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First-class delivery at Swansea baby unit makes it one of UK’s best

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Methods including sealing babies in plastic bags to keep them warm have helped Singleton Hospital’s Neonatal Unit deliver top marks that significantly exceed the UK national average.

The simple technique, which sees vulnerable newborns put in a clear plastic bag that is sealed at the neck and placed under a heater, means a higher number of babies cared for by the neonatal team are kept at the optimum temperature for survival.

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A mannequin dummy sealed inside a plastic bag as part of the neonatal team’s thermal management at birth. (Image: Swansea Bay NHS)

It is an approach that has helped revolutionise thermal management at birth across the world.

It’s one of many methods, which also include a newly-purchased transfer system, utilised by the unit that has helped put them among the leading performers among hospitals in the UK in two particular categories in a recent audit.

The National Neonatal Audit Project (NNAP), run by the Royal College of Paediatrics and Child Health, assesses whether babies admitted to neonatal units in Wales, England and Scotland receive consistent high-quality care and identify areas for quality improvement.

The NNAP asks doctors and nurses to record important data on babies’ care such as temperature on admission, timely medicines that influence outcomes, screening for eye disorders and follow up support.

It evaluates and benchmarks performance across the country so that excellent practice is highlighted to allow underperforming hospitals to learn from them and improve the care they provide.

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In the NNAP’s latest audit, which covers data for the year 2020, Singleton has been identified as a high-performing unit in two specific areas.

The hospital has performed way above national average figures for admission normothermia – maintaining a newborn baby’s temperature between 36.5C and 37.5C – as well as ensuring high-risk babies are followed up and supported for at least two years after receiving intensive care following birth on the Neonatal Unit.

The hospital received ‘outstanding’ classification for achieving normal temperature on admission in 89.8 per cent of premature babies – the national average is 71 per cent – and an ‘excellent’ classification for the 90.5 per cent rating for follow up work with high-risk babies, with the national average at 68 per cent.

Dr Sujoy Banerjee, consultant neonatologist and clinical director of children and young people services at Singleton Hospital, explained the importance of maintaining a baby’s temperature following birth within the recommended range and the challenges to achieve this goal.

“If a baby is admitted to the Neonatal Unit cold within the first few hours of life, it directly affects their survival and long-term outcomes. We have to maintain the temperature within a narrow range of 1C (36.5C and 37.5C) as neither being hot or cold is good for the babies,” he said.

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“Maintaining such tight control of a premature baby’s temperature is crucial but very challenging. The babies are fragile with delicate skin and very little fat reserves.

“There are also other priorities soon after birth to keep them alive like, for example, supporting their breathing and circulation which may require a lot of handling.

“Despite optimisation, the environment in labour ward and theatres are not ideal for babies when compared to the mother’s womb and they can lose heat very rapidly.

“It is not surprising that nationally for only seven out of 10 babies born very premature, the doctors and nurses can maintain their temperature at the recommended range within an hour of birth. That’s a national average.”

As a result, the Singleton neonatal team of doctors and nurses designed a Quality Improvement Initiative to address this challenge.

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The methods introduced saw the team improve the implementation of the plastic bag technique to minimise heat loss.

They focussed on early continuous temperature monitoring by using simple skin probes placed on the baby’s back prior to any other interventions and readjusted the power of the heater accordingly.

The temperature was maintained and readjusted during transfer to the neonatal unit using ‘The Shuttle’ – a newly-purchased transfer system which has its own power, heater and ventilator.

It can also minimise handling of the baby during the process of switching from one system to the other during the critical process of transfer of a baby from delivery rooms to the neonatal unit.

“The Neonatal Unit is very close to the theatre, but because the baby is on life support it’s very important that we handle everything quickly and efficiently,” said Dr Banerjee.

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“Several temperature measurements give us a clue on how we can adjust things. That’s how we’ve gone from 78 per cent to 89.8 per cent.

“While that may not sound much, it is a real battle to achieve more improvement when you are already performing at a high level.

“Displaying results on a monthly basis to staff members and analysing areas for improvement on a case-by-case basis has significantly helped in raising awareness and improving practice.”

Members of the neurodevelopmental team (left to right) Amanda Lawes, neonatal occupational therapist; Lucinda Perkins, consultant neonatologist; Joanna Webb, consultant neonatologist; Oliver Walker, locum consultant neonatologist; Vasiliki Makri, neonatal consultant; Sujoy Banerjee, consultant neonatologist; Ceri Selman, paediatric physiotherapist. (Image: Swansea Bay NHS)

The unit’s continued improvement for its work on the two-year neurodevelopmental follow up for high-risk infants has also reaped high praise.

