A STRUCTURED INTERVENTION PROGRAMME CAN IMPROVE THE BIOPHYSICAL WELLBEING IN CHILDREN WITH CONGENITAL HEART DISEASE
| Autor: | Callaghan, Sinead, Morrison, Margaret Louise, McCusker, Christopher, McKeown, Pascal, Casey, Frank, Leemon, Danielle, Cummins, David, Saxena, Nita, Anandarajan, Mugilan, Cuddy, Grace, McNaughten, Ben, Henderson, Rachel, Harris, Carl, Bell, A, Knox, S., Shah, S., Hogan, M., Clarke, W., McStay, P., Hanna, Martin, Clarke, Joseph, Ledwidge, Mary, Armstrong, Damien, Logue, Orla, Donnan, Kate, Fleck, Deborah, Hughes, Ciara, Shields, Michael D, Courtney, Julia, Lavery, Gavin |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: | |
| Zdroj: | The Ulster Medical Journal |
| ISSN: | 2046-4207 0041-6193 |
| Popis: | Background: Improved survival among children with congenital heart disease (CHD) has shifted focus to longterm physical and psychological outcomes. The benefits of an active lifestyle have been well described. This study aims to determine if a structured intervention programme can improve both physical and psychological functioning in children with CHD. Methods: This is a prospective randomised control trial. Patients aged 5-10years with CHD were identified and invited to participate. Each patient underwent baseline assessment including biophysical assessments and psychosocial assessments Patients were then randomised into intervention and control groups. The intervention group attended an education session during which motivational techniques were used to deliver exercise and positive lifestyle advice. They also received an individual written exercise plan. The control group continued with their usual level of care. After 4 months, all participants were reassessed. Results: 163 recruited, 100 males (61.3%), mean age of 8.4years (5.3 – 11.5). EST duration mean 5.89mins (SD2.02). Actigraph: Average MVPA time 45mins (SD-27.2). The ‘cyanotic palliated’ subgroup had significantly shorter EST and lower levels of daily MVPA. This subgroup also scored significantly lower on HrQOL physical wellbeing. There was a significant improvement in performance at peak exercise in the intervention group following the intervention Conclusions: Overall physical and psychological wellbeing is well preserved in the majority of children aged 5-11 years with CHD. A structured intervention programme significantly improved peak exercise capacity. Background: Neonatal intensive care provides a level of care that is both high in cost and low in volume. Admissions of term and near-term infants are a major contributor to workload, not to mention the emotional anxiety caused by separating a mother and new born baby. The aim of this audit was to determine the pattern of potentially avoidable admissions,and the degree of support required by these babies. Methods: This was a retrospective audit of all babies greater than 36 weeks gestation admitted to NICU during November 2016. All babies greater than 36 weeks and more than 1.8 Kg were included. Those who had a congenital abnormality diagnosed before or after birth were excluded. Results: 37% of admissions to NICU in 2016 were term babies greater than 37 weeks. In November alone, babies greater than 36 weeks made up 59% of admissions. 71% of these were admitted due to respiratory complications, 80% of them being delivered by C-section. However only 40% required respiratory support. The average length of stay was 6 and a half days. There were no admissions as a result of hypoglycaemia or hypothermia. Conclusions: 71% of admissions of babies greater than 36 weeks gestation could potentially have been avoided. A transitional care ward for babies requiring NG feeds or respiratory monitoring could reduce this admission rate. This audit needs to be bigger and expanded to other neonatal intensive care units in the province. Background: The stethoscope remains one of the most powerful diagnostic tools available to clinicians. However, there is an expanding body of evidence suggesting that stethoscopes may act as vectors for infection. Guidelines advise that stethoscopes should be cleaned after each patient contact. We sought to evaluate trainees’ perceptions on how regularly they clean their stethoscopes and to observe practice in the clinical environment. Methods: We distributed a questionnaire to trainees at local induction asking them how often they cleaned their stethoscope and where they stored it when not working. We also observed stethoscope hygiene practice on paediatric ward rounds. Results: A total of 17 trainees completed the questionnaire. Only five (29%) stated that they clean their stethoscope after every patient. Four clean it more than five times per day and seven clean it between one and five times daily. Most trainees (82%) take their stethoscope home with them. During the period of ward round observation there was a total of 36 patient encounters. Seven of these patients had an individual bedside stethoscope and this was used on five occasions when available. When a personal stethoscope was used this was cleaned before use in 59% of cases (17/29). Conclusions: Despite only 29% of trainees suggesting that they clean their stethoscope between patients, observation of ward round encounters revealed that this practice occurred more regularly (59% cases). However, there is significant scope for improvement in stethoscope hygiene practice and further education is required to enhance compliance with recommendations. Background: Traditionally baby checks have been carried out by paediatric doctors. Over recent years midwives have increasingly been carrying out these checks and a course is now offered in Queens University Belfast to train to complete these examinations. The Northern Ireland Medical and Dental Training Agency issued guidance to Craigavon Area Hospital that paediatric trainees should not be carrying out large numbers of normal baby checks on the postnatal ward in 2016. Aim: To reduce the number of baby checks carried out by the paediatric team and encourage a cultural shift towards midwife baby checks on the postnatal ward. Methods: Meetings were held with the Head of Midwifery to highlight that midwife appropriate baby checks were being carried out by paediatricians. Intervention 1: In July 2016 at the beginning of the day the midwifery team were reminded that there were baby checks suitable for midwives to complete. Intervention 2: In November 2016 the sheet where baby’s