Research and training drives changes to South West emergency service for babies born outside of hospital

In 2022/23, Health Innovation South West supported research investigating neonatal temperature management in the UK. We also supported two midwives from Yeovil District Hospital to deliver Perinatal Bias and Newborn Assessment training to local maternity and neonatal staff to improve understanding of perinatal bias and its impact.  

Katie McNee, Quality Improvement Paramedic at South Western Ambulance NHS Foundation Trust (SWASFT), has drawn upon this research and used what she learnt as a participant on the training course to drive new changes in paramedic practice to improve care for babies born outside of hospital in the South West. Here Katie shares her journey to implementing change. 

Better temperature measurement and management in newborns

It started with an audit looking at the potential reasons why newborn observations aren’t recorded by paramedics, for example in babies born outside of hospital.

I was invited to an event by Laura Goodwin, Associate Professor in Emergency Care at University of West of England, where she shared her research investigating neonatal temperature management and risk of hypothermia in babies born outside of hospital, known as Birth Before Arrival (BBA).

It snowballed from there. Laura wanted to introduce an intervention and there were a lot of opportunities to improve the way our service records held newborn observations. So, we started planning to create a new record page for newborns within our electronic patient care system (ePCS), highlighting to paramedics the need to measure and manage neonatal temperature.

The record page had areas for improvement. For example, newborn observations had to be written in a free text box, or paramedics had to open up a new record for the baby, separate to the mother’s record. A newborn baby often doesn’t have a name or NHS number, making logging difficult, and there’s the added complication in that if you have two patients’ records open on the ePCR, it won’t automatically upload results from the monitoring device to either record.

The new record page has lost the free text box and enables paramedics to record multiple observations including temperature, blood glucose, respiratory rate and oxygen saturation for the baby on the mother’s record.

The new record page is a collaborative effort. Associate Professor Goodwin was involved in the conversation as well as paramedic colleagues, our electronic care system developers and audit team, and our patient safety and patient experience teams. I’ve been supported by external partners Health Innovation South West and Health Innovation West of England, which have been good at connecting me with external people, such as a consultant midwife paramedic.

There are a few other changes we’re introducing at SWASFT in response to Associate Professor Goodwin’s research too; delayed cord clamping, skin-to-skin, breastfeeding, applying hats, and TransWarmer infant warming mattresses to all our frontline vehicles.

Driving culturally competent paramedic care for newborns

APGAR, a test given to newborns soon after birth, is embedded within SWASFT records and recording APGAR scoring is recommended in our [care] guidelines.

Some references used by APGAR can make detection of some conditions difficult. For example, APGAR refers to skin colour as pink, making cyanosis – when skin turns blue or grey – harder to detect in a black or brown baby.

In March 2023, Health Innovation South West invited me to take part in Perinatal Bias and Newborn Assessment training.

With what I learnt on the training I was encouraged to consult with the Equality, Diversity and Inclusion Lead at SWASFT and we decided to tweak our APGAR scoring to instruct clinicians to look in other places for changes on newborns, for example on the hands, the palms, the soles of the feet and inside the mouth. We’ve also adapted words we use, to ensure we are using culturally sensitive prompts when it comes to skin tone and colour.

The Perinatal Bias training as well as the BBA research supported by Health Innovation South West has helped provide direction to the improvements made to SWASFT’s electronic care system in order to improve the care of babies born before arrival at hospital.

The new record page for newborns is being implemented within South Western Ambulance Service NHS Foundation Trust’s electronic patient care system. The Trust is also incorporating culturally sensitive prompts as part of its recording process for newborns born outside of hospital. Learn more about our work to support research into babies born outside of hospital and Perinatal Bias & Newborn Assessment Training. 

With thanks to Katie McNee for sharing her reflections.