A-Z
Latest

Postnatal care overview

history control tooltip

divider handle tooltip

Postnatal care HAI

About

What is covered

The postnatal care pathway covers the essential core (routine) care that every woman and her baby should receive in the first 6–8 weeks after birth, based on the best evidence available.
Although for most women and babies the postnatal period is uncomplicated, care during this period needs to address any deviation from expected recovery after birth. This pathway gives advice on when additional care may be needed and these recommendations have been given a status level (indicating the degree of urgency needed in dealing with the problem) as follows:
Emergency – life-threatening or potential life-threatening situation
Urgent – potentially serious situation, which needs appropriate action
Non-urgent – continue to monitor and assess.
The pathway includes information about risk factors and inspection for neonatal jaundice and the quality standards on specialist neonatal care and postnatal care. It also covers recommendations from the NICE public health guidance on maternal and child nutrition, which support improvements in the nutrition of breastfeeding mothers and babies beyond the immediate postnatal period. This includes encouraging breastfeeding exclusively for 6 months and supporting women to continue breastfeeding for as long as they choose.

Updates

Information for the public

NICE produces information for the public. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics:
NICE has also written information for patients and the public explaining its quality standards on the following topics:

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

9 May 2014 Minor maintenance updates
6 March 2014 Neonatal jaundice (NICE quality standard 57) added
10 September 2013 A link to the 'Urinary incontinence in women pathway' has been added.
15 July 2013 The postnatal care quality standard has been added to this pathway.
25 January 2013 Minor maintenance updates
21 October 2011 Minor maintenance updates

Short Text

Routine postnatal care of women and their babies

What is covered

The postnatal care pathway covers the essential core (routine) care that every woman and her baby should receive in the first 6–8 weeks after birth, based on the best evidence available.
Although for most women and babies the postnatal period is uncomplicated, care during this period needs to address any deviation from expected recovery after birth. This pathway gives advice on when additional care may be needed and these recommendations have been given a status level (indicating the degree of urgency needed in dealing with the problem) as follows:
Emergency – life-threatening or potential life-threatening situation
Urgent – potentially serious situation, which needs appropriate action
Non-urgent – continue to monitor and assess.
The pathway includes information about risk factors and inspection for neonatal jaundice and the quality standards on specialist neonatal care and postnatal care. It also covers recommendations from the NICE public health guidance on maternal and child nutrition, which support improvements in the nutrition of breastfeeding mothers and babies beyond the immediate postnatal period. This includes encouraging breastfeeding exclusively for 6 months and supporting women to continue breastfeeding for as long as they choose.

Sources

The NICE guidance that was used to create the pathway.
Postnatal care. NICE clinical guideline 37 (2006)
Neonatal jaundice. NICE clinical guideline 98 (2010)
Maternal and child nutrition. NICE public health guidance 11 (2008)
Division of ankyloglossia (tongue-tie) for breastfeeding. NICE interventional procedure guidance 149 (2005)

Quality standards

Neonatal jaundice quality standard

These quality statements are taken from the neonatal jaundice quality standard. The quality standard defines clinical best practice in neonatal jaundice and should be read in full.

Quality statements

Care pathways and guidelines

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

In-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care follow perinatal network guidelines and care pathways that are integrated with other maternity and newborn network guidelines and pathways.

Quality measure

Structure
(a) Evidence of perinatal network guidelines and care pathways for in-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care.
(b) Evidence that perinatal network guidelines and care pathways for in-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care, are integrated with other maternity and newborn network guidelines and pathways.
(c) Evidence of network arrangements to ensure that when a baby is admitted to specialist neonatal care, the mother and any multiple birth siblings can be accommodated in the same hospital during their respective admissions.
Process
(a) Proportion of babies born at less than 28 weeks of gestation who receive intensive care in a neonatal intensive care unit (NICU) within the network.
Numerator: the number of babies receiving intensive care in a NICU within the network.
Denominator: the number of babies born at less than 28 weeks of gestation within the network.
(b) Proportion of babies with antenatally diagnosed fetal malformations requiring early surgery who are delivered at a designated network surgical centre.
Numerator: the number of babies delivered at a designated network surgical centre.
Denominator: the number of babies born within the network with antenatally diagnosed fetal malformations requiring early surgery.
(c) Proportion of babies who are transferred back to their local neonatal unit within 24 hours of request for repatriation.
Numerator: the number of babies transferred within 24 hours of repatriation request.
Denominator: the number of babies transferred back to their local neonatal unit.
(d) Proportion of babies who require neonatal surgery who receive it at a designated network surgical centre.
Numerator: the number of babies undergoing surgery at a designated network surgical centre.
Denominator: the number of babies born within the network who require neonatal surgery.
(e) For singleton births: proportion of mothers who still require inpatient care when their baby is transferred to specialist neonatal care, who are transferred to the same hospital as their baby.
Numerator: the number of mothers transferred to the same hospital as their baby.
Denominator: the number of mothers who still require inpatient care when their baby is transferred to specialist neonatal care.
(f) For multiple births: proportion of babies transferred to specialist neonatal care whose mother and/or multiple birth siblings are transferred to the same hospital if still requiring inpatient care.
Numerator: the number of babies whose mother and/or multiple birth siblings are transferred to the same hospital.
Denominator: the number of babies from multiple births transferred to specialist neonatal care whose mother and/or multiple birth siblings still require inpatient care.

Description of what the quality statement means for each audience

Service providers ensure perinatal network guidelines and care pathways for transfers for neonatal special, high-dependency, intensive and surgical care are implemented and integrated with other maternity and neonatal guidelines and pathways. Ensure regular monitoring of operation and effectiveness.
Healthcare professionals ensure perinatal network guidelines and care pathways are followed when transferring babies for neonatal special, high-dependency, intensive and surgical care, and invoke a report or alert mechanism where this is not possible.
Commissioners and networks ensure all eligible patients within their health economy are covered by perinatal network guidelines and care pathways for transfer for special, high-dependency, intensive and surgical care.
Parents of babies transferred to neonatal special, high-dependency, intensive or surgical care can expect the transfer to be in line with network guidelines and care pathways. These guidelines and care pathways describe specific procedures about safely transferring babies to other hospitals.

Definitions

The Department of Health toolkit (2009) defines a network as ‘linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and health board boundaries, to ensure equitable provision of high-quality, clinically effective services.'
Guidance on the content of guidelines and pathways can be found within the Department of Health toolkit (2009) under Principles 4 and 7.

Data source

Structure
Local and network data collection.
Process
Local and network data collection.

Annual needs assessments

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Networks, commissioners and providers of specialist neonatal care undertake an annual needs assessment and ensure each network has adequate capacity.

Quality measure

Structure
Evidence of an annual needs assessment including production of an annual report covering, as a minimum, specialist neonatal activity for the network's population, monitoring of quality metrics and how concerns are being addressed.
Process
(a) Proportion of mothers whose babies required specialist neonatal care and who were booked to deliver in the network who received all their perinatal care within the network area (standard 95% as per Department of Health toolkit [2009]).
Numerator: the number of mothers receiving all their perinatal care within the network area.
Denominator: the number of mothers whose babies required specialist neonatal care and who were booked to deliver in the network area.
(b) Proportion of babies who receive specialist neonatal care in the network who are from outside the network area.
Numerator: the number of babies from outside the network area.
Denominator: the number of babies receiving specialist neonatal care in the network.
(c) Bed occupancy for each level of care (standard 80% as specified in the Department of Health toolkit [2009]).

Description of what the quality statement means for each audience

Service providers cooperate with networks and commissioners to carry out an annual specialist neonatal care needs assessment. If service provision levels are found to be inadequate, they ensure action is taken in conjunction with commissioners.
Healthcare professionals assist with specialist neonatal care needs assessments by providing accurate and validated data.
Commissioners and networks ensure that, in conjunction with service providers, an annual specialist neonatal care needs assessment is undertaken. In addition, they clearly define expected levels of service provision.
Parents of babies receiving specialist neonatal care can expect that the needs of their baby will be met by services provided in their area.

Definitions

Quality metrics are defined further in the Department of Health toolkit (2009) section 5.

Data source

Structure
Local and network data collection.
Process
(a): Local and network data collection.
(b): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether all babies who access neonatal services are treated following their own neonatal network clinical pathway.
(c): Local and network data collection.

Skilled and multidisciplinary staff

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Specialist neonatal services have a sufficient, skilled and competent multidisciplinary workforce.

