From the NNAP annual conference in summer 2022
Our National Neonatal Audit Programme (NNAP) held its first conference in more than three years this past June. Delegates joined in person and online, and we had overwhelmingly positive feedback. Here's a summary of the QI projects shared at the event, with links to watch the full presentations.
Conference attendees had the opportunity to submit posters outlining local quality improvement projects they had been involved in. Three posters were selected from the entries, and these delegates were invited to present their work during a QI slot at the conference.
All three projects relate to specific NNAP measures and demonstrate how the initiative improved results for that measure in the unit.
ROP screening
The first project focused on screening of retinopathy of prematurity (ROP). Dr Yee Mon Aung outlined how her hospital in Whitehaven contributed to the Northern Neonatal Operational Delivery Network (ODN) being a negative outlier for this measure and what was done to address this issue.
After reviewing the results for the period 2018-2020, a multidisciplinary team approach was adopted to improve screening rates. Neonatal and ophthalmology colleagues worked together to create a ROP screening form that is now used routinely for all eligible babies. This free and simple tool has proved to be very effective. The hospital’s results for ROP screening have improved from 60% in 2020 to 100% in 2021.
RCPCH has updated the clinical guideline on UK screening of ROP, in collaboration with Royal College of Ophthalmologists (RCOphth) and British Association of Perinatal Medicine (BAPM).
Based on this guideline, the NNAP team has created an ROP screening calculator. This Microsoft Excel file can help plan the timing of the first ROP screening appointment for eligible babies.
Optimal cord management
The second project focused on optimal cord management (OCM), or deferred cord clamping, which was introduced as an NNAP measure in 2020. This work was presented by Anda Bowring, Advanced Neonatal Nurse Practitioner, at Oxford University Hospital NHS Foundation Trust.
Anda explained that the NNAP results in 2020 for OCM in the Thames Valley Network were below the national average. This provided the impetus to start the QI project to improve results for this measure. Despite challenges such as pandemic-related staff fatigue and resistance to change, by collaborating with perinatal and theatre teams and providing regular training, rates of OCM in the Oxford Academic Health Science Network improved by 30% between March 2020 & March 2022.
You can see case studies on OCM:
Optimising early maternal breastmilk
The third project focussed on optimising early maternal breastmilk at St Mary’s Hospital, Manchester, presented by Dr Nithya Laksmipathy. This project was a response to data from the NNAP annual report on 2020 data which highlighted the challenges St Mary’s had with achieving good rates of early maternal breast milk (MBM) feeding. The neonatal team identified the barriers to achieving good rates and supported the implementation of the five perinatal core elements to optimise early MBM for preterm babies as outlined in the BAPM MBM toolkit.
Infant feeding champions were key to the success of this work which underwent 3 PDSA cycles. MBM feeding rates improved from 76.6% in 2020 to 83.2% in 2021.
The project was featured as a case study in the NNAP annual report on 2020 data.
Other presentations at the NNAP conference
These included: Overview of the NNAP, Two year follow up, PERIPrem, Using the NICE guidelines to influence infection prevention, prevention of intraventricular haemorrhage, HUG: involving families & health inequalities.