PC.63 Adherence to NICE guidelines for postnatal observations of neonates delivered in meconium-stained liquor: an audit of practice in maternity units across Kent, Surrey and Sussex

Abstract

Background The National Institute of Clinical Excellence (NICE) Guideline on Intrapartum care (2007) advises the duration and type of observations needed on neonates delivered in meconium-stained liquor. Aim This audit investigated current practice for postnatal meconium observations in maternity units in Kent, Surrey and Sussex (KSS). NICE guidance was used as the gold standard for comparison. Method All maternity units in KSS were contacted and their local protocol for meconium observations obtained. Results All 19 units responded. 10/19 (53%) units did not differentiate the duration of observations depending on the type of meconium, prolonging the duration of observations for light meconium-staining. Most units performed observations for a maximum of 12 h, however 3/19 (16%) units continued them for 24 h. All units recorded temperature, heart rate and respiratory rate as part of the observations. But only 7/19 (37%) units recorded capillary refill time. Overall, only 2/19 (11%) units were fully adherent to the NICE guideline. Discussion By not differentiating between types of meconium or by performing observations for 24 h, many maternity units across KSS are spending more time than recommended by the evidence on performing meconium observations, which misuses midwifery resources and potentially delays discharge. Although most signs of neonatal well-being are well recorded, by not recording the capillary refill time, many units are neglecting an important marker of neonatal distress, which could potentially compromise their care. A nationwide project is underway to identify whether these deviations from NICE guidance are present throughout the country’s maternity units.