Gail Smith, Neonatal Unit ward manager who led the programme along with Dr Banerjee, said: “Our staff are fully committed and passionate to achieve the best outcomes for our babies and families, and it is great to see that our efforts are making a difference and being recognised in national data.”

Babies who are born under 32 weeks and under 1,500 grams are regarded as high risk and, as such, need monitoring for health issues throughout their first two years.

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They are identified while receiving treatment on the neonatal unit and have coordinated care from a range of specialists including physio and occupational therapists, specialist nurses and consultants.

The neurodevelopment programme has seen continuous improvement since commencing service in 2008. The high rate of follow up and documented outcome is a testament of motivation and effort by the team.

Dr Joanna Webb, clinical lead for the service, said: “We are especially proud of the neonatal neurodevelopment team for their continued enthusiasm and support for the high-risk infants and their families.

“Identification of developmental difficulties in early childhood is particularly important and will allow the appropriate support and intervention to be offered to help these infants achieve their full potential.

“The follow-up also has a role to support and reassure the families in the ongoing care of their infants following highly stressful admission to Neonatal Intensive Care.

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“It is thanks to the dedication of the whole team that we are able to continue to provide this excellent service.”

Dr Banerjee added: “We are really pleased with the results of the national audit and it’s testament to the teamwork and quality within the neonatal unit and everyone connected with the outcomes.

“We are team that is constantly analysing what we do in order to improve, and these results confirm that.

“We’re really happy to see our work being identified as a high outlier performer in this field.”

Lead image: Singleton Hospital Neonatal Unit staff members (from left to right) Marie Whiles, staff nurse; Gail Smith, ward manager; Annwen Vaughan, senior staff nurse; Laura Smith, staff nurse; Sujoy Banerjee, consultant neonatologist and clinical director of children and young people services (Image: Swansea Bay NHS)

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Dance

Doctors prescribe dance classes to keep patients on their feet

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Over 65s in Swansea Bay are being encouraged to attend dance classes in a bid to keep them on their feet.

Five of the health board’s clusters – groups of GP surgeries working together within a geographical area – are backing the scheme as the exercise to music is proven to aid falls prevention.

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Each class is led by a trained dance teacher with participants encouraged to follow a range of routines, designed to develop their strength and balance, with the option of using a chair for support if their mobility is limited.

The Dance for Health programme is a collaboration between the health board, clusters, local authorities, and Aesop, an arts focused charity.

Alyson Pugh, Programme Manager at Aesop, said: “We are delighted to be working with our partners in the health sector to improve the health and wellbeing of people aged over 65 through the medium of dance.

“During each class participants will move to a variety of music from all around the world. The classes are fun and vibrant, increasing fitness, mobility and strength.

“Afterwards, participants will have a good chance to get to know one another over a cup of tea or coffee. No previous experience is needed, everybody is welcome.”

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So far classes are held in Pontardawe, Morriston, Seven Sisters, Cwmavon and Briton Ferry, Upper Killay, Reynoldston, Mumbles and the Waterfront Museum.

Alyson said: “The health board asked for 12 classes across Swansea Bay and funded the management side while the GP clusters are funding the delivery of the classes. They wanted it to be grass roots up.

“Anyone can walk in but they wanted the main referrals to come from the virtual wards and local area coordinators and social prescribers, a whole community approach.”

Lizzie MacMillan (Image: Swansea Bay HNS)

Dance artist Lizzie MacMillan (left), a development officer for Dance for Health, said: “It’s for older people and people who are struggling a little bit with perhaps balance issues, mobility issues as well, so we are not expecting them to foxtrot along the floor on the first class or anything like that. It builds up over the weeks.

“We start off quite gently, just seeing where everyone is in the class – I like to gauge the class first of all to see if people are having problems with balance or perhaps giddiness or joint problems. I like to get to know each person in the class so that I can look after them and know their capacity for movement.

“We use the chairs quite a lot if someone is unsteady on their feet. They can still do a variation using the chair for support. We also do a standing variation if people are a little fitter or a little bit more able to push themselves further in the class.”

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Over 65s in Swansea Bay are being encouraged to attend dance classes in a bid to keep them on their feet. (Image: Swansea Bay NHS)

Mike Garner, Cwmtawe Cluster lead, said: “We are delighted to be participating in this programme as it fits in perfectly with our goal of improving well-being and helping people remain fit and healthy.”

One participant, Pauline Anderson, said: “I’ve been to four or five classes. I thought I would try it to see what it’s like and it’s been very good.

“As you get older you become more immobile. I’ve been struggling with my knees and joints, so I have found it helpful.

“I would advise anyone thinking about it to just come along.”

