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Transcript of NNAP Collaborators Meeting – 16 th March 2015 NNAP Update Sam Oddie, NNAP Clinical Lead...
NNAP Collaborators Meeting – 16th March 2015
www.rcpch.ac.uk
NNAP UpdateSam Oddie, NNAP Clinical Lead
Birmingham
NNAP Collaborators Meeting – 16th March 2015
www.rcpch.ac.uk
• Background• 2013 data report• Parents and carers• Survey Monkey• Widening clinical input• Changes in NNAP reporting• Changes in data flow• Mortality
National Neonatal Audit Programme (NNAP)
Commissioned - HQIP (NCAPOP).
Funding - NHS England and the Welsh Government.
Delivered RCPCH. 2006 – 2015 (contract extension)Wales since 2012 data
www.rcpch.ac.uk
www.rcpch.ac.uk/nnap
NNAP PB supports inclusion of Scottish NNUs
Logistics – no barrier
Next stepsHQIP/ RCPCH, Scottish National Neonatal Project, Scottish Clinical Outcomes and Measures for Quality Improvement
(COMQI)
Inclusion of Scottish Neonatal Units
National Neonatal Audit Programme (NNAP)
Aims:
i. assess whether babies admitted to NNU
in England and Wales receive consistent
care in relation to the audit questions;
ii. identify areas for quality improvement
in NNUs in relation to delivery and
outcomes of care.
www.rcpch.ac.uk
Audit Questions - 2013 Results: Temperature
Do all babies of less than or equal to 28+6 weeks have their temperature taken within an hour after birth?
www.rcpch.ac.uk/nnap
NNAP data year
Number of eligible
NNU
Number of Eligible babies
% with T taken within an hour of birth
2008 130 2647 78%2009 165 3230 63%2010 169 3380 83%2011 164 2786 90%2012 169 3023 89%2013 170 2908 93%
Audit Questions - 2013 Results: Temperature
Do all babies of less than or equal to 28+6 weeks have their temperature taken within an hour after birth?
www.rcpch.ac.uk/nnap
n <32.0 32.0-35.9 36.0-36.5 36.6-37.4 ≥37.5Other 27 1 15 (56%) 4 (15%) 5 (19%) 2 (7.4%)
SCU 144 0 15 (10%) 38 (26%) 74 (51%) 17 (12%)
LNU 749 0 117 (16%) 224 (30%) 336 (45%) 72 (9.6%)
NICU 1779 1 187 (11%) 505 (28%) 852 (48%) 234 (13%)
Total 2699 2 5 (19%) 5 (19%) 5 (19%) 325 (12%)
Audit Questions - 2013 Results: ANS
Are all mothers who deliver their babies between 24+0 and 34+6 weeks gestation given any dose of antenatal steroids?
www.rcpch.ac.uk/nnap
NNAP reporting year
Number of eligible NNU
Number of eligible
mothersPercentage with any
antenatal steroids given2008 129 9066 63%
2009 167 16031 70%
2010 173 16895 75%
2011 164 15716 76%
2012 173 16576 80%
2013 176 16992 83%
Audit Questions - 2013 Results: Consultation
Is there are documented consultation with parents by a senior member of the neonatal team?
www.rcpch.ac.uk/nnap
NNAP data year
Number of eligible
NNU
Number of eligible episodes Within 24 hours
2008 129 16538 56%2009 167 25704 45%2010 172 40199 67%2011 164 34450 68%2012 174 42792 79%2013 176 50757 84%
Audit Questions - 2013 Results: ROP
Do babies <1501g or 32/40 undego the first ROP screen in accordance with the current guideline recommendations?
www.rcpch.ac.uk/nnap
NNAP data year
Number of eligible
NNU
Number of eligible
babies
Screened on time
2008 148 3414 -2009 167 7913 27%2010 171 8235 58%2011 164 7887 67%2012 173 7996 60%2013 175 8000 78% (87%)
2014 Annual Report on 2013
Data completeness: Feeding and T - very goodROP is much better44% had FU dataInfection – still poor
ROP – big babies not always screened
Non participants and outliers
www.rcpch.ac.uk/nnap
Developing engagement with Parents & Carers
www.rcpch.ac.uk
• Existing strong partnership with BLISS
• Under ToR, add further representation to PB
• Parent & Carer version of 2013 data report
• PREM development work
Patient Reported Experience Measures (PREM)
www.rcpch.ac.uk
RCPCH and Partners• BLISS• Neonatal networks
Patient Reported Experience Measures (PREM)
www.rcpch.ac.uk
RCPCH and Partners• BLISS• Neonatal networks
Engagement with NNUs – Survey Monkey
www.rcpch.ac.uk
June 2014: ‘Developing the future of the NNAP'
Objectives: • Help PB better understand the views of clinicians• Develop work of NNAP in responsive manner including
whole of the neonatal community.
