Jul 092018
 

OBS Cymru, the all-Wales collaborative quality improvement project aiming to reduce harm from postpartum haemorrhage, has been shortlisted for two awards this year at the Patient Safety Awards and NHS Wales Awards.

We’ve been getting an update on the project from its two national lead midwives, Elinore Macgillivray and Kathryn Greaves.

 

For anyone who hasn’t heard of OBS Cymru, can you start by giving an overview?

Elinore: Postpartum haemorrhage (excessive bleeding after childbirth) is the second leading cause of direct maternal death in the UK, and accounts for 80% of maternal morbidity.1 in 20 women will experience a postnatal blood loss in excess of 1 litre, and for 1 in 200 life threatening bleeding will occur, leading to a number of adverse physical and emotional consequences. Rarely (around once every 3 years in Wales) postpartum haemorrhage (PPH) will result in a baby that goes home without its mother. This being so, there was a clear need for quality improvement in the management of PPH, with all the Health Boards in Wales agreeing to take part in the project.

Kathy: PPH is in the top five quality and safety risks identified for every maternity unit in Wales. OBS Cymru – the Obstetric Bleeding Strategy for Wales is a three year national quality improvement project, now in its second year, aiming to reduce harm from PPH. The primary aim of the project is to reduce the number of women suffering a massive obstetric haemorrhage.

How is the project meeting its aims?

Elinore:  Since the project was first launched in November 2016 a number of interventions have been put in place across all Obstetric led labour wards in Wales, and having positive results:

  • Risk Assessment for PPH is now becoming a routine part of the admission process in obstetric led birth settings, leading to increased awareness of and early planning for PPH detection, prevention and management.
  • Early identification by means of Measuring Blood Loss is quickly becoming embedded in practice, with over 90% of women having their postnatal blood loss measured.
  • Multidisciplinary Team Working is improving as a result of the training provided by OBS Cymru teams. Clinicians including Midwives, HCAs, anaesthetists, obstetricians, ODPs, and students working in maternity settings have received OBS Cymru training, and have embraced the 4 stage approach to PPH management.
  • ROTEM point of care testing machines have been installed in every labour ward in Wales to allow access to rapid coagulation results and guide blood product management. Early data suggests this is leading to a decrease in the administration of blood products for the reason of PPH.

Kathy:   These interventions are supported by a robust system of data collection by local OBS Cymru champion teams, we have a dedicated team in every obstetric led labour ward in Wales.  Local teams utilise this data collection to analysis and establish areas for improvement within their own health boards.  The Champion teams attend national meetings in which clinical examples presented show how the OBS Cymru principles supported resolution and improved outcomes for women.  In addition the Midwives from each of the health boards meet annually to review and share learning and take this back to their health boards to disseminate good practice.

Are you seeing any changes since the project was first launch in May 2016?

Elinore – Early data is showing that now over 90% of women are having their blood loss measured, which empowers clinicians to provide the right treatment to the right women at the right time. Blood product usage due to PPH is also beginning to decrease.

Kathy: OBS Cymru is a live quality improvement project and there are daily conversations about good practice happening in the health boards and about it’s impact on practice.  One health board has incorporated the risk assessment as part of their multidisciplinary handover when reviewing the women in labour so that as a team they know and are aware of any potential risks and make appropriate preparations as a team prior to delivery.  Others have noted a potential risk when using drapes during delivery and the hidden blood loss which is collected.  A simple solution of using the suction tubing during a procedure placed in the drape has fixed this potential to miss the slow steady bleed which goes unrecognised.  These gems of learning are being shared across Wales so that others can benefit from practice examples and our Champion teams are integral to the dissemination of this.  We are absolutely thrilled that the project has been recognised in the Patient Safety and NHS Wales Awards.  We are privileged to have been shortlisted and recognise that we are fortunate to be representing all of Wales maternity services and that this award is for them and their hard work and commitment to the project.

What makes you both so passionate about this project?

