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Some midwives 'confused' by new NICE guidelines on safe staffing levels

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Senior midwives have warned that they need clearer guidance on “red flag events” that could trigger a safe staffing alert in maternity settings.

The call follows the publication last month of new guidelines on safe staffing in maternity by the National Institute for Health and Care Excellence. Some midwives have described the guidance as “confusing”.

Under the guidelines, certain “red flag events” are intended to act as warning signs of staffing shortages and should be immediately reported to the midwife in charge.

“One of the biggest areas of concern has been around the red flags”

Jane Herve

These include the inability to provide at least one registered midwife for every woman in established labour, missed or delayed care and a delay of more than 30 minutes in providing pain relief.

However, midwives have said they need more detail on exactly what constitutes a “red flag event”, and when and how these should be reported.

Jane Herve, head of midwifery at Oxford University Hospitals Foundation Trust and one of the sector specialists who helped shape the NICE guidance, said uncertainty over red flags had emerged as an issue.

“Probably one of the biggest areas of concern has been around the red flags and how people are going to monitor and report those,” she told Nursing Times.

However, she said the NICE specialist advisers would be working with the Royal College of Midwives to develop a clear and consistent approach.

“[The] RCM is keen to set up groups with heads of midwifery to come to some consensus around how we define red flags and at what point we report them,” she said.

The guidelines have been welcomed for their emphasis on one-to-one care, but received a lukewarm reception at a conference yesterday on safe staffing in maternity attended by senior staff.

When asked to indicate whether they found the new guidelines “valuable”, only one or two delegates raised their hands. Some said they were disappointed the guidance was not more “straightforward”.

However, Ms Herve said she was not surprised people were as yet unsure about the guidance and what it involved.

“People need to use it in order to really understand it, but I think it does help us as midwives, and as topic specialists we’re pleased with the end result,” she said.

“It’s a different way of doing things so, of course, people won’t feel so comfortable with it,” she added. “But that’s not to say we can’t use some of the existing tools people are familiar with.”

Earlier she told the conference about the challenges in drawing up the guidance, including the fact there was so little hard evidence on safe staffing in maternity.

She admitted the four specialist advisers who worked on the NICE guidance had to “work hard” to ensure their knowledge, expertise and practical experience was factored in.

“Maternity services are really complex and complicated but they are still viewed as an easy service to manage,” she told delegates at the event organised by Healthcare Conferences UK.

“People can’t get their head around the complexity and see it as a nice, fluffy service, which is it is at times, but there are many challenges too,” she added.

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