Enhancing individualised care of multiple birth families on NICU

This week’s blog comes from Courtney Chater who qualified as a children’s nurse in 2016, and worked for 16 months on PICU at Birmingham Children’s Hospital before moving to NICU at Birmingham Women’s Hospital in February 2018. Courtney has developed an interest in supporting multiple birth families and describes her approach to mobilising new learning and encouraging individualised care on NICU.

In February 2019, I had the opportunity to develop my knowledge by undertaking an online module focussing on the individualised care of multiple birth families. Working my way throughout the course, I realised how much I did not know about these families and their journeys even though I care for multiple birth families regularly, working on the Level 3 Neonatal Intensive Care Unit at Birmingham Women’s Hospital. Half of twins and 95% of triplets are born before 37 weeks and 15% of twins and 42% of triplets are born before 32 weeks (NCT and TAMBA, 2015). Prematurity accounts for 65% of neonatal death in multiple births, compared with 43% in singletons and even though multiple births account for just 3% of live births in the UK, they make up 18.4% of neonatal death (NCT and TAMBA, 2015). In addition, some twins are also more at risk of specific conditions, such as Twin-to-Twin Transfusion Syndrome, which means they may be even more at risk of being born prematurely and requiring intensive care treatment. 

The course also covered all the topics that NICU staff should know to advise the parents for preparation for discharge as safe sleep, breastfeeding, and bottle-feeding. After completing the course, I wanted to take what I had learnt and apply it to practice. I created a PowerPoint presentation and began presenting it to our new starters on NICU. The results from my pre and post presentation questionnaires showed an improvement in staff knowledge and confidence, but I felt like more needed to be done.

In November 2020, following two days of Silver Belt Quality Improvement Training through my trust, I formally began a quality improvement project. I developed a quality improvement plan and had many ideas but decided to narrow down my focus to three main aims;

  1. Staff Education: I have shared bite-sized information with staff and through before and after questionnaires I have seen an improvement in staff knowledge and confidence in every topic.
  2. Specific bereavement support: this aim was more difficult to meet but our neonatal psychologist is working with other agencies to create a neonatal death bereavement pathway, so we plan to adapt this to meet the needs of multiple birth families in the future.
  3. To introduce co-bedding onto the NICU: It became clear that this would take more time through development of guidelines and SOPs so I decided to introduce ‘Twin Time’ to the NICU. This is when twins or multiples are placed together in the same incubator/babytherm/cot for a period then returned to their own. Twin time was something staff were doing sporadically but it was not a part of our every day care. That is when we introduced the ‘Twin Time Thermometer’. It is visually like a fundraising thermometer, with the goal being number of twin times to complete in that month on the neonatal unit. The first month of launch, we achieved 24 lots of twin time from five sets of twins. When staff fill in the thermometer, they also put their name and they receive a ‘Learning from Excellence’ recognition, which not only boosts staff morale and acts as a great encouragement but also provides a piece of evidence for their professional revalidation. We have also had fantastic feedback from parents about ‘Twin Time’.

Moving forward, I would like to spread the project more widely and have secured funding to support seven of my colleagues to attend the same multiple births module in October. I would like to work with other neonatal units, particularly those in the West Midlands Network and Level 3 units, to help them implement individualised multiple birth family care. If you are interested in learning more about my multiple birth quality improvement project and potentially launching one in your neonatal unit, please contact me at Courtney.chater1@nhs.net or find me on twitter @courtneynicu

I would like to acknowledge receipt of a funding support award from the Multiple Births Foundation to undertake the module.


NCT and Tamba (2015). Maternity Services and Multiple Births.

Further reading:

Bryan, E. and Hallett, F. (2001). Twins and Triplets: The First Five Years and Beyond. Guidelines for Professionals. [online] London: The Multiple Births Foundation. Available at: http://www.multiplebirths.org.uk/pdf/FirstFiveYears.pdf

Leonard LG. Breastfeeding rights of multiple birth families and guidelines for health professionals. Twin Res 2003;6:34– 45

Levene, M, Tudehope, D and Sinha, S. (2008). Chapter 25: Multiple Birth. In: Essential Neonatal Medicine. 4th ed. Oxford: Blackwell Publishing. p265-269.

Tamba (2017) Twin pregnancy and neonatal care in England

The Multiple Births Foundation (2011). Guidance for Health Professionals on Feeding Twins, Triplets and Higher Order Multiples. [online] London: The Multiple Births Foundation. Available at: http://www.multiplebirths.org.uk/MBF_Professionals_Final.pdf


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