Quality measure

Structure
(a) Evidence of local arrangements to ensure specialist neonatal staff are compliant with competency levels as described by the Department of Health toolkit (2009).
(b) Evidence of local arrangements to provide a multidisciplinary service, trained and competent in the care of neonates, that has access to:
  • specialist neonatal or paediatric dietitians
  • specialist neonatal occupational therapists
  • specialist neonatal physiotherapists
  • specialist neonatal speech and language therapists
  • specialist neonatal pharmacists.
Process
Proportion of completed specialist neonatal care shifts with the correct nursing and medical staffing levels as specified in the Department of Health toolkit (2009).
Numerator: the number of shifts with the correct nursing and medical staffing levels as specified in the Department of Health toolkit (2009).
Denominator: the number of completed specialist neonatal care shifts.

Description of what the quality statement means for each audience

Service providers ensure specialist neonatal services are staffed in accordance with the Department of Health toolkit (2009), and that training and competencies are regularly reviewed.
Healthcare professionals ensure they are skilled and competent for their roles and responsibilities by accessing appropriate training.
Commissioners ensure that specialist neonatal services assess and monitor the staffing levels, composition and competency of their workforce. In addition, they ensure that appropriate education programmes are commissioned.
Parents of babies receiving specialist neonatal care can expect care to be given by an appropriate number of fully trained healthcare professionals.

Definitions

Definition of a skilled and competent workforce can be found in Department of Health toolkit (2009) Principle 2.
The process measure 'proportion of completed shifts with the correct nursing and medical staffing levels' was considered by the Topic Expert Group (TEG) as an appropriate measure of staffing. It is noted that this is not a mandatory data collection requirement and that collection of this data is at the discretion of local units.

Data source

Structure
Local data collection.
Process
Local data collection.

Neonatal transfer services

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Neonatal transfer services provide babies with safe and efficient transfers to and from specialist neonatal care.

Quality measure

Structure
Evidence of network arrangements to provide a 24-hour, 7 days a week neonatal transport service with a single telephone contact.
Process
(a) Proportion of transfer teams responding to time-critical emergencies that depart from the transport base within 1 hour from the start of the referring call.
Numerator: the number of transfer teams departing from the transport base within 1 hour from the start of the referring call.
Denominator: the number of emergency transfer requests deemed time-critical.
(b) Proportion of newborn babies who receive specialist neonatal care who have an admission temperature of less than 36°C.
Numerator: the number of newborn babies with an admission temperature of less than 36°C.
Denominator: the number of newborn babies receiving specialist neonatal care.

Description of what the quality statement means for each audience

Service providers ensure a safe and efficient service for babies transferred to and from specialist neonatal care.
Healthcare professionals ensure babies receive a safe and efficient transfer to and from specialist neonatal care.
Commissioners and networks ensure transfer services are contracted and monitored to provide appropriate levels of service provision.
Parents of babies who need to be transferred to or from specialist neonatal services can expect this to be done safely and efficiently.

Definitions

The Department of Health toolkit (2009) states 'a transfer service is concerned with organising and implementing the transfer of babies and/or mothers from within a defined geographical area (network). It encompasses both users and providers, and transfers may be ex-utero or in-utero.'
Further description of a high quality transfer service can be found in Principle 4 of the Department of Health toolkit (2009).

Data source

Structure
Network data collection.
Process
(a) and (b): Network data collection.

Encouraging parental involvement in care

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Parents of babies receiving specialist neonatal care are encouraged and supported to be involved in planning and providing care for their baby, and regular communication with clinical staff occurs throughout the care pathway.

Quality measure

Structure
(a) Evidence of local arrangements to involve parents in decision-making processes.
(b) Evidence of local audit demonstrating active involvement of parents in providing care for their baby.
(c) Evidence of regular surveys on parent experience.
(d) Evidence of local arrangements to provide bereavement services.
(e) Evidence of local arrangements to provide palliative care.
Process
Parents' experience is monitored through satisfaction surveys and the evidence used to inform learning and change for improvement.

Description of what the quality statement means for each audience

Service providers ensure a policy is in place to maintain accurate records of communication with parents of babies receiving specialist neonatal care and that parents are involved in planning and providing care. Ensure plans are in place to seek regular parental views and experience.
Healthcare professionals communicate regularly with parents of babies receiving specialist neonatal care and ensure parents are involved in decision-making and their baby's care.
Commissioners ensure services use parental feedback on involvement in decision-making and planning and provision of care to inform service improvement of specialist neonatal care.
Parents of babies receiving specialist neonatal care can expect to be encouraged and supported to be actively involved in planning and providing care, joint decision-making and to be in regular contact with their healthcare team.

Definitions

Support provided will depend on the parents’ needs and may include physical, psychological or social support.

Data source

Structure
(a), (b), (d) and (e): Local data collection.
(c): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme denominator survey Question 8: In the last 12 months has the unit carried out a parent satisfaction survey?
Process
A Picker Institute parent survey, developed in conjunction with Bliss, is in development and will contain questions specifically aimed at assessing parent involvement in care and decision-making.

Breastfeeding

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Mothers of babies receiving specialist neonatal care are supported to start and continue breastfeeding, including being supported to express milk.

Quality measure

Structure
Evidence of a written local policy on breastfeeding and expressing milk for babies receiving specialist neonatal care.
Outcomes
(a) Proportion of babies born at less than 33 weeks of gestation who receive specialist neonatal care who are breastfed when discharged from hospital.
Numerator: the number of babies breastfed when discharged from hospital.
Denominator: the number of babies born at less than 33 weeks of gestation receiving specialist neonatal care and discharged from hospital.
(b) Proportion of babies born at less than 33 weeks of gestation who remain in hospital and still receive their mother's breast milk at 6 weeks.
Numerator: the number of babies receiving their mother's breast milk at 6 weeks.
Denominator: the number of babies born at less than 33 weeks of gestation, receiving specialist neonatal care and remaining in hospital at 6 weeks.

Description of what the quality statement means for each audience

Service providers ensure implementation of a local policy on breastfeeding and expressing milk for babies in specialist neonatal care.
Healthcare professionals ensure all mothers of babies receiving specialist neonatal care are supported to start and continue breastfeeding, including support to express milk.
Commissioners ensure services audit their compliance against agreed standards on supporting mothers to start and continue breastfeeding, including support to express milk.
Mothers of babies receiving specialist neonatal care can expect to be offered support to start and continue to breastfeed, including support to express milk.

Data source

Structure
Local data collection.
Outcomes
(a): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme produce figures on feeding status at discharge for babies born at less than 33 weeks of gestation.
(b): Local data collection.

Coordinated transition to community care

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Babies receiving specialist neonatal care have their health and social care plans coordinated to help ensure a safe and effective transition from hospital to community care.

Quality measure

Structure
(a) Evidence of provision of a neonatal outreach service.
(b) Evidence of multiagency discharge planning with input from community neonatal outreach services.
Process
Proportion of babies discharged from specialist neonatal care who receive an outreach service follow-up.
Numerator: the number of babies receiving outreach service follow-up.
Denominator: the number of babies discharged from specialist neonatal care requiring an outreach service follow-up.

Description of what the quality statement means for each audience

Service providers ensure that agreements are in place for coordinating the care plans of babies receiving specialist neonatal care between relevant agencies.
Health and social care professionals ensure the care plans of babies receiving specialist neonatal care are coordinated with all relevant agencies.
Commissioners and networks ensure services are commissioned according to agreed levels of care across the specialist neonatal care pathway to enable safe and effective transition from hospital to community care.
Parents of babies discharged from specialist neonatal care can expect to receive support from health or social care professionals working in the community if their baby requires it. They can also expect that their baby's care plan will be coordinated between relevant teams to help ensure a safe and effective transition from hospital to home.

Data source

Structure
(a) and (b): Local and network data collection.
Process
Local and network data collection.

Data, audit and research

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Providers of specialist neonatal services maintain accurate and complete data, and actively participate in national clinical audits and applicable research programmes.

Quality measure

Structure
(a) Evidence of a documented data validation process to ensure data completeness and accuracy.
(b) Evidence of participation in national clinical audits and benchmarking.
(c) Evidence of participation in applicable research studies.
Process
(a) Complete and accurate data collected for the National Neonatal Audit Programme.
(b) Complete and accurate data collected for the British Association of Perinatal Medicine (BAPM) dataset.
(c) Proportion of babies receiving specialist neonatal care whose parents are invited to participate in applicable research studies.
Numerator: the number of babies whose parents are invited to participate in applicable research studies.
Denominator: the number of babies receiving specialist neonatal care.

Description of what the quality statement means for each audience

Service providers ensure accuracy and completeness of specialist neonatal data collection systems and participate in national clinical audits and applicable research programmes.
Healthcare professionals ensure accurate record keeping and data collection.
Commissioners ensure service providers participate in agreed national clinical audits and applicable research programmes.
Parents of babies receiving specialist neonatal care can expect complete and accurate information to be kept about their baby's care and for it to be used to improve care. They can also expect to be invited to participate in applicable research programmes.

