Maternity staff help deliver new safety measure

Swansea Bay has become one of the first health boards in Wales to implement a new early warning system designed to enhance the safety of newborn babies.

The Newborn Early Warning Track and Trigger 2 (NEWTT2) chart records observations of babies identified as being at risk of becoming unwell and highlights a clear pathway to escalate any concerns. Some of the observations recorded include the infant's temperature, breathing rate, and heart rate.

And in a welcome move, parents are involved in the process, as parental concern will now score on the chart.

The move has been orchestrated by the Welsh Government in a bid to introduce a standardised approach across Wales.

Stacey Reed, Swansea Bay University Health Board’s Neonatal Safety Champion, has helped implement the changes.

She said: “The NHS Wales Executive, Maternity and Neonatal Safety Support Programme Implementation Network and MatNeoSSP local safety champions have supported the health board in implementing NEWTT2, providing guidance, strategic support, and monitoring progress while offering national updates to the Welsh Government.

“Early warning score systems are important to help to identify acute deterioration, determining when care needs to be escalated, and defining appropriate responses to escalation triggers.

“Practice across Wales was varied, potentially leading to inconsistencies that could pose risks to patient safety. This prompted a Welsh Government led drive to introduce a standardised, national approach using evidence-based tools designed to ensure clarity, minimise risk, and enhance patient outcomes.

“Standardising this process will enhance current practice, making it safer and consistent, ensuring that we all communicate using the same language and scoring system.

“We're helping to lead the way as we’re the third health board to introduce this chart - Cardiff and Vale University Health Board was the first and Betsi Cadwalladr University Health Board introduced it the day before us.

“Lots of babies wouldn't need their observations recorded, but there are some babies that would fit the criteria, depending on the circumstances surrounding the birth and antenatal risk factors.

“They would need to be started on these observations, which are usually carried out by the nursery nurses or midwives.”

It is important to stress that the chart is precautionary in nature.

Stacey said: “Very often the observations are recorded and the baby is well and doesn't need any escalation. But sometimes the observations recorded are outside of the norm and then the baby would need to be escalated to the neonatal team.”

Allowing parents to highlight any concerns they may have in relation to their baby supports Swansea Bay’s promise to ensure patients have their voices heard.

Stacey said: “It’s really important that the parent’s voice is heard and their concerns embedded into the process.

“The parents are with their baby the whole time, and there might be a change in the baby since the last set of observations were taken that they have identified first.

“This approach aligns not only with recommendations from recent national maternity investigations but also with our People Promise.

“As part of this promise, the Health Board is committed to ensuring that every voice counts—helping families feel safe and confident to speak up.

“We will listen, act, and respond, ensuring parental concerns are acknowledged and addressed to enhance patient safety and care outcomes.”

 Pictured left: nursery nurse Elin Whiskerd with a new mum and her baby

Samantha Willis, Advanced Neonatal Nurse Practitioner, explained the chart is now employed across a variety of settings.

She said: “This framework is designed for use in postnatal care settings including the delivery suite, postnatal ward and transitional care unit.”

She also explained that it also improves safety in the community.

She said: “In the rare event that a baby may deteriorate or at risk of deteriorating in a community setting, home or midwifery-led unit, the chart can be used to support monitoring of the baby while transfer to a suitable hospital is undertaken. The universal scoring system used will support the urgency of escalation and transfer to the closest hospital.”    

The move has been welcomed by parents and neonatal staff alike.

Neonatal consultant, Dr Sree Nittur, said: “This is an improved version of our previous observation chart. It has more improvised measures and parameters to identify a poorly or at risk baby.

“I strongly feel it is a step above what we were doing before.

“The most important noticeable change in the chart is to incorporate parental concerns. We know that parents are the best advocates for their baby – their opinion or feel for the baby is very important to us.

“Any concerns they have should be taken seriously. That is identified in this new chart.”

Elin Whiskerd, a nursery nurse, also gave it the thumbs up.

She said: “It’s a really good tool that I find useful on the ward. It gives us a good overview of how the parents are feeling, and if they have any concerns, they are able to address them with us.

“We are checking all the observations – heartrate, breathing rate, and temperature. It just gives us a nice overview of how the baby is. Is the baby responsive, do the parents have any concerns?

“It just flags up any issues and we can go to the doctors with any concerns and they can tell us what to do.”

New dad of baby Luca, Liam Everson, and his wife Courtney, praised the new measure.

Liam said: “It’s a great idea, a good process. Anything that makes things safer is very welcome.”

He also thanked the staff saying: “Everyone has been very supportive and comforting. It’s been brilliant.”

Main pic from left to right: Laura Rose Intrapartum Lead Midwife, Dr Nibras Yaseen Tier 1 Neonatal Doctor, Elin Whiskerd Nursery Nurse, Stacey Reed Neonatal Safety Champion, Helen Muxworthy Newborn Examination Midwife, Samantha Willis Advanced Neonatal Nurse Practitioner, Dr Sree Nittur Neonatal Consultant.