An investigation by the Healthcare Safety Investigation Branch (HSIB), a national safety watchdog, has revealed that babies are at risk of dying from common treatable infections because NHS staff on maternity wards are not following national guidance, and are too short-staffed and overworked.
The maternity investigations were carried out by HSIB between April 2018 and December 2019. As a result of these investigations, HSIB warned that NHS staff on maternity wards face sometimes conflicting advice on treating women who are positive for Group B streptococcus (GBS) infection.
The watchdog warned that the problems on maternity wards meant that even in cases where mothers were known to be positive for GBS, this information wasn’t shared with the mother or noted in the record, resulting in the standard care and antibiotics not being provided. The identification and escalation of care for babies who show signs of GBS infection after birth was also missed, resulting in severe brain injury and death for some of the affected babies. Specialist investigators examined 39 safety incidents in which GSB had been identified, and found that the infection had contributed to six baby deaths, six stillbirths and three cases of babies being left with severe brain damage.
The report said this showed an example of a wider issue in healthcare, with the difference between “work as prescribed” against the reality for staff, or “work as done”. A lack of staff was also noted in four incidents, with staff attending other mothers or carrying out other tasks when antibiotics needed to be started.
Some GBS-positive mothers were being told to wait too long at home after labour had started, despite guidance saying they should come in earlier to receive antibiotics. HSIB said it found cases where services were “encouraging mothers to stay at home for as long as possible.” With some reasons being due to information not being shared between clinicians, the right questions not being asked by the call receiver, or problems with the documentation of a mother’s GBS status.
GBS is the most common cause of severe infection in babies within the first week of life. It has been found in 13 per cent of more than 290 maternity investigations carried out by HSIB since 2018.
Jane Plumb, chief executive of the charity Group B Strep Support, added that national guidelines from 2017 have not been fully implemented and some health professionals are unaware of them.
A major trial to explore whether routine GBS screening for pregnant women could reduce infections and deaths is due to start this year. This will involve 80 hospitals in the UK and with 320,000 women expected to take part.
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