Data source

Structure
(a): Local and network data collection.
Process
(a): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme provides quarterly data completeness and accuracy reports to participating sites.
(b): Data completeness and accuracy figures of BAPM dataset submissions.
(c): Local and network data collection.

Health outcomes

This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.

Quality statement

Babies receiving specialist neonatal care have their health outcomes monitored.

Quality measure

Structure
Evidence of processes to enable collection of health outcome data within the network for babies who receive specialist neonatal care.
Process
(a) Proportion of babies born at less than 30 weeks of gestation who received specialist neonatal care who have a 2-year outcome form completed.
Numerator: the number of babies with a completed 2-year outcome form.
Denominator: the number of babies born at less than 30 weeks of gestation receiving specialist neonatal care.
(b) Proportion of babies born at 30 weeks of gestation or more who received specialist neonatal care who have a 2-year outcome form completed.
Numerator: the number of babies with a completed 2-year outcome form.
Denominator: the number of babies born at 30 weeks of gestation or more receiving specialist neonatal care.
(c) Proportion of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g who receive specialist neonatal care and undergo retinopathy screening prior to discharge from hospital.
Numerator: the number of babies undergoing retinopathy screening prior to discharge from hospital.
Denominator: the number of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g, receiving specialist neonatal care and discharged from hospital.
(d) Proportion of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g who receive specialist neonatal care who require laser surgery.
Numerator: the number of babies requiring laser surgery.
Denominator: the number of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g receiving specialist neonatal care.
e) Proportion of babies who received specialist neonatal care who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge from hospital.
Numerator: the number of babies who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge from hospital.
Denominator: the number of babies receiving specialist neonatal care.
f) Proportion of babies who have had neonatal encephalopathy.
Numerator and denominator under development for the National Neonatal Audit Programme.
Outcomes
(a) Proportion of babies born at less than 30 weeks of gestation who receive specialist neonatal care who have no functional impairment at 2 years when corrected for gestational age.
Numerator: the number of babies with no functional impairment at 2 years when corrected for gestational age.
Denominator: the number of babies born at less than 30 weeks of gestation receiving specialist neonatal care.
(b) Proportion of babies born at 30 weeks of gestation or more who receive specialist neonatal care who have no functional impairment at 2 years when corrected for gestational age.
Numerator: the number of babies with no functional impairment at 2 years when corrected for gestational age.
Denominator: the number of babies born at 30 weeks of gestation or more receiving specialist neonatal care.
(c) 2-year survival rates within and compared with other networks.

Description of what the quality statement means for each audience

Service providers ensure the health outcomes of all babies receiving specialist neonatal care are monitored.
Healthcare professionals ensure accurate and complete baseline data collection through pregnancy, childbirth and the perinatal period.
Commissioners and networks ensure specialist neonatal care health outcomes are monitored and used to inform service improvement.
Parents of babies receiving specialist neonatal care can expect their baby's health will continue to be assessed after discharge from hospital.

Data source

Structure
The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether health outcomes are collected.
Process
(a) and (b): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether 2-year outcomes are collected.
(c): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on retinopathy screening prior to discharge from hospital for babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g.
(d): Local and network data collection.
(e): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme will collect data on babies who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge.
(f): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme will collect data on neonatal encephalopathy.
Outcomes
(a), (b) and (c): Network data collection.

Continuity of care

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

The woman and baby's individualised postnatal care plan is reviewed and documented at each postnatal contact.

Rationale

Postnatal care should be a continuation of the care the woman received during her pregnancy, labour and birth. Planning and regularly reviewing the content and timing of care, for individual women and their babies, and communicating this (to the woman, her family and other relevant postnatal care team members) through a documented care plan can improve continuity of care.

Quality measures

Structure
Evidence of local arrangements to ensure that the woman and her baby's individualised postnatal care plan is reviewed and documented at each postnatal contact.
Data source: Local data collection.
Process
The proportion of women and their babies who have an individualised and documented postnatal care plan, which is reviewed at each postnatal contact.
Numerator – the number of contacts in which the woman and baby's individualised postnatal care plan is reviewed and documented.
Denominator – the number of postnatal contacts.
Data source: The Maternity Services Secondary Uses Data Set, once implemented, will collect data on the date on which the care plan was created or changed. This covers antenatal, birth and postnatal care plans (global numbers 17201890 and 17201900).
Outcome
Women's satisfaction with the continuity and content of their postnatal care.
Data source: Local data collection. The Care Quality Commission Maternity Services Survey 2010 collected information about women's experiences of maternity care.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place to provide women and their babies with an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.
Healthcare practitioners provide women and their babies with an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.
Commissioners ensure that they commission services in which women are provided with an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.

What the quality statement means for patients, service users and carers

Women and their babies have an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.

Source guidance

Definitions of terms used in this quality statement

Postnatal care plan
The individualised postnatal care plan should be documented and developed with the woman, ideally in the antenatal period or as soon as possible after birth. The plan should be comprehensive and include as a minimum:
  • relevant factors from the antenatal, intrapartum and immediate postnatal period
  • details of a named midwife or health visitor, including a 24 hour telephone number to enable the woman to contact her named healthcare practitioner or an alternative practitioner should he or she not be available
  • details of the healthcare practitioners involved in her care and that of her baby, including roles and contact details
  • plans for the postnatal period including:
    • specific plans for managing pregnancy-related conditions when they occur, such as gestational hypertension, pre-eclampsia, thromboembolism, gestational diabetes, postnatal wound care and mental health conditions
    • details about adjustment to motherhood, emotional wellbeing and family support structures
    • plans for feeding, including specific advice about either breastfeeding support or formula feeding
    • plans for contraceptive care.
(Definition adapted with expert group consensus from NICE clinical guideline 37, recommendation 1.1.3.)
Postnatal contact
Women and their babies should receive the number of postnatal contacts appropriate to their care needs. A postnatal contact is a scheduled postnatal appointment which may occur in the woman or baby's home or another setting such as a GP practice or children's centre. Where a woman remains in hospital following delivery, her postnatal care plan should be reviewed on a daily basis until her transfer home and then reviewed at each subsequent contact.

Equality and diversity considerations

Communication and information-giving between women (and their families) and members of the maternity team is a key aspect of this statement. The individualised postnatal care plan and the information within it should be accessible to women, including women who do not speak or read English and those with additional needs such as physical, sensory or learning disabilities.

Maternal health – life-threatening conditions

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women are advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten their lives and require them to access emergency treatment.

Rationale

Women are at increased risk of experiencing serious health events in the immediate hours, days and weeks following the birth, some of which could lead to maternal death or severe morbidity. Providing women with information about the symptoms and signs that may indicate a serious physical illness or mental health condition may prompt them to access immediate emergency treatment if needed. Emergency treatment could potentially avoid unnecessary deaths and severe morbidity.

Quality measures

Structure
Evidence of local arrangements to ensure that women are advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten her life and require her to access emergency treatment.
Data source: Local data collection.
Process
The proportion of women who are advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten her life and require her to access emergency treatment.
Numerator – the number of women in the denominator who are advised, within the first 24 hours, after birth of the symptoms and signs of conditions that may threaten her life and require her to access emergency treatment.
Denominator – the number of women who have given birth.
Data source: Local data collection.
Outcome
a) Incidence of potentially avoidable maternal morbidity and mortality.
Data source: Local data collection. The Maternity Services Secondary Uses Data Set, once implemented, will collect data on maternal deaths (global number 17207470). The Confidential Enquiries into Maternal Deaths (now undertaken by MBRRACE-UK) reports on rates of maternal death. MBRRACE are expanding their work programme to include severe maternal morbidity.
b) Women feel informed about symptoms and signs of postnatal life-threatening conditions.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for women to be advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten their lives and require them to access emergency treatment.
Healthcare practitioners advise women, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten their lives and require them to access emergency treatment.
Commissioners ensure that they commission services that advise women, within 24 hours of the birth, of conditions that may threaten their lives and require them to access emergency treatment.

What the quality statement means for patients, service users and carers

Women are advised, within 24 hours of the birth, of the symptoms and signs of potentially life-threatening conditions that should prompt her to call for emergency treatment.

