Context According to the British Association of Perinatal Medicine Categories of Care 2011, a baby receiving transitional care (TC) must be resident with the mother.
Problem TC admissions and neonatal intravenous antibiotic administration (n-IVAB) on the neonatal unit (NNU), which was geographically remote from the postnatal ward, resulted in mother-baby separation soon after birth and suboptimal documentation.
Assessment of problem and analysis of its causes Three audits over four months in 2012 showed that:
3–10% of admissions to NNU represented between 23–62 TC bed days per month
There were 905 episodes of n-IVAB administration
Only 30% of TC babies had complete/accurate documentation, 59% had an incomplete/inaccurate record and 11% were not recorded at all
Engaging staff Audit results were presented to the stakeholders in a combined meeting across Maternity, Neonatal, Divisional Management, Pharmacy and Estates Departments
Strategy for change
Agreed criteria for admission to the TCW
Introduced a proforma to allow accurate documentation for each TC admission, management and discharge plan
Delineated a transitional care ward (TCW) within the postnatal ward
Provided 24 h TCW cover with allocated neonatal nurses administering n-IVAB and undertaking neonatal observations
Adopted the Neonatal National Early Warning Score (nNEWS) for recording observations on TC babies
Initiated midwifery training in checking neonatal drugs and providing opportunities for practice development in neonatal care
Measurement of improvement Following implementation, a 4 week pilot showed 34 TCW admissions and 183 episodes of n-IVAB administration on TC, matching previous TC activity and now no longer required to be undertaken on NNU.
Effects of change All TC babies are now managed on TCW, preventing mother-baby separation and allowing improved quality of care via a new neonatal/maternity working partnership.
Lessons learnt Service improvement to an inefficient but established NHS system has proved challenging because of changes required to the physical working environment and the impact on staff of new working patterns and documentation.
Message for others The implementation of a neonatal TCW has been achieved by motivating buy in from diverse stakeholders, excellent interpersonal skills and a solution-based approach focussed on keeping TC babies together with their mothers to improve quality of care.