Kathy:  It’s always humbling to see the growth in confidence of myself as a practitioner and my midwifery colleagues as a profession and their integral role in managing PPH.  The 4 stage paper work has given midwives an indicative tool that is diagnostic of PPH and that it has formalised defined trigger points for action that supports the team’s situational awareness when managing obstetric bleeding. Everyday midwifery teams go to work intent on doing a good job, this is one tool in their armoury to achieve this day in day out, from Bangor in the North to Carmarthen in the West and Cardiff in the South, once for Wales.

Elinore: It’s a privilege to be involved in a project that is not only improving outcomes for women, but also empowering teams to use the skills they have acquired to have the confidence to provide the right treatment to the right women at the right time. Measured blood loss is becoming a powerful tool for communication during postpartum haemorrhage, improving team working.  An important part of the project is the women’s experience. Our patient survey shows that although PPH can be a frightening experience, women and their birth partners feel confident that they are receiving a high standard of care, which is very pleasing.

Two years into a three year project, what does the future hold for OBS Cymru?

Elinore:  Although we have made great inroads towards improving care during a PPH, we will continue to work on sustaining these changes beyond the lifespan of the project. The OBS Cymru approach to PPH management has now been incorporated into All Wales PROMPT as an integral part of sustaining the principles of risk assessment, measuring blood loss, early MDT involvement, and ROTEM POCT testing. We are also keen to see how the data reflects these changes.

Find out more about OBS Cymru here and follow the conversation on Twitter #OBSCymru

Jul 092018
 

Mae OBS Cymru, prosiect gwella ansawdd cydweithredol Cymru gyfan sydd â’r nod o leihau niwed yn sgil gwaedlif ôl-enedigol, wedi cyrraedd y rhestr fer ar gyfer dwy wobr eleni yn y Gwobrau Diogelwch Cleifion a Gwobrau GIG Cymru.

Rydym ni wedi bod yn cael diweddariad ar y prosiect gan ei ddwy fydwraig arweiniol genedlaethol, Elinore Macgillivray a Kathryn Greaves.

 

Ar gyfer unrhyw un sydd heb glywed am OBS Cymru, allwch chi ddechrau trwy roi trosolwg?

Elinore: Gwaedlif ôl-enedigol (gwaedlif gormodol ar ôl geni plentyn) yw’r ail achos mwyaf o farwolaethau mamol uniongyrchol yn y DU, ac mae’n cyfrif am  80% o farwolaethau mamol. Bydd 1 o bob 20 menyw yn colli dros 1 litr o waed ôl-enedigol, ac ar gyfer 1 o bob 200, bydd gwaedu sy’n bygwth bywyd yn digwydd, sy’n arwain at nifer o ganlyniadau corfforol ac emosiynol niweidiol. Mewn achosion prin (oddeutu unwaith bob 3 blynedd yng Nghymru), bydd gwaedlif ôl-enedigol (PPH) yn arwain at faban yn mynd adref heb ei fam. Gan ystyried hyn, roedd angen amlwg i wella ansawdd rheoli gwaedlif ôl-enedigol, a chytunodd yr holl Fyrddau Iechyd yng Nghymru i gymryd rhan yn y prosiect.

Kathy: Mae gwaedlif ôl-enedigol yn un o’r pum prif risg ansawdd a diogelwch a amlygwyd ar gyfer pob uned famolaeth yng Nghymru. Mae OBS Cymru – Strategaeth Gwaedu Obstetrig i Gymru yn brosiect gwella ansawdd tair blynedd cenedlaethol, bellach yn ei ail flwyddyn, sy’n ceisio lleihau niwed yn sgil gwaedlif ôl-enedigol. Prif nod y prosiect yw lleihau nifer y menywod sy’n dioddef gwaedlif obstetrig enfawr.

Sut mae’r prosiect yn cyflawni ei nodau?

