Patient Safety and Clinical Risk in Neonatal Care

By John Tingle                                     

The CQC (The Care Quality Commission)  is the independent regulator of health and adult social care in England. They make sure that health and social care services provided to people are safe, effective, compassionate, high-quality care and they encourage care services to improve. The  CQC inspects health facilities and they have important statutory regulatory powers and sanctions.They have recently produced a report on neonatal care and  on  providing care for infants in the community who need respiratory support. As well as some positive findings, the report does reveal a number of major patient safety risks and failings.

In England, one in every nine babies is born needing care from neonatal services and  this is on the increase. The care process here can be challenging with sick babies with complex health needs receiving hospital care and then care at home and in the community. The care of the baby traverses’ distinct pathways or care areas and sometimes problems can occur:

A lack of consistency in care and communication across a pathway can result in poor outcomes for both babies and parents.” (p.3)

The report looks at current practice in three different aspects of care:

  1. Detecting fetal anomalies and handing over care for babies with a suspected or known fetal anomaly between antenatal, obstetric and neonatal services.
  2. Identifying, and managing the care of, newborn babies whose condition could deteriorate (with a focus on diagnosing and managing hypertension).
  3. Managing care for infants in the community who need respiratory support (with a focus on managing respiratory support technologies, including tracheostomies.The report found national provision to be inconsistent:

“Across England, NHS trusts are using a range of different processes to identify and manage clinical risk in newborn babies and infants. We believe that this inconsistency is partly a result of the limitations of the available national guidance, which is not sufficiently detailed for this area of care.”(p.4)

On one visit to a hospital the CQC identified a lack of any antenatal clinical notes within new-born babies notes, including scans. This is a patient safety breach and is an illustration of how such lapses can have a knock on effect in the care process and lead to adverse events occurring to the patient.The report found that there was variability in the way that care facilities flagged risks such as fetal anomalies in the maternal record.They  found evidence of variation in the monitoring of blood pressure in new-born babies. Only one hospital that the CQC visited had developed guidelines that specifically outlined diagnosing neonatal hypertension.The report does contain some positive findings about care services provided in this area but there are also a lot of uncomfortable negatives which tend to over shadow the good findings particularly in the area of communication which is a prime cause of adverse patient safety incidents.

John Tingle

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I am also a Patient Safety Specialist at ECRI Institute. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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