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Training package for midwives developed in the Thames Valley shortlisted for national patient safety awards

Patient Safety Awards 2020 - Finalist - Patient Safety Innovation of the YearA new online training course to improve the safety of women and babies in labour is in the running for three national awards.

The interactive programme is the first to integrate real fetal heart sounds, helping midwives provide safer care when they monitor a baby’s heartbeat in the womb. This approach, known as intelligent intermittent auscultation (IIA), will benefit tens of thousands of low-risk pregnant women across the country who receive midwife-led care every year – approximately one in three pregnancies.

IIA is the recommended method of monitoring the heart rates of babies in the womb during low risk labour. It is a practical skill required of all midwives in any birth setting. The training enables midwives to make an assessment of how the baby is coping with the stress of contractions based on what they are hearing and take the right next steps. It is designed to provide reassurance for well babies and to prompt rapid escalation and a move to continuous electronic fetal monitoring if appropriate.

The free programme was developed by the Oxford Academic Health Science Network with consultant midwives Christine Harding (Royal Berkshire Hospital, Reading) and Wendy Randall (Oxford University Hospitals) with valuable input from the OxSTaR Centre, the University of Oxford’s medical simulation, research and teaching facility.

Eileen Dudley, Patient Safety Manager at the Oxford AHSN, said: “This is a fantastic example of how the sharing of ideas, knowledge and resource can bring improvements in patient safety. By creating local solutions and being willing to share these, the team has proved that you can have a positive impact on national patient safety in a relatively short space of time.”

Christine Harding said: “I am absolutely thrilled that our work has been shortlisted for these awards. We believe improving the accuracy of intelligent intermittent auscultation is vital for keeping mothers and babies safe so being recognised by the HSJ Patient Safety Awards is just fantastic.”

Wendy Randall said: “Christine and I are delighted with the recognition this project has received. We feel that the education and assessment that it offers enables more consistent and safer practice in assessing fetal wellbeing in labour.”

Helen Higham, Director of the OxSTaR Centre, said: “The innovative use of technology to enhance learning in this training means that midwives have a much more realistic experience and have multiple opportunities to practice the skill of auscultation. Our Chief Technician Alan Inglis worked to ensure the recordings of the fetal heart sounds accurately reflected the baby’s response both when labour is progressing normally and where there are signs of deterioration. The ability to differentiate normal from abnormal heart sounds is vital in the rapid escalation of care for these more worrying cases.”

Alison Provins, Lay Partner at the Oxford AHSN, said: “This initiative deserves its place on the shortlist for so many reasons, but above all it highlights what happens when everyone works together. By working with their clinical colleagues, Oxford AHSN gave them the confidence, resource and local contacts to achieve what they knew was needed. The result is a tangible impact on patient safety and a reminder that when the NHS works as a ‘national’ organisation everyone benefits.”

This is the only training package that assesses competency in intermittent auscultation to meet the requirements of the Saving Babies’ Lives version 2 care bundle for reducing perinatal mortality. Improving knowledge and skills improves safety for mother and baby by ensuring midwives are better able to identify abnormalities in the fetal heart rate pattern and/or changes in the mother’s level of risk and take prompt action.

It is available to all midwives in England through the Health Education England e-LfH (e-Learning for Healthcare) platform.

Martin Sinclair, Programme Lead at HEE e-LfH, said: “The team were great to work with and we welcomed the opportunity to help create a resource to improve the knowledge, skills and confidence of midwives to undertake intermittent auscultation safely and effectively to improve safety for women in labour.”

Since its launch in January 2020, more than 2,000 people have accessed the training package. A supporting webinar created by the Oxford AHSN has had more than 400 views on YouTube and a short introductory video has been seen almost 4,000 times.

The programme is shortlisted in the following categories of the HSJ Patient Safety Awards:

  • Patient Safety Innovation of the Year
  • Maternity and Midwifery Services Initiative of the Year
  • Patient Safety Education and Training Award

This initiative has already received national recognition including winning the Contribution to Midwifery Education at The British Journal of Midwifery Practice Awards and judged the top poster submission at the National Maternity and Perinatal Audit/Each Baby Counts conference, both in 2019.