Elinore:  Ers lansio’r prosiect ym mis Tachwedd 2016, mae nifer o ymyriadau wedi cael eu rhoi ar waith ar draws wardiau geni dan arweiniad obstetrig yng Nghymru, gan arwain at ganlyniadau cadarnhaol:

  • Mae asesu risg ar gyfer gwaedlif ôl-enedigol nawr yn dod yn rhan arferol o’r broses dderbyn mewn lleoliadau geni dan arweiniad obstetrig, sydd wedi arwain at ymwybyddiaeth gynyddol o ganfod, atal a rheoli gwaedlif ôl-enedigol a chynllunio’n gynnar ar gyfer hynny.
  • Mae amlygu cynnar trwy fesur colli gwaed yn cael ei ymsefydlu mewn ymarfer, a chaiff faint o waed ôl-enedigol a gollir gan dros 90% o fenywod ei fesur.
  • Mae gwaith tîm amlddisgyblaethol yn gwella o ganlyniad i’r hyfforddiant a ddarparwyd gan dimau OBS Cymru. Mae clinigwyr, gan gynnwys bydwragedd, cynorthwywyr gofal iechyd, anesthetyddion, obstetryddion, ymarferwyr yr adran lawdriniaethau, a myfyrwyr sy’n gweithio mewn lleoliadau mamolaeth, wedi derbyn hyfforddiant OBS Cymru, ac maent wedi defnyddio’r ymagwedd 4 cam i reoli gwaedlif ôl-enedigol.
  • Mae peiriannau profi pwynt gofal ROTEM wedi cael eu gosod ym mhob ward geni yng Nghymru i ganiatáu mynediad at ganlyniadau tolchi cyflym ac arwain rheoli cynhyrchion gwaed. Mae data cynnar yn awgrymu bod hyn yn arwain at ostyngiad mewn rhoi cynhyrchion gwaed yn sgil gwaedlif ôl-enedigol.

Kathy:   Caiff yr ymyriadau hyn eu cefnogi gan system gadarn o gasglu data gan dimau hyrwyddo OBS Cymru lleol, ac mae gennym ni dîm pwrpasol ym mhob ward geni dan arweiniad obstetrig yng Nghymru. Mae timau lleol yn defnyddio’r data a gesglir i ddadansoddi a sefydlu meysydd i’w gwella o fewn eu byrddau iechyd eu hunain. Mae’r timau hyrwyddo yn mynychu cyfarfodydd cenedlaethol lle mae enghreifftiau clinigol a gyflwynir yn dangos sut mae egwyddorion OBS Cymru wedi cefnogi penderfyniadau a chanlyniadau gwell i fenywod.  Yn ogystal â hyn, mae bydwragedd o bob bwrdd iechyd yn cyfarfod yn flynyddol i adolygu a rhannu dysgu, a chyflwyno hyn i’w byrddau iechyd i ledaenu arfer da.

Ydych chi wedi gweld unrhyw newidiadau ers lansio’r prosiect ym mis Mai 2016?

Elinore – Mae data cynnar yn dangos bod faint o waed a gollir gan dros 90% o fenywod yn cael ei fesur, sy’n grymuso clinigwyr i roi’r driniaeth gywir i’r menywod cywir, ar yr adeg gywir. Mae’r defnydd o gynhyrchion gwaed yn sgil gwaedlif ôl-enedigol hefyd yn dechrau gostwng.

Kathy: Mae OBS Cymru yn brosiect gwella ansawdd byw a chynhelir sgyrsiau dyddiol yn y byrddau iechyd am arfer da a’i effaith ar arferion. Mae un bwrdd iechyd wedi ymgorffori asesu risg yn rhan o drosglwyddo amlddisgyblaethol wrth adolygu’r menywod sy’n esgor, fel bod y tîm yn ymwybodol o unrhyw risgiau posibl ac yn gwneud paratoadau priodol fel tîm, cyn i’r menywod roi genedigaeth. Mae eraill wedi nodi risg bosibl wrth ddefnyddio gorchuddion yn ystod  esgor, a’r gwaed cudd a gollwyd sy’n cael ei gasglu. Mae ateb syml, sef gosod y tiwb sugno a ddefnyddir yn ystod gweithdrefn yn y gorchudd, wedi datrys y posibilrwydd o fethu gwaedu araf, cyson, na sylwir arno. Mae’r perlau dysgu hyn yn cael eu rhannu ledled Cymru, er mwyn i eraill allu elwa ar enghreifftiau o ymarfer, ac mae ein timau hyrwyddo yn rhan annatod o ledaenu hyn. Rydym ni wrth ein bodd bod y prosiect wedi cael ei gydnabod yn y Gwobrau Diogelwch Cleifion a Gwobrau GIG Cymru. Mae’n fraint cyrraedd y rhestr fer ac rydym ni’n cydnabod ein bod ni’n ffodus i gael cynrychioli holl wasanaethau mamolaeth Cymru, a bod y wobr hon ar eu cyfer nhw, a’u gwaith caled a’u hymrwymiad i’r prosiect.

