153          7.3%
37 weeks gestation in spontaneous labour


Nulliparous women with a single cephalic pregnancy, at greater than or equal to
37 weeks gestation who either had labour induced or were delivered by                 272         924           28%
caesarean section before labour
                                               Caesarean Section Not in Labour        83          83           100%


Multiparous women, without a previous caesarean section, with a single cephalic
pregnancy at greater than or equal to 37 weeks in spontaneous labour                  25         2509          1.7%


Multiparous women, without a previous caesarean section, with a single cephalic
pregnancy at greater than or equal to 37 weeks gestation who either had labour        34          762          5.0%
induced or were delivered by caesarean section
                                               Caesarean Section Not in Labour        62          62           100%


All multiparous women, with at least one previous caesarean section and a single
cephalic pregnancy at greater than or equal to 37 weeks gestation                     435         748          56.4%


All nulliparous women with a single breech pregnancy                                  152         166          88.4%


All multiparous women with a single breech pregnancy including women with
previous caesarean sections                                                           87          98           88.9%


All women with multiple pregnancies, including women with previous
caesarean sections                                                                    52          102          53.8%


All women with a single pregnancy with a transverse or oblique lie, including
                                                                                      33          33           100%
women with previous previous caesarean sections


All women with a single cephalic pregnancy at less than or equal to 36 weeks
                                                                                      131         346          34.9%
gestation, including women with previous caesarean sections

Total Multips                                                       4407 (55.2%)
Total Nullips                                                       3579 (44.8%)




                                                                                                                           71
     The National Maternity Hospital, Holles Street Annual Report 2006



     Annual Report Statistics for the National Maternity Hospital - Definitions
     Emergency Room Attendances:
     Obstetric/Gynaecology: Figures based on ‘Casualty’ attendances between 4pm and 8am weekdays and 24 hours a day on weekends
     and bank holidays.These attendances are seen in the Fetal Assessment Unit and are audited by Mary Finnegan, Casualty Nurse who
     returns them to me monthly.


     ‘Casualty’ (Unbooked) attendances during normal working hours are seen in the Fetal Assessment Unit and are accounted for in
     their figures (below).


     Paediatric: Figures relate to baby visits to the ‘Baby Couch’ when the Baby Clinic is closed (after 1pm weekdays and 24 hours a day
     on weekends and bank holidays)


     Fetal Assessment Attendances
     Attendances at Fetal Assessment during normal office hours: 8am – 4pm weekdays
     These can be classified into the following groups:
     • Early Pregnancy Assessment Unit
     • All Booked Attendances
     • Fetal Echo
     • High Risk
     • Rhesus
     • Unbooked/Emergency*
     *these are unbooked attendances (referrals from Outpatients) and attendances by Inpatients on wards.


     Theatre Activity
     Major Operations: This figure reflects the number of women who had at least one major operation.
     Minor Operations: This figure reflects the number of women who had at least one minor operation and no major operations.


     Inpatient Discharges
     Reflects the number of discharges of patients who stayed in the hospital for at least one night; therefore Day Cases excluded.


     Outpatient Activity
     Includes all attendances at the Outpatient clinics between 8am and 4pm weekdays. Does not include attendances at Fetal
     Assessment, Synagis or any Unbooked Obstetric or Gynaecology Attendance.


     Inpatient and Day Case Admissions
     All Obstetric Day Cases are considered by the Health Service Executive as being Inpatients having used one bed day. All Day Cases
     are included as Gynaecology where Admission and Discharge date are the same.




72

				
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