Neonatal Care in Scotland: A Quality Framework

3.1 Person-centred

Neonatal units in Scotland are committed to providing a high quality service that focuses on the needs of the baby and family by responding to the families' cultural and religious preferences, needs and values.

This commitment will be demonstrated through ensuring quality of communication; involvement in decision-making and planning of care; ensuring treatment with dignity and respect; access to professional support; and in the level of facilities available.

3.1.1 Communications

Neonatal services will provide parents with information, in language and formats appropriate to the local community that is accurate, timely and relevant to the current point on the patient journey which also takes into account any past medical history which will impact on the current episode of care.

This will be evidenced by:

• The offer of a visit to the neonatal unit in the antenatal period for planned admissions.
• Parents^[3] of new admissions to the unit being orientated appropriately to facilities, routines, staff and equipment. This will be supported by information given in a format appropriate to the individual's needs.
• Availability of information provided to parents in circumstances which require consent.
• Discussion with parents following a diagnosis of their baby's condition and the implications of this diagnosis.
• Discussion with parents regarding the care and treatment of their baby.
• Clear and concise written communication in a format appropriate to the individual's needs being given to parents informing of: admission and discharge procedures, social care and support contacts and contact details for named key worker within the neonatal unit.
• Provision of a photograph of baby for parents within four hours of admission if unable to be with baby. The use of telemedicine, where available, should be explored to provide additional contact.
• All staff being trained in effective methods of communication with parents.
• Parents being offered the opportunity to discuss their baby's diagnosis and care with an experienced clinician within 24 hours of admission, or following a significant change in condition.
• Parents being offered access to appropriate communication and advocacy services to support them in their participation in ward round discussions, clinical care decision-making, palliative care planning and end-of-life care if required.

3.1.2 Involvement in Decision-making Within a High Quality Service

Parents will be encouraged and supported to participate in the planning and decision-making about the care and treatment of their baby, taking into account families' cultural and religious preferences, needs and values.

This will be evidenced by:

• Care plans being updated and developed in collaboration with parents.
• Parental involvement in the provision of care for their baby at the most appropriate time.
• Support being given to parents in skin-to-skin and physical contact with their baby, if appropriate for clinical condition.
• Education of parents in handling and positioning of baby.
• Parents being offered the opportunity to be present when care and other medical interventions are delivered if clinically appropriate.
• Positive action having been taken to keep a mother and her baby in the same hospital during their respective admissions wherever possible.
• Parents being encouraged to provide all appropriate personal care to their baby.
• Parents not being restricted in the time spent with their baby, whilst ensuring parents have time for adequate rest and sleep.
• Transfers being planned and documented in collaboration with parents.
• Parents being given the opportunity to see and hold their baby, if clinically appropriate, prior to transfer.
• Staff providing assistance to parents in making their own transport arrangements.
• Parents being invited to travel with baby in the ambulance, providing it is in keeping with clinical need and local neonatal transport policy. The final decision on individual cases will be made by the team transporting the baby.
• Parents being supported and educated appropriately to ensure effective involvement in discharge planning and discussion with community and social care.
• If required, palliative care planning and end-of-life decisions being made in partnership with professionals and parents in an appropriate environment. The available options including hospice and homecare will be discussed if clinically appropriate.
• Parents being offered support if they wish to provide personal care for their baby following death.

3.1.3 Professional Support

Families (including the baby's siblings) will be provided with information and support to access appropriate professional help, in a timely manner, as required.

This will be evidenced by:

• Discussion with parents and staff regarding need for pastoral, religious and/or social support.
• Provision of up-to-date information and how to access these services in formats appropriate to the individual's need on NHS, social care and third sector services, local and national support groups, palliative care services, social services, counselling and bereavement support.
• Referral for counselling and bereavement support following discharge where required.
• The provision of a financial support policy for long-term admission and/or long distance transfer from referring unit.

3.1.4 Facilities

A high quality service will make dedicated facilities available for parents and families of babies receiving neonatal care wherever possible.

Family friendly facilities will include accommodation appropriate for family need.

This will be evidenced by:

• A list of local accommodation with agreed rates being provided.
• Appropriate access to hot drinks outwith normal hours.
• Access to a telephone, toilet and washing area including shower.
• Provision of a parent sitting room.
• Secure and readily accessible storage being available for parents' personal items.
• Non-secure storage of personal items (e.g. baby clothes) being provided at the cot side.
• A room for counselling or privacy for distressed parents being available as required.
• A minimum of two rooms within or adjacent to the unit (with gas and air supply points to be available) for "rooming in" prior to discharge (level two and three units).
• An area offering privacy to express milk and to feed, if required, being available within the neonatal unit.
• The unit holding enough breast pumps to provide access for each mother if the unit is at full capacity.

Family friendly outpatient facilities will include:

• An appropriate area to feed baby.
• Changing area.
• Access for prams.
• Consulting room large enough for baby, parents and siblings.
• Play area.
• Appropriate toys available.

Any future design for new Neonatal Units should comply with the Disability and Equality Act (2010). Requirement may vary from one unit to another dependent on factors such as geography. Units should work with MCNs to assess local need and make provision accordingly.

This will include:

• Overnight accommodation for parents. All rooms should be free of charge with bathroom facilities.
• Several rooms provided in line with predicted need in the region, located within 10-15 minutes' walking distance of the unit.
• A suitable number of rooms within or adjacent to the unit (with gas and air supply points to be available) for 'rooming in' prior to discharge.
• A changing area for other young children.
• A play area for siblings of baby receiving care.
• A dedicated room set aside and furnished appropriately for counselling and to provide distressed parents with privacy and quiet.