Beth sy’n eich gwneud chi’ch dwy mor frwdfrydig am y prosiect hwn?

Kathy:  Mae bob amser yn galonogol gweld twf yn fy hyder i fel ymarferwr, a fy nghydweithwyr bydwreigiaeth fel proffesiwn, a’u rôl annatod o ran rheoli gwaedlif ôl-enedigol. Mae’r gwaith papur 4 cam wedi rhoi offeryn dangosol i fydwragedd sy’n mesur gwaedlif ôl-enedigol yn ddiagnostig, ac mae wedi ffurfioli pwyntiau sbardun penodol ar gyfer gweithredu, sy’n ategu ymwybyddiaeth sefyllfaol y tîm wrth reoli gwaedu obstetrig. Bob dydd, mae timau bydwreigiaeth yn mynd i’r gwaith gyda’r bwriad o wneud gwaith da, a dyma un o’r dulliau sydd ganddyn nhw i allu cyflawni hyn bob dydd, o Fangor yn y gogledd, i Gaerfyrddin yn y gorllewin, a Chaerdydd yn y de, unwaith i Gymru.

Elinore: Mae’n fraint bod yn gysylltiedig â phrosiect sydd nid yn unig yn gwella canlyniadau i fenywod, ond hefyd yn grymuso timau i ddefnyddio’r sgiliau y maen nhw wedi’u caffael i gael yr hyder i ddarparu’r driniaeth gywir, i’r menywod cywir, ar yr amser cywir. Mae mesur colli gwaed yn dod yn offeryn pwerus i gyfathrebu yn ystod gwaedlif ôl-enedigol, sy’n gwella gwaith tîm. Rhan bwysig o’r prosiect yw profiad y menywod. Mae ein harolwg cleifion yn dangos, er y gall gwaedlif ôl-enedigol fod yn brofiad brawychus, mae menywod a’u partneriaid geni yn teimlo’n hyderus eu bod nhw’n derbyn gofal o safon uchel, sy’n rhoi boddhad mawr.

Ar ôl dwy flynedd o brosiect tair blynedd, beth yw dyfodol OBS Cymru?

Elinore:  Er ein bod ni wedi cymryd camau breision tuag at wella gofal yn ystod  gwaedlif ôl-enedigol, byddwn ni’n parhau i weithio ar gynnal y newidiadau hyn y tu hwnt i oes y prosiect. Mae ymagwedd OBS Cymru at reoli gwaedlif ôl-enedigol wedi cael ei hymgorffori yn PROMPT Cymru Gyfan, fel rhan annatod o gynnal egwyddorion asesu risg, mesur colli gwaed, ymwneud cynnar gan dîm amlddisgyblaethol, a phrofi pwynt gofal ROTEM. Rydym ni hefyd yn awyddus i weld sut mae’r data’n adlewyrchu’r newidiadau hyn.

Darganfyddwch fwy am OBS Cymru yma a dilynwch y sgwrs ar Twitter #OBSCymru

Oct 112017
 

HeatherJane Coombs – SANDS

In 2004, I thought after your 12 week scan you were home and dry in your pregnancy and you just waited for the little of bundle of joy to join you. How naïve was I! I had heard of stillbirth and babies dying but only from soap operas, it didn’t happen in real life to normal people… Did it?