Source guidance

Definitions of terms used in this quality statement

Expert group opinion is that the first postnatal contact should occur within 24 hours after the birth.
Information provision
The woman should receive accurate, evidence-based verbal and written information. If the woman is too unwell to receive this information within the first 24 hours after the birth, the information should be discussed once the woman has made a recovery and is able to identify symptoms and signs of life-threatening conditions in herself. All women should also be provided with a contact number that can be used at any time of the day or night to seek urgent maternity advice (for example, the labour ward triage number).
Symptoms and signs of life-threatening physical conditions
The following symptoms and signs are suggestive of potentially life-threatening physical conditions in the woman:
  • sudden and profuse blood loss or persistent, increased blood loss
  • faintness, dizziness or palpitations or tachycardia
  • fever, shivering, abdominal pain, especially if combined with offensive vaginal loss or a slow-healing perineal wound
  • headaches accompanied by visual disturbances or nausea or vomiting within 72 hours of birth
  • leg pain, associated with redness or swelling
  • shortness of breath or chest pain
  • widespread rash.
(Definition adapted with expert group consensus from NICE clinical guideline 37, recommendation 1.2.1, table 2.)
Symptoms and signs of life-threatening mental health conditions
The following symptoms and signs are suggestive of potentially life-threatening mental health conditions in the woman:
  • severe depression, such as feeling extreme unnecessary worry, being unable to concentrate due to distraction from depressive feelings
  • severe anxiety, such as uncontrollable feeling of panic, being unable to cope or becoming obsessive
  • the desire to hurt others or yourself, including thoughts about taking your own life
  • confused and disturbed thoughts, which could include other people telling you that you are imagining things (hallucinations and delusions).
(Definition adapted with expert group consensus from RCOG's Good practice point 14, section 5.)

Equality and diversity considerations

Communication and information-giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English. Written and verbal information should be appropriate for the woman's level of literacy, culture and language.

Infant health – life-threatening conditions

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women or main carers of babies are advised, within 24 hours of the birth, of the symptoms and signs of potentially life-threatening conditions in the baby that require emergency treatment.

Rationale

Babies may experience serious health conditions in the immediate hours, days and weeks following the birth, which can lead to severe illness or in rare cases, death. Providing the mother or main carer with verbal and written information about the symptoms and signs that might indicate their baby has a serious health problem may result in emergency treatment being sought more promptly. This information should be provided within 24 hours of the birth.

Quality measures

Structure
Evidence of local arrangements to ensure that the women or main carers of babies are advised, within 24 hours of the birth, of the symptoms and signs of potentially life-threatening conditions in the baby that require emergency treatment.
Data source: Local data collection.
Process
The proportion of women or main carers of the baby who are advised, within 24 hours of the birth, of the symptoms and signs of potentially life-threatening conditions in the baby that require emergency treatment.
Numerator – the number of women or main carers of babies who are advised, within 24 hours of the birth, of the symptoms and signs of potentially life-threatening conditions in the baby that require emergency treatment.
Denominator – the number of mothers or main carers of babies.
Data source: Local data collection.
Outcome
a) Incidence of potentially avoidable infant morbidity and mortality.
Data source: Local data collection. The Maternity Services Secondary Uses Data Set, once implemented, will collect data on neonatal deaths (global number 17209680). The Confidential Enquiries into Perinatal Deaths (now undertaken by MBRRACE-UK) reports on rates of perinatal death. MBRRACE are expanding their work programme to include severe infant morbidity.
b) Women and main carers feel informed about symptoms and signs of potentially life-threatening conditions in the baby.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for women or main carers of babies to be advised, within 24 hours of the birth, of the symptoms and signs of potentially life threatening conditions in the baby that require emergency treatment.
Healthcare practitioners advise women or main carers of babies, within 24 hours of the birth, of the symptoms and signs of potentially life-threatening conditions in the baby that require emergency treatment.
Commissioners ensure that they commission services that advise women or main carers of babies, within 24 hours of the birth, of the symptoms and signs of potentially life threatening conditions in the baby that require emergency treatment.

What the quality statement means for patients, service users and carers

Women or the main carer of the baby are advised, within 24 hours of the birth, of the symptoms and signs of potentially life threatening conditions in the baby that require emergency treatment.

Source guidance

Definitions of terms used in this quality statement

Expert group opinion is that the first postnatal contact should occur within 24 hours after the birth.
Information provision
The woman or main carer of the baby should receive accurate, evidence-based verbal and written information. If the baby is unwell and in hospital, the information should be provided to the mother or main carer prior to the baby's discharge.
The woman or main carer of the baby should also be provided with a contact number that can be used at any time of the day or night to seek urgent advice (for example, the labour ward triage number). The woman or main carer of the baby should be advised to contact the emergency services if they are very concerned about their baby's health.
Symptoms and signs of life-threatening conditions in the baby (0–3 months)
The following symptoms and signs are suggestive of potentially life-threatening physical conditions in the baby (0–3 months):
A major change in the baby's behaviour, for example:
  • less active than usual
  • less responsive than usual
  • more irritable than usual
  • breathing faster than usual or grunting when breathing
  • feeding less than usual
  • nappies much less wet than usual
  • has blue lips
  • is floppy
  • has a fit
  • has a rash that does not fade when pressed with a glass
  • vomits green fluid
  • has blood in their stools
  • has a bulging or very depressed fontanelle
  • has a temperature higher than 38°C
  • with the exception of hands and feet, feels cold when dressed appropriately for the environment temperature
  • within the first 24 hours after the birth:
    • has not passed urine
    • has not passed faeces (meconium)
    • develops a yellow skin colour (jaundice).
(Adapted with expert group consensus from information provided in the Department of Health's Birth to Five book [no longer in print but available for download], NICE clinical guideline 149 and NICE clinical guideline 160.)
Main carer
For the majority of babies the main carer will be the mother. For some babies the main carer could be a close relative, for example the baby's father or grandparent, or for looked-after babies this could be a foster parent.

Equality and diversity considerations

Communication and information-giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English.

Infant health – safer infant sleeping

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Safer infant sleeping is discussed with women, their partner or the main carer at each postnatal contact.

Rationale

There are specific behaviours that increase a baby's risk of sudden infant death syndrome. Providing the woman, her partner or the main carer with the opportunity to regularly discuss infant sleeping practices can help to identify and support them and the wider family to establish safer infant sleeping habits, and to reduce the baby's risk of sudden infant death syndrome.

Quality measures

Structure
Evidence of local arrangements to ensure that information about safer infant sleeping is discussed with women, their partner or the main carer at each postnatal contact.
Data source: Local data collection.
Process
a) Proportion of women, their partners or main carers of newborn babies who have a discussion about safer infant sleeping within 24 hours of the birth.
Numerator – the number of women, their partners or main carers of newborn babies who have a discussion about safer infant sleeping within 24 hours of the birth.
Denominator – the number of newborn babies.
Data source: Local data collection.
b) Proportion of women, their partners or main carers of newborn babies who have a discussion about safer infant sleeping at every postnatal contact.
Numerator – the number of postnatal contacts in which women, their partners or main carers of newborn babies have a discussion about safer infant sleeping.
Denominator – the number of postnatal contacts.
Data source: Local data collection.
c) Proportion of women, their partners or main carers of newborn babies who have a discussion about safer infant sleeping at a postnatal contact 10–14 days after the birth (at the midwifery and health visitor handover when the woman and baby are discharged from the care of the community midwifery team to the care of the health visitor).
Numerator – the number of women, their partners or main carers of newborn babies who have a discussion about safer infant sleeping at a postnatal contact 10–14 days after the birth.
Denominator – the number of newborn babies.
Data source: Local data collection.
d) Proportion of women, their partners or main carers of newborn babies who have a discussion about safer infant sleeping at the 6–8 week postnatal check.
Numerator – the number of women, their partners or main carers of newborn babies who have a discussion about safer infant sleeping at the 6–8 week postnatal check.
Denominator – the number of newborn babies.
Data source: Local data collection.
Outcome
a) Incidence of sudden infant death syndrome.
Data source: Office for National Statistics report Unexplained deaths in infancy – England and Wales, 2010.
b) Women's and main carers' knowledge about safer infant sleeping.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for women, their partner or the main carer of the baby to have a discussion about safer infant sleeping at every postnatal contact.
Healthcare practitioners ensure that safer infant sleeping is discussed with the woman, her partner or the main carer at every postnatal contact.
Commissioners ensure that they commission services that provide the woman, her partner or the main carer of the baby with the opportunity to discuss safer infant sleeping at every postnatal contact.

What the quality statement means for patients, service users and carers

Women, their partner or the main carer are given the opportunity to discuss safer infant sleeping at every postnatal contact.

Source guidance

Definitions of terms used in this quality statement

Information provision
The woman, her partner or main carer of the baby should receive accurate, evidence-based verbal and written information about safer infant sleeping. This written information should be discussed with the woman, her partner or main carer within 24 hours of the birth, and safer infant sleeping discussed at each subsequent postnatal contact (including 10–14 days after the birth and at the 6–8 week postnatal check).
Main carer
For the majority of babies the main carer will be the mother. For some babies the main carer could be a close relative, for example the baby's father or grandparent, or for looked-after babies this could be a foster parent.
Postnatal contact
Women and their babies should receive the number of postnatal contacts appropriate to their care needs. A postnatal contact is a scheduled postnatal appointment that may occur in the woman or baby's home, a GP practice or children's centre, or a hospital setting if the woman or baby needs extended inpatient care. For the majority of women, babies and families the postnatal period ends 6–8 weeks after the birth.

