Shared learning database

Type and Title of Submission


The Positive Impact of a Pregnancy and Childbirth Implementation Group


Through the development of a joint working group across all the acute specialties concerned with pregnancy, childbirth and newborn care, we have maximized the effectiveness of the resources used in implementing maternity related NICE guidance. This has ensured that patients experience the benefits of the implemented guidance throughout their entire journey, from antenatal care through delivery to neonatal services (where necessary) and minimized the chance of service disconnect both in relation to NICE guidance initiatives and other aspects of the services. It has also enabled the staff of these services to identify problems with NICE implementation earlier than would otherwise have been the case and pool resources to address these issues.



Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG55 - Intrapartum Care

Category(s) that most closely reflects the nature of the submission:

Implementation policy
The Effecitve Use of An Implementation Group

Is the submission industry-sponsored in any way?


Description of submission


To ensure that pregnant women experienced a high quality, integrated service throughout their journey; a journey which will uniformly reflect the recommendations of appropriate NICE guidance in each department or specialty.


1) To bring together a working group with representatives from midwifery, obstetrics and neonatology to jointly review new NICE guidance and plan for its implementation. Each member of this group needed to be of appropriate seniority to both make decisions about implementing the guidance and drive the implementation agenda within their own department. 2) To minimize the disconnect between departments in terms of implementation so that pregnant mothers received a high quality service where NICE was fully implemented at each stage of the patient journey. 3) To identify areas of concern about implementation at the earliest possible opportunity and thus allow for a full process of action planning and resources focused activity to resolve the same.


Prior to the development of the group the implementation of NICE guidance in pregnancy, childbirth and neonatal care was undertaken in a piecemeal fashion. Each service would begin the implementation process individually and consultation around the guidance would occur at a later stage. This led to the entrenchment of positions within each department whereby each generated a view on the best approach for implementation, views which at times were not compatible. This created obstacles of opinion to overcome when implementing guidance in addition to those of resource and planning. The overall impact of this was to delay the implementation of guidance, necessitate the alteration of medium term implementation goals and, most importantly, make the realisation of high quality, NICE aligned services for patients more challenging.


1)A more streamlined and effective implementation of pregnancy and childbirth related NICE Guidance. Specific Example 2)The early development of a new clinical policy to reflect the recommendations of NICE CG 55 Intrapartum Care throughout midwifery, obstetrics and neonatology. 3)The consultation process for the implementation of the guideline and the writing of the policy identified staffing and resource issues. These specifically related to the frequency of observations recommended for babies whose mothers had a pre-labour rupture of membranes (PROMS) but who were not given antibiotics because no specific source of infection was identified. 4)Meetings were convened with midwifes who were concerned that the extra observations they should undertake according to the guideline and policy would not be possible at night. Between the hours of 8p.m. and 9 a.m. there was no nursery nurse service and so the full burden of the observations would fall to the midwives. They were concerned that when the labour ward was running at capacity the observations would slip and this would endanger the babies in question. 5)As a result of the meeting and further review by the NICE pregnancy and childbirth group a business case was prepared to extend the hours of working for the nursery nurse service and increase midwifery cover outside of these hours. Alterations were also made to the midwifery teams out of hours workflows to allow for the prioritisation of the required observations. 6)The work of the NICE pregnancy and childbirth group meant that the review of CG55, the identification of implementation challenges and the response to those challenges happened sooner, was more effective and involved all the appropriate departments and staff. This level of effective co-ordination, problem solving and participation did not occur prior to the formation of the group.

Results and evaluation

The implementation of the guidance that the group facilitates is monitored via the standard audit and review programme.

Key learning points

Bringing together departments that are linked by patient journeys or NICE guidance for the review and implementation of the guidance :- a) speeds up the implementation process, b) identified problems earlier c) eases the planning process to overcome these problems. Existing organisational forums may not meet the needs of the guidance; be prepared to form new and ad hoc groups. For review and implementation groups to maximise their effectiveness they must have members who can a) speak for their department or speciality b) drive change in their own department or speciality c) have control of or influence the distribution of resources within their department or speciality

View the supporting material

Contact Details

Name:Richard Beard
Job Title:Clinical Effectiveness Facilitator
Organisation:Brighton and Sussex University Hospitals NHS Trust
Address:Latilla Annexe, Royal Sussex County Hospital
County:East Sussex
Postcode:BN2 5BE
Phone:01273 696955 xt 4684


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This page was last updated: 30 September 2008

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.