A modified WHO ‘sign out’ to improve neonatal safety following caesarean section

 

Dr Laura Bremner1, Dr Katherine Barrett1, Dr ShriyaVarghese1, Dr Ayesha Ahmad1, Dr Shuchen Zhang1, Dr Kar Yan Chong, Dr Khadija 

Ben-Sasi2 and Ms Roshan Zeirideen-Zaid1

 

1Department of Women’s health, Northwick park Hospital, London Northwest University Healthcare Trust

1Department of Neonatology, Northwick park Hospital, London Northwest University Healthcare Trust

 

BACKGROUND

The World Health Organisation (WHO) Surgical Safety Checklist has been shown to reduce perioperative maternal morbidity and mortality worldwide1. Whilst the maternity ‘sign out’ checklist has a section pertaining to labelling of the baby and taking cord bloods and or gases it does not address immediate neonatal care needs. As such, the paper checklist used at Northwick Park Hospital was adapted to include three neonatal specific questions relating to thermoregulation, monitoring blood glucose and completing the ‘keeping mothers and babies together’ post-natal record.

 

METHOD

1.Review of current practice

In October 2022, an audit of the weekly term admissions and monthly  neonatal morbidity and mortality meetings at Northwick Park Hospital was carried out

2. Implementing change

Adaptation of the maternity sign out checklist

3.Measuring outcome 

Checklist quality was evaluated by measurement of checklist completion and active participation. Results of the modified ‘sign out’ checklist were obtained through the ongoing review of term admissions and neonatal morbidity and mortality meetings.

 

AIM

The aim was to reduce avoidable admissions to NNU following ELCS at term

 

RESULTS

In May 2023, a re-audit of the weekly term admissions and monthly neonatal morbidity and mortality meetings at Northwick Park Hospital was carried out

 

Findings

-The new process was well received.

-Compliance with completing the amended ‘sign out’ checklist was 73%. The main limitation being the delay in receiving the new maternity perioperative safety checklist from the printers. In the interim an additional form with the three new questions was designed and printed to be used and attached to the existing safety checklist

-From January 2022 – October 2022 there were124 term admissions to NNU. 18 of these wereinfants born via ELCS. 6 were deemed avoidable, of which 3 were deemed to be secondary to incorrect or substandard immediate neonatal care relating to a failure to recognise the risk of hypoglycaemia, a failure to thermoregulate. 

-From November 2022 – May 2023 (following introduction of the amended ‘sign out’ checklist there were 65 term admissions to NNU. 9 of these were infants born via ELCS. 2 were deemed avoidable, of which none were deemed to be secondary to incorrect or substandard immediate neonatal care relating to a failure to recognise the risk of hypoglycaemia, a failure to thermoregulate.

 

CONCLUSION

A modified maternal WHO surgical sign out checklist with specific neonatal safety questions reduced the number of poor neonatal outcomes in term babies born via planned ELCS. This has contributed to overall enhanced safety of newborn babies following ELCS at term. We have extended the checklist for use in all caesarean sections and propose that other maternity units across the country adopt the modified checklist to further understand the potential benefit in neonatal safety.