Equality and diversity considerations

Communication and information-giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English. Verbal and written information should be appropriate in terms of the women's (and their families) level of literacy, culture, language and family circumstances.

Breastfeeding

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women receive breastfeeding support from a service that uses an evaluated, structured programme.

Rationale

Breastfeeding contributes to the health of both the mother and child in the short and longer term. Women should be made aware of these benefits and those who choose to breastfeed should be supported by a service that is evidence-based and delivers an externally audited, structured programme. Delivery of breastfeeding support should be coordinated across the different sectors.

Quality measures

Structure
Evidence of local arrangements for breastfeeding support to be provided through a service that uses an evaluated, structured programme.
Data source: Local data collection.
Process
a) Proportion of women who receive breastfeeding support through a service that uses an evaluated, structured programme.
Numerator – the number of women in the denominator who receive breastfeeding support through a service that uses an evaluated, structured programme.
Denominator – the number of women who breastfeed (exclusively or partially).
Data source: Local data collection.
b) Proportion of women who wanted to continue breastfeeding but stopped before they had planned to.
Numerator – the number of women who wanted to continue breastfeeding but stopped before they had planned to.
Denominator – the number of women who breastfed (exclusively or partially).
Data source: Local data collection.
Outcome
a) Rates of breastfeeding initiation.
Data source: The Maternity Services Secondary Uses Data Set, once implemented, will collect data on 'baby first feed breast milk status' (global number 17205882), 'baby breast milk status (at discharge from hospital)' including exclusive and partial breast milk feeding (global number 17207550). The Infant Feeding Survey 2010 collected self-report data on the prevalence and duration of breastfeeding in the first 8–10 months after the baby was born.
b) Rates of exclusive or partial breastfeeding on discharge from hospital and at 5–7 days, 10–15 days, 6–8 weeks and 16 weeks after the birth.
Data source: The Maternity Services Secondary Uses Data Set, once implemented, will collect data on 'baby first feed breast milk status' (global number 17205882), 'baby breast milk status (at discharge from hospital)', including exclusive and partial breast milk feeding (global number 17207550). The Children and Young People's Health Services Secondary Uses Data Set, once implemented, will collect data on 'breastfeeding status' (global number 17101340), including 'Exclusively Breast Milk Feeding', 'Partially Breast Milk Feeding' and 'No Breast Milk Feeding at all', and also data on observation date (breastfeeding status) (global number 17104440). The Infant Feeding Survey 2010 collected self-report data on the prevalence and duration of breastfeeding in the first 8–10 months after the baby was born.
c) Women's satisfaction with breastfeeding support.
Data source: The Care Quality Commission Maternity Services Survey 2010 collected information about women's experiences of maternity care and this included a section on 'Feeding your baby'.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that women receive breastfeeding support through a service that uses an evaluated, structured programme.
Healthcare practitioners ensure that women receive breastfeeding support through an integrated service that uses an evaluated, structured programme.
Commissioners ensure that they commission a service that delivers breastfeeding support through an evaluated, structured programme.

What the quality statement means for patients, service users and carers

Women receive breastfeeding support through a service that uses an evaluated, structured programme.

Source guidance

  • NICE clinical guideline 37 recommendation 1.3.3 (key priority for implementation)
  • NICE public health guidance 11 recommendations 1 (key priority for implementation) and 7 (key priority for implementation).

Definitions of terms used in this quality statement

Structured programme
NICE clinical guideline 37 recommends that all maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard. If providers implement a locally developed programme, this should be evidence-based, structured, and undergo external evaluation. The structured programme should be delivered and coordinated across all providers, including hospital, primary, community and children's centre settings. Breastfeeding outcomes should be monitored across all services.
Breastfeeding support
All people involved in delivering breastfeeding support should receive the appropriate training and undergo assessment of competencies for their role. This includes employed staff and volunteer workers in all sectors, for example, hospitals, community settings, children's centres and peer supporter services.

Equality and diversity considerations

Breastfeeding support should be culturally appropriate and accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English. Women should have access to an interpreter or advocate if needed. Special consideration will be needed if the mother and baby have been separated for any reason, for example if the baby has been admitted to neonatal care or the baby has been taken into care.

Formula feeding

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Information about bottle feeding is discussed with women or main carers of formula-fed babies.

Rationale

Babies who are fully or partially formula fed can develop infections and illnesses if their formula milk is not prepared safely. In a small number of babies these cause serious harm and are life threatening, and require the baby to be admitted to hospital. The mother or main carer of the baby needs consistent, evidence-based advice about how to sterilise feeding equipment and safely prepare formula milk.

Quality measures

Structure
Evidence of local arrangements to ensure that information about bottle feeding is discussed with women or main carers of formula-fed babies.
Data source: Local data collection.
Process
The proportion of women or main carers of formula-fed babies who have information about bottle feeding discussed with them.
Numerator – the number of women or main carers in the denominator who have information about bottle feeding discussed with them.
Denominator – the number of women or main carers of formula-fed babies.
Data source: Local data collection.
Outcome
a) Rates of hospital admissions for formula feeding-related conditions.
Data source: Local data collection.
b) Women's and main carers' knowledge of how to sterilise feeding equipment and safely prepare formula milk.
Data source: The Infant Feeding Survey 2010 collected self-report data on how mothers prepared powdered formula feed in the last 7 days, including whether they had followed all 3 recommendations for making up feeds (only making 1 feed at a time; making feeds within 30 minutes of the water boiling; and adding the water to the bottle before the powder).
c) Women's and main carers' satisfaction with feeding support.
Data source: The Care Quality Commission Maternity Services Survey 2010 collected information about women's experiences of maternity care and this included a section on 'Feeding your baby'.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that information about bottle feeding is discussed with women or main carers of formula-fed babies.
Healthcare practitioners discuss information about bottle feeding with women or main carers of formula-fed babies.
Commissioners ensure that they commission services in which information about bottle feeding is discussed with women or main carers of formula-fed babies.

What the quality statement means for patients, service users and carers

Women or main carers of formula-fed babies have the opportunity to discuss information about bottle feeding.

Source guidance

Definitions of terms used in this quality statement

Formula-fed baby
This statement relates to mothers and main carers who totally or partially formula feed their baby, and breastfeeding mothers who plan to formula feed their baby.
Information provision
The woman or main carer of the baby should receive accurate, evidence-based information that includes written information about formula feeding.
To ensure the mother or main carer has a good understanding of how to prepare formula feeds, it may be appropriate to give a demonstration as well as discussing bottle feeding.
Main carer
For the majority of babies the main carer will be the mother. For some babies the main carer could be a close relative, for example the baby's father or grandparent, or for looked-after babies this could be a foster parent.

Equality and diversity considerations

Communication and information-giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who don't speak or read English. Verbal and written information should be appropriate in terms of women's (and their families) level of literacy, culture, language and family circumstances.

Infant health – physical examination

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Babies have a complete 6–8 week physical examination.

Rationale

The purpose of the examination is to identify babies more likely to have conditions that would benefit from further investigation and management. This includes an overall physical examination as well as screening for eye problems, congenital heart defects, developmental dysplasia of the hip and undescended testicles. Most babies will be healthy, but the small number of babies who do have serious problems will benefit from prompt identification. Early treatment can improve the health of the baby and prevent or reduce disability.

Quality measures

Structure
a) Evidence of local arrangements to ensure that parents or main carers of babies are offered an appointment for the baby to attend for their 6–8 week physical examination before 10 weeks of age.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that a system is in place to monitor the competency of practitioners undertaking the 6–8 week physical examination.
Data source: Local data collection.
Process
Proportion of babies who have undergone a 6–8 week physical examination.
Numerator – the number of babies in the denominator who have undergone a 6–8 week physical examination.
Denominator – the number of babies aged 10 weeks.
Data source: Local data collection.
Outcomes
a) Incidence of physical abnormalities in babies.
Data source: Local data collection.
b) Health outcomes associated with early intervention for babies with physical abnormalities.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that babies are offered a complete 6–8 week physical examination.
Healthcare practitioners ensure that they perform a complete 6–8 week physical examination of babies and that they maintain the necessary competencies for this role.
Commissioners ensure that they commission services that offer a complete 6–8 week physical examination for babies, which is carried out in timely manner and by a competent practitioner.

What the quality statement means for patients, service users and carers

The mother or main carer of the baby is given the opportunity for their baby to have a complete 6–8 week physical examination, which is carried out in timely manner and by a competent practitioner.

