Safe staffing and skill mix in Maternity Care

Ensuring safe staffing levels and skill mix is essential to providing safety maternity care

The issue of safe staffing levels has become a serious focus of attention in many healthcare systems, particularly across the UK following major inquiries into serious patient safety events. Maternity services can face particular challenges in ensuring that they are effectively staffed with safe numbers of midwives and doctors, and that there is a safe and appropriate mix of skills at all times of day and night.

A wide range of evidence has demonstrated the important relationship between staffing levels and safe care in maternity. Staffing levels can have a considerable impact on outcomes. Staffing is often one of the most challenging issues in maternity care, and increasing attention is being given to practical and pragmatic approaches to deploying staff flexibly, shifting tasks appropriately and creating new or extended roles within maternity services to support the safe delivery of maternity care.

A range of tools, guidelines and principles have been developed to help ensure that patient safety is maintained in maternity care through effective staffing and skill mix. Measurement and monitoring tools have been developed to allow the accurate tracking of current and past staffing and activity levels in maternity units. The Intrapartum Scorecard provides one example, and the data collected and the tools it provides can be used in a number of ways, either retrospectively or prospectively to support decision making and investigation purposes.

There are a range of guidelines and standards on staffing levels in maternity care, and these are often linked with guidelines on appropriate skill mix and training requirements for staff. A key priority is to match the staff resources to the workload within a unit to ensure that safe levels of care can always be provided. One set of minimum standards has been produced by a group of Royal Colleges in the UK, which provides a detailed and practical set of standards regarding what constitutes safe and effective levels of staffing, training, facilities and resourcing in maternity care.

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