lisa bacon lsa midwifery officer n.
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  2. Themes from Midwife Investigations - 2011

  3. The North West Picture – 2010/11 • 4,275 midwives • 318 Supervisors of Midwives • Approx 1:13 ratio • April 2010 to March 2011 - 28 supervisory investigations (54 in 2010/2011) • 10 programmes of supervised practice (16 year before) • 7 Programmes successfully completed since April 2011 to date. • In vast majority system failures identified and fed back to service by Supervisors

  4. Key Trends from Supervisory Investigations • Drug errors • Lack of understanding of accountability • Documentation and record keeping • CTG interpretation • Sphere of practice • Communication, including calling for medical staff

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

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

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

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

  9. Summary of themes - clinical • The most consistent – DOCUMENTATION • Failure to recognise deviations from the norm • Inadequate care • Failure to escalate concerns • CTG interpretation • Lack of understanding of accountability

  10. Summary of themes – none clinical • Unprofessional behaviour • Poor communication • Falsifying records or signatures • Telling lies • Poor Teamwork • Lack of assertiveness

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

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

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

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

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