needing a baby check were recorded were redesigned to highlight midwife appropriate baby checks and those (based on local guidelines) requiring a paediatrician check. Results: Our interventions have reduced the average number of baby checks carried out by paediatrics from 65 per week to 25 per week (intervention 1) to 19 per week (intervention 2). Conclusions: These interventions have reduced the number of normal baby checks carried out by paediatric doctors by 70%. These simple interventions could be introduced in other hospitals province wide to increase training opportunities for paediatric trainees. Background: In 2012 the National Institute for Health and Care Excellence (NICE) published ‘Neonatal Sepsis (early onset): Antibiotics for prevention and treatment’. This project set out to establish how well this guideline was adhered to in Altnagelvin Hospital and identify any areas for improvement. Method: Thirty neonates screened for early onset sepsis were identified by the microbiology laboratory. The management of these infants were audited using the NICE audit tool. Two Quality Improvement Plan, Do, Study Act (PDSA) cycles were completed to improve adherence. Result: In Altnagelvin Hospital adherence to the Neonatal Sepsis guideline was generally good. 28 (93%) had correct indications for screening, 30 (100%) had blood cultures and CRPs carried out before commencing antibiotics, 30 (100%) had the right antibiotics and doses prescribed. 23 (77%) had a CRP repeated at the correct interval. However, only 16 (53%) received antibiotics within recommended hour from decision to treat. This was identified as an area for improvement. The first intervention was a discussion with Delivery Suite Staff to ensure adequate stocking of the neonatal trolley. In the following two weeks 71% of screened neonates received antibiotics within one hour.The project was then presented to the Paediatric Staff and the importance of timely antibiotics was reiterated. In the next two weeks 83% had first dose antibiotics within one hour. Conclusions: Time to antibiotics in early onset sepsis is often delayed by simple factors like poor stocking of equipment and with small changes this has been greatly improved. Background: It is known that physiotherapy Cough Assist (CA) techniques help clear lung secretions during infections in children with neuromuscular disease. It is not known whether CA results in an improvement in Peak Cough Flow. Methods: We performed a systemic review using MedLine, Embase and Web of Science of relevant cough assist terms in the neuromuscular context with cough peak flow (CPF) as outcome. Results: The initial 555 papers were culled to 46 relevant publications. These were independent assessed and 19 were deemed suitable at addressing the key question. 7 of the 19 papers described effect sizes and were used in a meta-analysis with Forest Plots. The weighted mean improvement in CPF was 125 L/min (95% CI: 98-151, normal PCF > 250). The remaining papers were reviewed for qualitative evidence of effect which was in the same positive direction. Conclusion: Cough assist physiotherapy in neuromuscular disease is associated with a major improvement in CPF and moves these children closer to normal cough. Future research is needed to determine how long the benefit lasts and thus how frequently CA should be performed each day. Background & Aims: Good clinical handover is a vital component of high quality, safe medical care. Handover has been highlighted as a priority by several professional bodies. The National Patient Safety Agency describe handover as ‘one of the most perilous procedures in medicine’ which can be a ‘major contributory factor to subsequent error and harm to patients.’ The importance of handover is escalating with changing work patterns and the Royal College of Physicians state that ‘establishing standards for handover should be a priority.’ Importantly, ‘effective communication lies at the very heart of good patient care’ and the BMA recommend ‘handover champions.’ The Safety Forum is focussed on improving professional communication in Northern Ireland as a priority. Methods: A baseline survey of all paediatric trainees in Northern Ireland was conducted. The results are informing further improvement work reflecting the perceptions, concerns and priorities of trainees. Results: 35% - no formal training on handover, 58% - want regional handover practices changed/improved Morning(8-9am) handover; 12% no formal handover, 15% no structured handover tool, 73% not bleep free, 27% last >30 minutes, 12% no senior presence/ set location, 35% no task list identified.Afternoon/5pm handover; 27% no formal handover, 8% bleep free, 23% no set location, 35% senior supervision and 15% no structured handover tool Conclusions: The evidence and support are growing for the requirement for systematic improvement based on a standardised, collaborative approach. Background: Alternative approaches to analysing what has gone wrong to improve safety are emerging in other fields similar to healthcare. The ethos is to focus on what is done well and adapt this behaviour as a team to improve the overall service. This culture is now emerging in healthcare. Methods: In order to identify excellence we created a postcard to be completed by staff for each other. Staff can use the postcards to nominate a colleague who has achieved excellence, detail how they achieved excellence and what could be done to develop excellence further. The postcards are deposited in a post-box and are collected at intervals. Certificates are created for the nominees who can be add them to their appraisal folders. We ran a pilot of the project in the neonatal unit in a DGH. Results: 48% of staff completed a staff morale questionnaire prior to starting the pilot. Most people disagreed with the statement “I receive feedback on how I am performing in my job” and neither agreed or disagreed with “My team inspires me to do my best work”. 31 cards have been completed and certificates created for each nominee. The project has been received positively. Conclusions: Next steps are to begin to analyse the themes of excellence that have been identified and begin to adapt them as a team. We hope to roll out this project to the rest of the directorate, then to other paediatric teams regionally and possibly to other specialities. |
| Databáze: | OpenAIRE |
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