Another participant, Betty Didcock, said: “I try to keep active as much as I can. I used to enjoy dancing when I was younger. I’ve made friends here. If you’re a bit shy, it’s a wonderful place to come to get used to talking to people. I’m a quiet one. I don’t always do it right but I have a go.”

While Amber Davies said: “I thought I’d come along to see what it was like. It’s important to keep busy and remain active. It’s also a good way of meeting new people.”

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(Lead image: Swansea Bay NHS)

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One-in-a-million nurse bids farewell to NHS after epic 46 year career

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A “one in a million” nurse is saying his final goodbye to the NHS after 46 years.

When Martin Green hangs up his scrubs for the final time on Sunday (May 15th) it will signal the end of an epic career which has spanned several hospitals and services dealing with everything from birth to death.

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“I have done my fair share,” said the Morriston Hospital bed site manager, who turns 66 next week.

“I left school at 15 without any qualifications and had to work my way up the hard way. I often sit there and reminisce.

“One of the things I will miss is the team I am with at the moment. We have been together a while and have been through quite a bit.”

Martin is a valued member of a team right at the heart of the incredibly busy Swansea hospital, monitoring patient movements and bed capacity across the site.

It is the type of role which did not exist when Martin joined a very different NHS in May 1976.

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Having left his native Ebbw Vale, where he had volunteered at the local hospital, he joined a nurse training programme at Frenchay Hospital in Bristol when he was just 18.

As a pupil nurse working towards qualification as an enrolled nurse, Martin had to live in the hospital accommodation and obey strict rules.

“I must admit it was a strict but wonderful training school at Frenchay,” said Martin, who lives in Port Eynon, Gower, with long-term partner Wayne.

“If you came onto the ward and your uniform wasn’t up to scratch you were sent back to your room.

“We didn’t wash our uniforms ourselves. They went to the hospital laundry and came back starched stiff as a board. You could stand them up on your own.

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“If you couldn’t wear a starched uniform you had to get a special note from the doctor.”
Martin added: “The uniforms have changed a bit since then. I think the scrubs we have now are the most comfortable.”

Once qualified, Martin worked in the intensive care unit in Frenchay for a short period, then Singleton Hospital in Swansea before moving to mental health at Pen-y-Fal Hospital in Abergavenny.

After that he took an interest in urgent care and worked first in the accident and emergency department at the Royal Gwent Hospital in Newport before joining A&E at Morriston for its opening in late 1985.

While there he went back to being a full-time student for a year on a course that enabled him to progress from enrolled to registered nurse.

“The course was birth to death,” he said.

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“You started in maternity because you had to see so many deliveries and worked up from there.

“A few years later, when I was back in A&E at Morriston, a mother came in with a boy of about five or six years and asked if I remembered him.

“Turned out I had witnessed his birth while on my course.”

There can be few nurses who have worked across such a wide range of services as Martin.

But whatever he has done, he has done so with compassion and it is for that his colleagues will remember him most.

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Colleagues gathered outside the main entrance of Morriston Hospital to bid farewell to nurse Martin Green, centre, and presented him with gifts including John Lewis vouchers. (Image: Swansea Bay NHS)

Carol Doggett, Interim Director of Nursing at Morriston Hospital, said Martin’s colleagues have dubbed him “one in a million”.

Summarising some of the many compliments that have been paid to Martin, she said: “Being a nurse is much more than wearing a uniform. It is being kind, compassionate, professional and recognising it’s a privilege to work with people from all walks of life and provide them with care.

“I’ve been told that Martin is unique – one of a kind. He is there for everyone as a friend and a nurse who will always go the extra mile.

“His closest colleagues have called him in Welsh, halen y ddaer, which means salt of the earth. He really is one in a million.”

Lead image: Left, Martin Green as a pupil nurse during his first month of training at Frenchay Hospital in Bristol in 1976, and right, working his last few days before retirement from his role as bed site manager at Morriston Hospital in Swansea. (Image: Swansea Bay NHS)

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Overseas nurses made huge personal sacrifices to strengthen workforce

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International nurses spent up to two years away from their own families after relocating to Swansea Bay during the Covid pandemic.

These are among the huge sacrifices made by more than 130 nurses who were recruited from around the world in the past two years to boost the workforce and improve the level of care during a hugely challenging period Swansea Bay University Health Board have said.

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Many came from India, Philippines, the Caribbean and Africa, spending months – years in some cases – without seeing their families in order to continue their development in nursing in Swansea Bay.

The level of sacrifice has been more than first anticipated for some of the nurses recruited from overseas.

For Susan Mhlahleli, the start of the Covid pandemic coinciding with her arrival from Zimbabwe meant she spent two years away from her husband and two children – one of whom has cerebral palsy – before they finally reunited in March this year.

