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Huh? What's optimal cord management #BAPMQI?


So this blog comes a little delayed. As you know COVID and all its associated factors have become all-consuming time zappers, to state the least!


I am thrilled to share the latest BAPM and NNAP Quality Improvement Toolkit 'Optimal Cord Management in Preterm Babies'.


This document recognises the significant harms associated with the continued use of the unindicated intervention of early cord clamping. It also fulfils the current void in practical guidance for perinatal professionals wanting to make service and safety improvements using optimal cord clamping.


Let's remember that early cord clamping increases neonatal mortality by 28% in preterm infants! (Fogarty et al, 2018)
© Courtesy of the Rojas family

This work feeds into national UK quality workstreams such as the 'Maternity and Neonatal Safety Improvement Programme' (MatNeoSIP) in England, and the 'Maternity and Children Quality Improvement Collaborative-Scottish Patient Safety Programme' (MCQIC-SPSP) in Scotland and is aligned with the 'Saving Babies’ Lives Care Bundle' (SBLCB v2).



What is the meaning of Optimal Cord Management?


This quality improvement toolkit focusses on Optimal Cord Management defined by waiting for a minimum of 60 seconds before clamping the cord in preterm infants.


"But shouldn't that already be happening?" I hear you say...

As you know, delayed cord clamping was first advocated as best practice internationally sometime ago (WHO, 2014). However, as explained in the toolkit, statistics demonstrate poor uptake of the recommendations in many areas worldwide, including the UK, this leaving many preterm babies vulnerable to harm.


What's in the toolkit?


The toolkit provides users with a framework to undertake quality improvement within the workplace. Crucially the toolkit contains evidence, best practice solutions, advice and techniques that support quality improvement in 'Optimal Cord Management' for all babies who are likely to benefit from this practice. It helps define enablers and barriers to implementation and facilitates the embedding of Optimal Cord Management into perinatal team culture in order to achieve the aim of less babies being harmed by immediate cord clamping.


The toolkit is well structured with clear graphics and diagrams to aid comprehension of quality improvement processes. This is an example of what might be considered a best practice flowchart from the toolkit. Units may choose to adapt this to support their improvement activity or as a process flowchart to aid staff understanding.