G586(P) Phototherapy management in jaundiced babies: jaundice management tool

Abstract

Context This quality improvement work aimed to improve the management of infants on the postnatal ward (PNW) at Queen Alexandra Hospital, Portsmouth who were undergoing phototherapy for the management of neonatal jaundice. The main staff groups targeted were those involved in the care of infants on the PNW (neonatal trainees, ANNPs, midwives and health care support workers). Problem In 2010, the National institute for Health and Clinical Excellence (NICE) published evidence-based guidelines aimed at standardising the management of neonatal jaundice across the UK. In 2014, an audit of the management of jaundiced infants on the PNW against NICE standards revealed deficiencies relating to the timing of repeat serum bilirubin measurement (SBR) with only 21% having a repeat SBR which complied with the NICE standard. This in turn was potentially putting babies at risk from jaundice. Assessment of problem and analysis of its causes The NICE phototherapy pathway was displayed on a wall on the PNW. Its complex nature meant that many members of staff did not use it to guide their management of infants under phototherapy. Midwives would often ask the neonatal trainees for advice regarding management and timings of future SBR samples. With trainees changing frequently and a variety of level of experience, there appeared to be a lack of consistency in the management of neonatal jaundice. Intervention A Jaundice Management Tool (JMT) based on the NICE guidance was designed to use alongside the NICE jaundice graphs (see figure 1). This formally documents times of SBRs, guides the phototherapy management, and advises on timings of subsequent SBRs. Study design A reaudit following a month of using the JMT will investigate whether adherence to NICE guidelines is improved. Strategy for change The JMT was printed, attached to the jaundice treatment threshold graphs and distributed to all the PNW. At the same time, midwives, healthcare support workers and neonatal trainees underwent training in the use of the JMT. Measurement of improvement Following a month of using the JMT on the postnatal ward, a formal reaudit will be underway, along with a questionnaire to provide feedback regarding the JMT, and assess how user-friendly it is. Effects of changes So far the JMT has resulted in improved clinical care with more babies having appropriately timed repeat SBRs. In addition, it appears that the JMT has removed confusion around the timing of repeat SBRs and has encouraged a standardised approach across disciplines who are involved in the care of postnatal ward babies. Lessons learnt I have learnt that in order to implement the JMT, it was crucial that those involved were engaged in the process and keen to be part of the change in practice. It necessitated me liaising with a multidisciplinary group and I learnt to change my style depending on the disciplines I was addressing. Message for others In line with several studies relating to practice change, passive dissemination of guidelines is rarely effective. It is not sufficient to merely display guidance but necessitates meeting with the various disciplines and educating them on the need for change and how it will improve patient care The active dissemination strategy using a multifaceted used in this project seemed effective in improving practice. Useful elements included tailoring the implementation of change to the local setting and users, education of staff groups, and the JMT itself as both a reminder and an easily accessible guide to care. (Table Presented).