182 responses from 166 units. “I think measuring (temperature) is important AND ensuring it is in (the) normal range” ROP “I am glad this question was audited……..no one listened……. we are making progress!! Finally!!”BrMilk: “The aim is laudable - the attempt to shame is not”
Wider clinical input - CRAG
www.rcpch.ac.uk
Clinical Reference and Advisory Group
Purpose:• Represent full range of NNUs by geography and unit size• Broaden base of clinical representation into NNAP• Reconsider existing questions and analyses• Suggest and refine new questions
• Meetings by teleconference/ face to face meeting
What has NNAP changed? – Infection questions
www.rcpch.ac.uk
LOI – hopefully preventable
Current measures in NNAP relate to EOI + LOI
Most quality improvement work focussing on blood cultures taken >72 hours
NB views of CRAG
What has NNAP changed? – ROP
www.rcpch.ac.uk
NNAP interpretation of RCOPhth guidance ROP screen in window, but after discharge = “adherent”
ROP in Badger• Daily data• Ad hoc forms
PB agreed “daily data” OR “ad hoc forms” would count as evidence that an ROP screen had taken placeSignificant impact on data completeness
(87% to 91% overall, Units <90% complete 84 to 66)Change to Badger system
What has NNAP changed? – Temperature
www.rcpch.ac.uk
Unrecordably low temperatures• Now assumed to be low in analysis
Values in report
What has NNAP changed? – parental consultation
www.rcpch.ac.uk
• Short admissions (<12 hours) no longer included
What has NNAP decided to change? – BPD/ CLD
www.rcpch.ac.uk
Mild: resp support (ETT, BIPAP, CPAP Hi Flow or any O2 for first 28/7) + air at 36/40Significant: (mod+severe) resp support (ETT, BIPAP, CPAP Hi Flow or any O2 for first 28/7) + resp support(ETT, BIPAP, CPAP Hi Flow or any O2 for first 28/7) at 36/40 corrected.
Eligible babies: <32/40 or <1500g, and alive at 36/60Data sources and years
Daily data entry form in the Badger systems.3 year rolling averages (2012/2013/2014)
Assigning BPD/ CLD to a neonatal unitBPD/ CLD is assigned to the unit of birth
What has NNAP considered changing?
www.rcpch.ac.uk
• Infection• Temperature• Antenatal steroids for term El LSCS• OFC growth• Equity of access to care • Breastmilk analysis• Report format• Reporting process• Mortality
NNAP support for improved 2014 data quality
www.rcpch.ac.uk/nnap
Process for the 2014 data report
Beginning of May - NNAP will notify all units with:
• provisional outlier status for particular questions
• current non-participant status (i.e. less than 90% data completeness for a particular question)
Throughout June - All neonatal units will be offered
• the opportunity to review their data for accuracy before the final data download is taken for analysis and reporting at the end of June.
www.rcpch.ac.uk/nnap
Process for 2015 data report
Mini quarterly unit reports for all NNAP units to include:
• Data completeness reporting• Adherence to audit standards • Definitive 2015 NNAP dataset will be established after data
quality window closes• Publication in Summer rather than Autumn without the need
to highlight provisional outlier status.
Full details will be communicated to all NNAP units later in March 2015
NNAP reporting process for 2015 data
Work in progress - Mortality
www.rcpch.ac.uk
Competing analyses?MBRACE/ TNS/ Local analysesNNAP possible USP is gestationally limited denominator data to NNU discharge
ChallengesNon NNAP units (eg surgical)
Small numbers (power)Need to aggregate yearsUnit of analysis
Choice of model for risk adjustmentConfidence in our approachWhy?
Work in progress – Mortality (2)
www.rcpch.ac.uk
Expert group met Nov 2014Recommendation: that NNAP can and should report
Denominator: All born alive @ 23 (or 24) - 31/40 inclusive
Numerator: Inpatient deaths (including LW, NNU deaths, deaths on non NNAP units) and babies discharged with LOTA and expected death.Excluded deaths: Those due to lethal congenital malformation. (Eurocat classification)
3 year rolling averagesPrimary unit of analysis – networksLimited adjustment (gestation +/- ethnicity)
Work in progress - Mortality (3)
www.rcpch.ac.uk
Implications:• Need for reporting of LW deaths via badger• Development of system to for units to validate their
deaths (incl LW deaths)• Development of mechanisms to report late deaths
prior to 44/40 GCA on non NNAP units
Consultation:• Lower gestational age limit• Risk adjustment for ethnicity• Case mix adjustment model – unit level reporting
• More communication from NNAP in 2015