On the 1 September 2004 I realised that yes stillbirth DOES happen to normal people like myself when I was told at 10.31pm that my son Xander had died inside of me due to a placenta abruption. I wasn’t sure how I expected him to come out, but to then realise I was going to have to give birth to a baby that would never cry broke me in two.

I was in labour for the next 2 days and finally gave birth at 2.43pm to a gorgeous (yes I’m biased, but he was) 5lb 5.5oz baby boy who we named Xander Dangerfield Coombs. I can tell you every single detail of the time spent in that room waiting to give birth, even how uncomfortable the bed was and the posters of babies on the wall. That first night I heard 7 babies being born and knowing my baby would never cry like their babies was torture.

When I was told my baby had no heart beat and then the news that he had died, it was a student midwife who held my hand and cried with me. Her compassion stays with me.  My midwife Cath who was there for the days of my labour and helped me through some tough hours is on a pedestal and will always remain Queen of Midwives to me, she was amazing.  I also know that her shift finished at 2pm on that Wednesday, but she was still there looking after her “poppet” as she referred to Xander and me until gone 9pm when I left.  She dressed him, talked to him and gave us the time to be with him, whilst still being there when we needed something, she was amazing.  I am in awe of a midwife who can deal so lovingly and perfectly with a family in heartbreak and then go next door to a family whose lives have changed in another way differently to ours.

Through my work with Sands (Stillbirth and neonatal death charity), first as a volunteer and then as an employee I have heard so many stories and met so many health professionals, some good and some not so good.  When I was asked to join the National Stillbirth Working Group I was both elated and scared!  My work back ground was a team leader in a call centre and my first few meetings I felt like I was a rabbit caught in the head lights, I was just waiting for someone to tell me I was an imposter and ask me what I was doing there.  The medical talk went right over my head, and often I went home with lots of notes so that I could google what words meant so I could understand what the conversation was about. I would like to think that over time though I have started contributing as the voice of the parents and made a small difference within the group.

Being part of the launch of the Safer Pregnancy Wales Campaign and fortunate enough to be able to share Xander with everyone was amazing and the partnership between Sands and the Maternity Network/1000 Lives Improvement seems to have gone from strength to strength, the upcoming launch of the Pathway being even more exciting.  When we start seeing the stillbirth rates reduce as they did in Scotland then that will really be amazing. His feet may have been small, but Xander’s foot print gets deeper with time.

We will be joining in raising awareness during baby loss awareness week. For more details of events please go to http://www.babyloss-awareness.org

Oct 112017
 

HeatherJane Coombs – SANDS

Yn 2004, roeddwn yn meddwl eich bod yn ddiogel ar ôl eich sgan 12 wythnos yn ystod eich beichiogrwydd, ac mai aros i’ch babi gyrraedd oedd y cam nesaf. Dyna naïf roeddwn i! Roeddwn wedi clywed am fabis marw-anedig ac am fabis yn marw ar ôl cael eu geni ond dim ond mewn operâu sebon. Doedd hyn ddim yn digwydd mewn bywyd go iawn ac i bobl arferol….Nag oedd?

Ar 1 Medi 2004, sylweddolais fod pobl arferol fel fi yn cael babis marw-anedig pan ddywedwyd wrthyf am 10.31pm fod fy mab Xander wedi marw y tu mewn i mi oherwydd toriad yn y brych. Doeddwn ddim yn gwybod sut roeddwn yn disgwyl iddo ddod allan, ond fe wnaeth y sylweddoliad fy mod yn mynd i roi genedigaeth i fabi na fyddai byth yn crio dorri fy nghalon yn ddwy.

Parhaodd yr enedigaeth am y 2 ddiwrnod nesaf ac, yn y diwedd, am 2.43pm ganwyd bachgen bach 5lb 5.5oz hynod hardd (ydw, dw i’n unochrog, ond mae’n wir) a enwyd gennym yn Xander Dangerfield Coombs.  Gallen i ddweud pob manylyn wrthoch chi am yr amser y treuliais yn yr ystafell honno yn aros i roi genedigaeth, hyd yn oed pa mor anghyffyrddus oedd y gwely a’r posteri o fabis ar y waliau. Y noson gyntaf honno, fe glywais 7 babi yn cael eu geni ac roedd gwybod na fyddai fy mabi i byth yn crio yn artaith.