Susan, who is a staff nurse on Morriston Hospital’s Pembroke Ward, said: “I came in March 2020 right at the start of Covid.

“The plan was for my family to come here two or three months after I arrived, but Covid hit and it wasn’t possible.

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“There was a chance for them to come here, but I didn’t want them to spend 11 hours on a plane in a confined space in the heat of Covid.

“I wanted to progress my career and coming here gave me the experience to work with equipment I had only heard and read about.

“I originally came here wanting to be a perfusionist, but there are so many other opportunities I can now pursue.”

Susan was among the 130 overseas nurses who were invited to an event at the Swansea.com Stadium to show appreciation for their efforts and sacrifice.

An event was held to mark International Nurses Day (Image: Swansea Bay NHS)

The event was held to mark International Nurses Day, which coincides with the birthday of Florence Nightingale, the founder of modern nursing.

Swansea Bay’s international nurses have predominantly gone into acute care settings in Singleton, Morriston and Neath Port Talbot hospitals.

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At the celebratory event, nurses were treated to an afternoon tea, with a number of senior health board officials in attendance.

Mark Hackett, Swansea Bay UHB Chief Executive, said: “It was a fantastic event. These people have come from the other side of the world to work for Swansea Bay.

“It’s really heart-warming to see people and talk to them about why they wanted to come to Swansea Bay, and what they can contribute.

“We want to see a far more diverse work force where everybody gets an opportunity to advance and succeed in their careers.

“We have a thriving health system and there are huge opportunities for everybody, particularly these nurses who are giving an enormous boost to our workforce.

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“We want to encourage more and more nurses to come here. By giving these international nurses a fantastic experience, what that will do is encourage their friends and colleagues to come to Swansea Bay.

“From our perspective, that will help us in delivering high-quality excellent patient care.”

Nurses came to Swansea from places such as India, Philippines, the Caribbean and Africa (Image: Swansea Bay NHS)

Gareth Howells, executive director of nursing and patient experience, said: “These nurses have travelled from all parts of the world to come to our health board to help our communities and help us care for people who need it.

“It’s exceptionally brave and we owe them support and respect.

“These nurses complement the quality nurses we already had in the health board.

“They have a high level of experience – they are exceptionally skilled nurses.

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“Whichever country these nurses have come from, they care and want to make a difference here.”

The influx of international nurses has helped fill a big void within the health board’s workforce.

Lynne Jones, heard of nursing education, has played a key role in the recruitment drive of international nurses.

“In what has been a very challenging time for the entire world over the past two years, these nurses have opted to continue their careers in Wales and our health board,” she said.

“They have made a huge contribution to filling vacancies and providing the level of care our patients require.

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“As a health board, we are well aware of the sacrifices they have made to come here. They’ve left their homes, they families and job, which isn’t an easy decision to make.

“We are really pleased with our recruitment of overseas nurses over the past two years, and this event has shown them our appreciation of what they’ve brought to our health board.”

Some nurses have spent months – years in some cases – without seeing their families in order to continue their development in nursing in Swansea Bay. (Image: Swansea Bay NHS)

Other overseas nurses who attended the celebration included Beulah Shenje, who arrived from Zimbabwe in January 2020 and works in cardiology in Singleton Hospital.

She said: “This event made me feel special and appreciated.

“I was honoured the health board took the time to hold this event for us, and for senior figures to be in attendance.

“It means a lot to me and shows they appreciate us.

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“This will certainly encourage more nurses from Africa to come to Swansea and help the health board even more.

“My friends in Zimbabwe have asked about coming here to work because they’ve heard so many good things.

“The exposure to more advanced technology here is a big thing because it helps you develop so you can help more people.

“Everyone shares the same goal here – helping people.”

International nurses spent up to two years away from their own families after relocating to Swansea Bay during the Covid pandemic. (Image: Swansea Bay NHS)

Dolapo Akinnayajo works in Morriston Hospital’s Intensive Therapy Unit following her arrival from Nigeria in September 2020.

She spoke about the sense of pride felt in working for the health board, and believes her experience will encourage more nurses to pursue a nursing career in Swansea Bay.

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She said: “I feel very proud to work for our health board. I believe we are all making a difference to the community.

“The reception we’ve received as nurses has been amazing. From the first impression onwards, what we’ve received is love and warmth. It has surpassed expectations.

“And now, to have an event like this put on for us international nurses really shows how much we are appreciated.

“I’ve been telling all my friends, family and former colleagues in Nigeria just how lovely Swansea and Wales is.

“It was a massive relocation but it was a huge opportunity.

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“I am from a developing country, but this is a developed country and the bar is set high. There is access to world-class equipment to help people, and it helps develop you in your role too.”

(Lead image: Swansea Bay NHS)

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