Source guidance

Definitions of terms used in this quality statement

NICE clinical guideline 37 recommendation 1.4.11, 1.4.13 and the Newborn and Infant Physical Examination Standards and Competencies (March 2008) detail the components of the 6–8 week physical examination.
Note on measures
The National Screening Committee recommend that where possible, the baby's 6–8 week physical examination should be combined with the baby's first set of vaccinations to provide a 'one stop service'. However, as the baby's vaccinations should only exceptionally be scheduled before the age of 8 weeks, the 6–8 week examination is usually undertaken when the baby is at least 8 weeks of age. Therefore, for pragmatic reasons the examination should take place before 10 completed weeks of age, that is before 77 days.

Maternal health – weight management

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women with a body mass index (BMI) of 30 kg/m2 or more at the 6–8 week postnatal check are offered a referral for advice on healthy eating and physical activity.

Rationale

The woman's eating habits and physical activity levels could influence the health behaviour of the wider family, including children who are developing habits that may remain with them for life. Supporting the woman in the postnatal period to change her eating habits and physical activity levels may improve her health, her infant's health and the health of the wider family. It may also improve the outcomes of future pregnancies.
Women who are obese during pregnancy face increased risks of complications that include gestational diabetes, miscarriage, pre eclampsia, thromboembolism and maternal death. Risks for the infant include fetal death, stillbirth, shoulder dystocia, and macrosomia. Infants of obese women face health risks in childhood including diabetes and obesity in later life.

Quality measures

Structure
a) Evidence of local arrangements to ensure that women have their BMI assessed and recorded at the 6–8 week postnatal check.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check are offered a referral for advice on healthy eating and physical activity.
Data source: Local data collection.
c) Evidence of local arrangements to ensure that the local workforce has appropriate numbers of staff trained to deliver healthy eating and physical activity services to postnatal women.
Data source: Local data collection.
Process
a) The proportion of women who have their BMI recorded at the 6–8 week postnatal check.
Numerator – the number of women in the denominator who have their BMI recorded.
Denominator – the number of women who attend a 6–8 week postnatal check.
Data source: Local data collection.
b) The proportion of women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check who are offered a referral for advice on healthy eating and physical activity.
Numerator – the number of women in the denominator who are offered a referral for advice on healthy eating and physical activity.
Denominator – the number of women with a BMI of 30 kg/m2 or more who attend a 6–8 week postnatal check.
Data source: Local data collection.
c) The proportion of women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check who accept a referral for advice on healthy eating and physical activity.
Numerator – the number of women in the denominator who accept a referral for advice on healthy eating and physical activity.
Denominator – the number of women with a BMI of 30 kg/m2 or more who attend a 6–8 week postnatal check.
Data source: Local data collection.
Outcome
Women feel able to make informed decisions about healthy eating, physical activity and weight management for themselves and their family.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check to be offered a referral for advice on healthy eating and physical activity.
Healthcare practitioners offer women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check a referral for advice on healthy eating and physical activity.
Commissioners ensure that they commission services that offer women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check a referral for advice on healthy eating and physical activity.

What the quality statement means for patients, service users and carers

Women who have a body mass index of 30 kg/m2 or more at the 6–8 week postnatal check are offered a referral for advice on healthy eating and physical activity.

Source guidance

Definitions of terms used in this quality statement

Structured programme
Women should be offered a referral to an individual or group-based service that uses a structured programme. NICE public health guidance 11 recommendation 6 states that services should deliver a structured programme that:
  • addresses the reasons why women may find it difficult to lose weight, particularly after pregnancy
  • is tailored to the needs of an individual or group
  • combines advice on healthy eating and physical exercise (advising them to take a brisk walk or other moderate exercise for at least 30 minutes on at least 5 days of the week)
  • identifies and addresses individual barriers to change
  • provides ongoing support over a sufficient period of time to allow for sustained lifestyle changes.
Services should be delivered by an appropriately trained person. This is someone who can demonstrate expertise and competencies in healthy eating and/or physical activity, including weight management for women in the postnatal period. This may include midwives, health visitors, obstetricians, dietitians, GPs, nurses, midwifery assistants, support workers and those working in weight management programmes (commercial or voluntary).
(Adapted with expert group consensus from NICE public health guidance 27, recommendations 3 and 4).
Women who choose not to accept a referral should be given information about where they can get support on healthy eating and physical activity in future.

Equality and diversity considerations

Women should be able to access services that are appropriate to their cultural and religious beliefs, and that make relevant adjustments for anyone who has communication difficulties, and for those who don't speak or read English.

Emotional wellbeing and infant attachment

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women have their emotional wellbeing, including their emotional attachment to their baby, assessed at each postnatal contact.

Rationale

The baby's relationship with the mother (or main carer) has a significant impact on the baby's social and emotional development. In turn, the woman's ability to provide a nurturing relationship is partly dependent on her own emotional wellbeing. Regular assessment of the woman's emotional wellbeing and the impact of this on her attachment to her baby may lead to earlier detection of problems.

Quality measures

Structure
Evidence of local arrangements that women have their emotional wellbeing, including their emotional attachment to their baby, assessed at each postnatal contact.
Data source: Local data collection.
Process
a) Proportion of women whose emotional wellbeing, including emotional attachment to their baby, is assessed at each postnatal contact.
Numerator – the number of postnatal contacts in the denominator in which the mother's emotional wellbeing, including emotional attachment to the baby, is assessed.
Denominator – the number of postnatal care contacts.
Data source: Local data collection.
b) Proportion of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 5–7 days after the birth.
Numerator – the number of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 5–7 days after the birth.
Denominator – the number of women receiving a postnatal contact 5–7 days after the birth.
Data source: Local data collection.
c) Proportion of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 10–14 days after the birth (at the midwifery and health visitor handover when the woman and baby are discharged from the care of the community midwifery team to the care of the health visitor).
Numerator – the number of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 10–14 days after the birth.
Denominator – the number of women receiving a postnatal contact 10–14 days after the birth.
Data source: Local data collection.
d) Proportion of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 6–8 weeks after the birth.
Numerator – the number of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 6–8 weeks after the birth.
Denominator – the number of women receiving a postnatal contact 6–8 weeks after the birth.
Data source: Local data collection.
e) Proportion of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 16 weeks after the birth.
Numerator – the number of women whose emotional wellbeing, including their emotional attachment to their baby, is assessed at a postnatal contact 16 weeks after the birth.
Denominator – the number of women receiving a postnatal contact 16 weeks after the birth.
Data source: Local data collection.
Outcome
a) Incidence of postnatal mental health problems.
Data source: Local data collection.
b) Incidence of mother-to-baby emotional attachment problems.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place so that women are asked about their emotional wellbeing, including their mother-to-baby emotional attachment, assessed at each postnatal contact.
Healthcare practitioners ensure that women have their emotional wellbeing, including their mother-to-baby emotional attachment, assessed at each postnatal contact.
Commissioners ensure that they commission services that have local agreements to ensure women have their emotional wellbeing, including their mother-to-baby emotional attachment, assessed at each postnatal contact.

What the quality statement means for patients, service users and carers

Women have their emotional wellbeing, including their relationship with their baby (called 'emotional attachment'), assessed at each postnatal contact.

Source guidance

Definitions of terms used in this quality statement

Postnatal contacts
Women and their babies should receive the number of postnatal contacts that are appropriate to their care needs. A postnatal contact is a scheduled postnatal appointment that may occur in the woman or baby's home or another setting such as a GP practice, children's centre or this could be a hospital setting where women and/or the baby requires extended inpatient care.
Emotional wellbeing
NICE public health guidance 40 defines emotional wellbeing as 'being happy and confident and not anxious or depressed'.
Mother-to-baby emotional attachment
This involves the formation of a secure bond between the mother and the baby, in which the mother responds sensitively and appropriately to the baby's signals, providing an environment in which the baby feels secure.

Equality and diversity considerations

Communication between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who don't speak or read English.

Maternal health – mental wellbeing

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women who have transient psychological symptoms ('baby blues') that have not resolved at 10–14 days after the birth should be assessed for mental health problems.

Rationale

Women experience emotional changes in the immediate postnatal period which usually resolve within 10–14 days after the birth. Women who are still feeling low in mood, anxious, experiencing negative thoughts or lacking interest in their baby at 10–14 days after the birth may be at increased risk of mental health problems. These women should receive an assessment of their mental wellbeing.

