Examples of safety critical processes and prioritisation on newborn units
| Task/work focus | Observations/experience | Prioritisation |
| Full assessment and documentation of admission by medical and nursing teams. | Documentation tasks regarded as professional norms may be prioritised over clinical needs. | Agree clear rules on elements of documentation and clinical action that are critical and those that can be deferred to a lower workload period. |
| Cleaning/disinfecting equipment, incubators/cots as part of infection control. | Task commonly informally delegated to mother or unskilled worker with limited supervision. Frequently not completed. | Agree formal delegation of selected tasks and process of supervision and monitoring. Plan training of unskilled staff to standardise practice and maintain safety. |
| Checking and documenting babies’ vital signs and routine weighing. | Workforce deficits mean recommended frequency rarely achieved. Observations commonly missed, poorly done or sometimes guessed. | Prioritise patient groups by need and illness severity. Develop consistent approach to delegation. Make clear that inaccurate information may be worse than absent information. |
| Feeding baby prescribed milk volumes through an existing oro/nasogastric tube. | Often informally delegated to mother or unskilled worker. Frequently missed completely at night. | Formalise task sharing or delegation. Train unskilled personnel or family members. Skilled staff check tube position at agreed intervals. |
| Checking prescribed drug dose calculations during ward rounds. | Inexperienced medical staff may not be familiar with neonatal prescribing. Nurses may be reluctant to challenge doctors. | Agree dose calculation checking as core responsibility of medical team. Empower all team members to identify and correct errors. Recognise this as a positive intervention and learning opportunity. |
| Administering oral and intravenous drugs. | Time-pressure results in poorly executed procedures and informal delegation to students, unskilled workers and parents. | Identify high-risk medicines and prioritise as professional nursing task. Consider planned delegation for less critical medicines (eg, oral vitamins). |