Footnotes
UMJ is an open access publication of the Ulster Medical Society (http://www.ums.ac.uk).
. 2018 May 30;87(2):138–139.
Ulster Med J. 2018 May 30;87(2):138–139.
Abstract
Background:
Lumbar puncture (LP) and CSF analysis is a recommended investigation for evaluation of suspected sepsis in neonates (NICE guideline-CG149 August 2012).
Prior to January 2014, process mapping for LP in a district general hospital, included clinical evaluation by a senior doctor, transfer from the postnatal to neonatal unit with monitoring for 1-hour post procedure. Documentation is recorded by both clinical teams, with two handovers of information.
Service review was performed following multidisciplinary meetings and a reorganisation plan was devised, aiming to minimise transfer of neonates, thus improving safety and documentation.
3 of the 4 regional neonatal units in NI perform LPs by the same method. Length of admission ranges from 2 to > 12 hours.
Methods:
A ‘Plan, Do Study Act’ (PDSA) cycle was used. The planning stage involved meetings with stakeholders and risk assessment of the proposed change of having LP performed on the postnatal ward. A process map for the new method was trialled. Postnatal staff training was updated in post LP care. Equipment was checked and patient groups advised of parental preferences. When the new system was in place, incident reporting revealed no evidence of adverse outcomes. Rapid cycle audits proved patient safety was not compromised and parent satisfaction improved.
Results:
The total number of LPs performed from 1/7/14 to 1/1/15 was 16. No incident reports, significant events, or contamination of CSF was reported. Ongoing service review identified areas of improvement, including patient information leaflets and documentation.
Conclusions:
This project proposes that LP can be safely carried out on the postnatal ward, under observation by transitional care nurses. Information leaflets and stickers for clinical notes have been implemented with planned continuous evaluation.
Ulster Med J. 2018 May 30;87(2):138–139.
Abstract
Background:
The Ulster Hospital has approximately 4000 deliveries/year with postnatal checks completed in the postnatal ward by midwifes and paediatric team prior to discharge. Verbal advice is routine and had been custom and practice. Following a category 2 adverse incident, the paediatric team reviewed practice after process mapping postnatal infant discharges. Patient families were approached to provide input regarding what advice they would have preferred to have received prior to discharge. Among the suggestions were “general” and “infant with suspected cardiac disorder” discharge leaflets.
Aim:
To learn from adverse events locally using clinical leadership, cultural change and standardisation, to make service improvements that enhance the safety of our systems.
The Review Process:
Initial review led to meetings with parents and service mangers as part of incident reporting and complaints processes. Process mapping then enabled risk and prevention assessment with implementation of immediate operational actions supporting recurrence risk reduction. Establishment of the Working Group with multidisciplinary team input facilitated improvement planning with the design and introduction of information leaflets.
Discussion & conclusion:
Adverse incident review and input from The Paediatric Working Group facilitated insight into an area requiring system improvement. This allowed utilisation of the learning potential from the event and resulted in discharge information leaflets, which could be modified for use in other postnatal wards across Northern Ireland.
Ulster Med J. 2018 May 30;87(2):138–139.
Abstract
Background and Aims:
Resuscitation of the acutely unwell neonate is an important role of the multidisciplinary team.1
Simulation can bridge the gap between teaching and clinical practice, by improving both technical and non-technical skills.2-8 The aims are; to embed twice monthly in situ simulations in the Ulster Hospital by June 2016; to improve staff confidence in resuscitation skills by 10% over 6 months; and to improve patient safety by a reduction in critical incidents. Secondary aims are to embed a simulation culture across Northern Ireland (NI) with collaboration between trusts to enable shared learning.
Methods:
Simulation leads were identified and a training programme for instructors implemented. Multidisciplinary staff participated in the in situ simulation sessions.
A questionnaire was devised, adapted from recent studies and approved by local stakeholders and ethics committee.4,8-11 Participants completed the questionnaire before and after each simulation. The 20 questions are a subjective assessment of simulation experience, clinical and team-working skills. An online simulation network was created to allow for universal access to scenarios, a database of facilities and an online discussion forum.
Results:
Results showed significant improvement in multiple domains. For example, in neonatal airway management, participants reported significantly improved self reported confidence scores, measured on a 5-point likert scale (Presimulation mean= 2.471, post-simulation mean= 3.57 p=0.0039). Communication with team members also showed significant improvement (pre simulation mean= 3.647, postsimulation mean=4.15, p=0.0177).
Conclusions:
Multidisciplinary simulation is an effective method of improving clinical and teamwork skills. Development of a simulation network across NI allows transfer of skills when doctors move trusts and has allowed simulation leaders to emerge. Using an incident reporting system during simulation, allows for improvements in the actual clinical environment, limiting future errors during real resuscitation.7-9,12
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