Quality measures

Structure
Evidence of local arrangements for women in whom transient psychological symptoms ('baby blues') have not resolved at 10–14 days after the birth to have an assessment for mental health problems.
Data source: Local data collection.
Process
Proportion of women in whom transient psychological symptoms ('baby blues') have not resolved at 10–14 days after the birth who are assessed for mental health problems.
Numerator – the number of women in whom transient psychological symptoms ('baby blues') have not resolved at 10–14 days after the birth who are assessed for mental health problems.
Denominator – the number of women in whom transient psychological symptoms ('baby blues') have not resolved at 10–14 days after the birth.
Data source: Local data collection.
Outcome
Incidence of postnatal mental health problems.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for women in whom transient psychological symptoms ('baby blues') have not resolved at 10–14 days after the birth to have an assessment for mental health problems.
Healthcare practitioners ensure that women in whom transient psychological symptoms ('baby blues') have not resolved at 10–14 days after the birth are assessed for mental health problems.
Commissioners ensure that they commission services with local arrangements for women in whom transient psychological symptoms ('baby blues') have not resolved at 10–14 days after the birth to have an assessment for mental health problems.

What the quality statement means for patients, service users and carers

Women in whom 'baby blues' have not resolved at 10–14 days after the birth are assessed for mental health problems.

Source guidance

Definitions of terms used in this quality statement

Transient psychological symptoms ('baby blues')
NICE clinical guideline 37 recommendation 1.2.25 provides 'tearfulness, feelings of anxiety and low mood' as examples of the symptoms and signs of unresolved transient psychological symptoms.
Assessment for mental health problems
For women who have a possible mental health issue, NICE clinical guideline 45 recommends that healthcare practitioners may consider the use of self-report measures such as the Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS) or Patient Health Questionnaire-9 (PHQ-9) as part of a subsequent assessment process.

Equality and diversity considerations

Communication between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who don't speak or read English.

Parent–baby attachment

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Parents or main carers who have infant attachment problems receive services designed to improve their relationship with their baby.

Rationale

Problems with parent-to-baby attachment may result in the baby developing emotional, psychological or behavioural issues in childhood. Providing family-based interventions could improve attachment, thereby providing the building blocks for the child to develop healthy behaviours and mental wellbeing.

Quality measures

Structure
Evidence of local arrangements to ensure that parents or main carers with infant attachment problems receive services designed to improve their relationship with their baby.
Data source: Local data collection.
Process
Proportion of parents or main carers with infant attachment problems who receive services designed to improve their relationship with their baby.
Numerator – the number of parents or main carers with infant attachment problems who receive services designed to improve their relationship with their baby.
Denominator – the number of parents or main carers with infant attachment problems.
Data source: Local data collection.
Outcome
a) Emotional, behavioural and social wellbeing of developing babies.
Data source: Local data collection.
b) Parental or main carer satisfaction with services to support parenting skills.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that parents or main carers with infant attachment problems receive services designed to improve their relationship with their baby.
Healthcare practitioners offer parents or main carers with infant attachment problems services designed to improve their relationship with their baby.
Commissioners ensure that they commission services that have systems in place to offer parents or main carers with infant attachment problems services designed to improve their relationship with their baby.

What the quality statement means for patients, service users and carers

Parents or main carers who are having difficulties forming a bond with their child are able to receive services designed to improve their relationship with their baby.

Source guidance

Definitions of terms used in this quality statement

Services to improve parent-baby relationships
Services have the aim of promoting emotional attachment and improving parenting skills. Services should be tailored to the needs of the family and baby and may include the woman, partner and wider family. Services should be sensitive to a wide range of attitudes, expectations and approaches in relation to parenting. NICE public health guidance 40 provides guidance about the types of services which may provide additional parenting support, for example a series of intensive home visits delivered by an appropriately trained nurse, baby massage and video interaction.
Main carer
For the majority of babies the main carer will be the mother. For some babies the main carer could be a close relative, for example the baby's father or grandparent, or for looked-after babies this could be a foster parent.

Equality and diversity considerations

In order to promote equality, the parents of babies who are vulnerable to poor parent-baby relationships may require additional intensive support. Services should take into account the parent's first language, and this may influence the interventions to achieve specified goals around the baby's communication, speech and language development.

Information for parents or carers

This quality statement is taken from the neonatal jaundice quality standard. The quality standard defines clinical best practice in neonatal jaundice care and should be read in full.

Quality statement

Parents or carers of newborn babies have a discussion with healthcare professionals and are given written information about neonatal jaundice within 24 hours of the birth, including what to look for and who to contact if they are concerned.

Rationale

Early identification of neonatal jaundice is essential to ensure that babies receive appropriate treatment for either underlying disease or for hyperbilirubinaemia caused by physiological jaundice in order to prevent complications and achieve the best clinical outcomes. Advising parents or carers about what to look for and when to contact a healthcare professional will help to ensure rapid access to treatment if needed. This is particularly important in the context of early discharge from maternity units. Giving parents or carers information about neonatal jaundice will also reassure them that it is common, usually transient and harmless, and that normal feeding and normal care of the baby can usually continue (including extra support with breastfeeding). This will reduce their anxiety if their baby does develop jaundice and needs investigations or treatment. Parents or carers of newborn babies receive a large amount of information, which is why a discussion, in addition to written information, is important.

Quality measures

Structure
a) Evidence of local availability of written information about neonatal jaundice for parents or carers of newborn babies.
Data source: Local data collection.
b) Evidence of local arrangements to ensure telephone access to a relevant healthcare professional for parents or carers who are concerned about neonatal jaundice.
Data source: Local data collection.
Process
Proportion of newborn babies whose parents or carers have a discussion with healthcare professionals and receive written information about neonatal jaundice within 24 hours of the birth, including what to look for and who to contact if they are concerned.
Numerator – the number of babies in the denominator whose parents or carers have a discussion with healthcare professionals and receive written information about neonatal jaundice within 24 hours of the birth, including what to look for and who to contact if they are concerned.
Denominator – the number of newborn babies.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure the availability of written information about neonatal jaundice (including what to look for and who parents or carers can contact if they are concerned) and that healthcare professionals understand and act on the need to discuss this with parents or carers of newborn babies.
Healthcare professionals ensure that they discuss neonatal jaundice with parents or carers of newborn babies and give them written information within 24 hours of the birth, including what to look for and who to contact if they are concerned.
Commissioners ensure that they commission services in which written information on neonatal jaundice is available and there is telephone access to relevant healthcare professionals for parents or carers who are concerned about jaundice.

What the quality statement means for patients and carers

Parents or carers of newborn babies have a discussion with healthcare professionals and are given written information about jaundice within 24 hours of the baby being born. This includes information about how to check whether the baby might have jaundice, as well as who to contact if they are concerned.

Source guidance

  • Neonatal jaundice (NICE clinical guideline 98), recommendation 1.1.1 (key priority for implementation)
  • Postnatal care (NICE clinical guideline 37), recommendation 1.4.16

Definitions of terms used in this quality statement

Information about neonatal jaundice
Information about neonatal jaundice should be tailored to the needs and expressed concerns of parents or carers of newborn babies. The information should be provided through discussion backed up by written information. Care should be taken to avoid causing unnecessary anxiety to parents or carers. The combination of discussion and written information should cover:
  • factors that influence the development of significant hyperbilirubinaemia
  • how to check the baby for jaundice (signs and symptoms to look for):
    • the naked baby in bright and preferably natural light
    • note that examination of the sclerae, gums and blanched skin is useful across all skin tones
  • who to contact if they suspect jaundice, jaundice is getting worse, or their baby is passing pale chalky stools or dark urine
  • the importance of recognising jaundice in the first 24 hours and of seeking urgent medical advice
  • the fact that neonatal jaundice is common, and reassurance that it is usually transient and harmless
  • reassurance that support will be provided to continue with normal feeding (including extra advice and support with breastfeeding) and normal care of the baby.
[Adapted from Postnatal care (NICE clinical guideline 37) recommendation 1.4.16, Neonatal jaundice (NICE clinical guideline 98) recommendations 1.1.1 (key priority for implementation) and 1.2.5, and Postnatal care (NICE quality standard 37) statement 3]
A neonatal jaundice parent information factsheet and information for the public about neonatal jaundice are available from NICE.

Equality and diversity considerations

Information about neonatal jaundice should be accessible to parents or carers with additional needs such as physical, sensory or learning disabilities, and to parents or carers who do not speak or read English. Parents or carers of babies with neonatal jaundice in any setting should have access to an interpreter or advocate if needed.
Extra support with visual checks for jaundice in babies and checking nappies for pale stools or dark urine should be provided to parents or carers with sight impairments.
It may be difficult to recognise jaundice in some babies with dark skin tones. The instructions about how to check the baby for jaundice are written to be useful across all skin tones: examination of the sclerae, gums and blanched skin in bright (preferably natural) light.

Measurement of bilirubin level in babies more than 24 hours old

This quality statement is taken from the neonatal jaundice quality standard. The quality standard defines clinical best practice in neonatal jaundice care and should be read in full.

Quality statement

Babies with suspected jaundice who are more than 24 hours old have their bilirubin level measured within 6 hours of a healthcare professional suspecting jaundice or a parent or carer reporting possible jaundice.