Pan ddywedwyd wrthyf nad oedd gan fy mabi guriad calon ac yna’r newyddion ei fod wedi marw, myfyrwraig o fydwraig ddaliodd fy llaw a chrio gyda mi. Mae ei thosturi hi wedi aros gyda mi. Dwi wedi rhoi fy mydwraig, Cath, oedd yna am ddyddiau’r enedigaeth ac a’m helpodd i drwy oriau anodd iawn, ar bedestal a hi fydd brenhines y bydwragedd am byth yn fy marn i. Roedd hi’n anhygoel. Dw i hefyd yn gwybod bod ei shifft gwaith hi wedi dod i ben am 2pm ar y dydd Mercher hwnnw, ond roedd hi’n dal yna yn gofalu am ei “poppet”, sef yr enw roddodd hi ar Xander, a mi tan wedi 9pm pan adewais i. Fe’i gwisgodd, siaradodd ag e a rhoi amser i ni gael bod gydag e, ac roedd hi yno pan oedd angen unrhywbeth arnon ni. Roedd hi’n anhygoel… Dw i’n rhyfeddu at fydwraig sy’n gallu ymdrin mor gariadus a pherffaith â theulu yn ystod torcalon ac yna’n mynd drws nesaf at deulu y mae eu bywydau wedi newid mewn ffordd arall, yn wahanol i’n bywyd ni.

Trwy fy ngwaith gyda  Sands (elusen ar gyfer babis marw-anedig a marwolaeth ar ôl genedigaeth), yn gyntaf fel gwirfoddolwr ac yna fel gweithiwr, dw i wedi clywed gymaint o straeon ac wedi cwrdd â chymaint o weithwyr iechyd proffesiynol, rhai’n dda a rhai nad ydynt cystal. Pan ofynnwyd i mi ymuno â’r Gweithgor Marw-anedig Cenedlaethol, roeddwn wrth fy modd ac yn ofnus! O ran fy ngwaith, roeddwn yn arweinydd tîm mewn canolfan alwadau, ac yn ystod fy nghyfarfodydd cyntaf roeddwn yn teimlo allan o fy nyfnder, yn aros i rywun ddweud wrthyf fy mod yn twyllo a gofyn i mi beth oeddwn i’n ei wneud yno. Doeddwn i ddim yn deall y siarad meddygol, a byddwn yn aml yn mynd adref â llawer o nodiadau fel y gallwn chwilio ystyr geiriau ar y we, er mwyn deall am beth oedd y sgwrs. Serch hynny, hoffwn feddwl fy mod wedi dechrau cyfrannu dros amser, fel llais y rhieni, ac wedi gwneud rhywfaint o wahaniaeth o fewn y gweithgor.

Roedd bod yn rhan o lansio’r Ymgyrch Beichiogrwydd Mwy Diogel Cymru a bod yn ddigon ffodus i allu rhannu Xander gyda phawb yn anhygoel, ac mae’r bartneriaeth rhwng Sands a’r Rhwydwaith Mamolaeth/Gwella 1000 o Fywydau i’w weld wedi mynd o nerth i nerth, gyda lansio’r Llwybr hyd yn oed yn fwy cyffrous. Pan fyddwn yn dechrau gweld niferoedd y marw-anedig yn gostwng fel y gwnaethon nhw yn yr Alban, bydd hynny wir yn ardderchog. Efallai bod ei draed yn fach, ond mae Xander yn sicr yn gadael ei ôl.

Byddwn yn ymuno i godi ymwybyddiaeth yn ystod wythnos ymwybyddiaeth o golli babis. Am ragor o fanylion am ddigwyddiadau, ewch i www.babyloss-awareness.org