Rationale

Visual inspection is used to recognise jaundice but is not very good for assessing the clinical severity of the jaundice. Although bilirubin should not be measured routinely in babies who are not visibly jaundiced, measuring bilirubin levels in babies with suspected or obvious visible jaundice assesses the degree of jaundice and determines whether the baby needs further investigations or treatment. Measuring the bilirubin level as soon as possible (within 6 hours) in babies with suspected jaundice will ensure that those with rapidly rising bilirubin levels are identified promptly for treatment. Bilirubin can be measured by taking a blood sample (serum bilirubin) or, within defined circumstances (see Definitions below), using a transcutaneous bilirubinometer (followed by a blood test if needed). Transcutaneous bilirubinometers, although not as accurate as measuring serum bilirubin, are more accurate than visual inspection alone, are non-invasive, can be used in the community and provide instant results.

Quality measures

Structure
Evidence of local protocols and adequate access to bilirubin measurement, to ensure that babies with suspected jaundice who are more than 24 hours old have their bilirubin level measured within 6 hours of a healthcare professional suspecting jaundice or a parent or carer reporting possible jaundice.
Data source: Local data collection.
Process
a) Proportion of babies with suspected jaundice who are more than 24 hours old who have their bilirubin level measured.
Numerator – the number of babies in the denominator having their bilirubin level measured.
Denominator – the number of babies with suspected jaundice who are more than 24 hours old.
Data source: Local data collection.
b) Proportion of babies with suspected jaundice who are more than 24 hours old who have their bilirubin level measured within 6 hours of a healthcare professional suspecting jaundice or a parent or carer reporting possible jaundice.
Numerator – the number of babies in the denominator having their bilirubin level measured within 6 hours of a healthcare professional suspecting jaundice or a parent or carer reporting possible jaundice.
Denominator – the number of babies with suspected jaundice who are more than 24 hours old who have had their bilirubin measured.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure adequate access to bilirubin measurement and have local education and protocols in place that enable healthcare professionals to measure, within 6 hours, bilirubin levels in babies with suspected jaundice who are more than 24 hours old.
Healthcare professionals ensure that they measure, within 6 hours, bilirubin levels in babies with suspected jaundice who are more than 24 hours old.
Commissioners ensure that they commission services with adequate access to bilirubin measurement that enable healthcare professionals to measure, within 6 hours, bilirubin levels in babies with suspected jaundice who are more than 24 hours old.

What the quality statement means for patients and carers

Babies with suspected jaundice who are more than 24 hours old have their bilirubin level measured within 6 hours of the possible jaundice being noted (bilirubin is the substance that causes the yellow colour seen in jaundice). This may be done by a healthcare professional at the baby’s home, but it may need to be done at a hospital.

Source guidance

  • Neonatal jaundice (NICE clinical guideline 98), recommendations 1.2.14 and 1.2.15 (key priority for implementation).

Definitions of terms used in this quality statement

Measurement of bilirubin level
When measuring the bilirubin level in babies more than 24 hours old:
  • use a transcutaneous bilirubinometer in babies with a gestational age of 35 weeks or more (always use serum bilirubin measurement to determine the bilirubin level in babies less than 35 weeks’ gestational age)
  • if a transcutaneous bilirubinometer is not available, measure the serum bilirubin
  • if a transcutaneous bilirubinometer measurement indicates a bilirubin level greater than 250 micromol/litre check the result by measuring the serum bilirubin
  • always use serum bilirubin measurement for babies at or above the relevant treatment thresholds for their postnatal age, and for all subsequent measurements
  • do not use an icterometer.
[Adapted from Neonatal jaundice (NICE clinical guideline 98) recommendation 1.2.15]
Within 6 hours
The 6-hour timeframe begins when a healthcare professional suspects jaundice or when a parent or carer reports possible jaundice.
[Expert opinion]
Transcutaneous bilirubinometer
A device that uses reflected light to measure the yellow colour (bilirubin level) in the skin.

Equality and diversity considerations

Some parents or carers may find it difficult to access postnatal care for their baby after discharge from hospital; for example, they may be unable to afford to travel to their local clinic or hospital. This quality statement focuses on the period after the initial 24 hours after birth (and so in many cases after discharge from hospital). It promotes equitable access to postnatal care by making reference to the use (where clinically indicated) of transcutaneous bilirubinometers, which can be used in the community.

Management of hyperbilirubinaemia: treatment thresholds

This quality statement is taken from the neonatal jaundice quality standard. The quality standard defines clinical best practice in neonatal jaundice care and should be read in full.

Quality statement

Babies with hyperbilirubinaemia are started on treatment in accordance with standardised threshold tables or charts.

Rationale

Once jaundice in babies is recognised, it is important to know when and how to treat it. Phototherapy is an effective treatment for significant hyperbilirubinaemia and can reduce the need for exchange transfusion (a procedure involving a complete changeover of blood), which is necessary only in the most severe cases. The consistent use of treatment thresholds, alongside NICE guidance, will help to ensure a balance between the thresholds being low enough to prevent complications (such as kernicterus) but not so low that phototherapy is used unnecessarily.

Quality measures

Structure
Evidence of local arrangements to ensure the use of standardised treatment threshold tables or charts when starting treatment for babies with hyperbilirubinaemia.
Data source: Local data collection.
Process
Proportion of babies identified with hyperbilirubinaemia who are started on treatment in accordance with standardised threshold tables or charts.
Numerator – the number of babies in the denominator who are started on treatment in accordance with standardised threshold tables or charts.
Denominator – the number of babies identified with hyperbilirubinaemia.
Data source: Local data collection.
Outcome
Incidence of kernicterus.
Data source: Local data collection. The ICD-10 code for Kernicterus is P57. Data available via Hospital episode statistics (HES) online or the Neonatal Critical Care Minimum Data Set.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that healthcare professionals have access to, and are competent to use, standardised threshold tables or charts when deciding whether to start (or not start) treatment for babies with hyperbilirubinaemia.
Healthcare professionals ensure that they use standardised threshold tables or charts when deciding whether to start (or not start) treatment for babies with hyperbilirubinaemia.
Commissioners ensure that they commission services in which healthcare professionals have access to, and are competent to use, standardised threshold tables or charts when deciding whether to start (or not start) treatment for babies with hyperbilirubinaemia.

What the quality statement means for patients and carers

Babies with high levels of bilirubin receive treatment according to tables or charts that tell the healthcare team whether to start (or not start) treatment. The information used when making decisions about when to start treatment includes how high the baby’s bilirubin level is, the age of the baby when the bilirubin was measured, and the baby’s maturity at the time of birth (that is, how many weeks of pregnancy they were born after).

Source guidance

  • Neonatal jaundice (NICE clinical guideline 98), recommendations 1.3.4 (key priority for implementation) and 1.2.13.

Definitions of terms used in this quality statement

Standardised threshold tables or charts
These are tables or charts that help healthcare professionals to implement treatment thresholds for phototherapy and exchange transfusion in accordance with NICE clinical guideline 98. These include treatment threshold graphs published on the NICE website. All tables or charts should take into account serum bilirubin level, gestational age and postnatal age.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Pathway information

Information for the public

NICE produces information for the public. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics:
NICE has also written information for patients and the public explaining its quality standards on the following topics:

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

9 May 2014 Minor maintenance updates
6 March 2014 Neonatal jaundice (NICE quality standard 57) added
10 September 2013 A link to the 'Urinary incontinence in women pathway' has been added.
15 July 2013 The postnatal care quality standard has been added to this pathway.
25 January 2013 Minor maintenance updates
21 October 2011 Minor maintenance updates

Supporting information

Glossary

In this pathway, the term 'diet' refers to the habitual eating patterns of individuals and groups of people who are not slimming or eating to manage or treat a medical condition.
Life-threatening or potential life-threatening situation.
Under UK law, follow-on formula may provide the liquid component of a progressively varied diet for healthy infants aged over 6 months.
There is no standard definition. However it is widely accepted that 'healthy eating' means following a diet which is low in fat (particularly saturated fat), sugar and salt, and high in fruit, vegetables and fibre-rich starchy foods. More details are available from NHS Choices.
Under UK law, infant formula is the term used to describe a food intended to satisfy, by itself, the nutritional needs of infants during the first months of life. The Department of Health advises that infant formula may be used on its own for the first 6 months.
Continue to monitor and assess.
An elevation of the serum bilirubin to a level requiring treatment.
Potentially serious situation, which needs appropriate action.
Jaundice detected by visual inspection.
Weaning or 'complementary feeding' is the transition from an exclusively milk-based diet to a diet based on solid foods.

Paths in this pathway

Pathway created: May 2011 Last updated: May 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.

Recently viewed