Footnotes
UMJ is an open access publication of the Ulster Medical Society (http://www.ums.ac.uk).
. 2018 May 30;87(2):143.
Ulster Med J. 2018 May 30;87(2):143.
Abstract
Background and aims:
In situ simulation is an emerging tool medical in education with demonstrated benefits in quality improvement1. We report our experience of running multiprofessional in-situ simulations of paediatric emergencies in the clinical areas of a tertiary referral hospital
Method:
We deliver regular, unannounced simulated emergencies in various clinical areas involving nursing and medical staff of all grades. In this report we describe the technical requirements and issues that have arisen. We report participant experience based on post event interviews and ward system failures that have been identified.
Results:
Delivering ward based high fidelity simulation, including video recording, is feasible. The equipment can be used by medical staff with basic IT skills but without technical support. In the post simulation interview both medical and nursing staff voiced some initial anxiety in taking part. However most participants reported an increase in confidence in their clinical skills and agreed that they would welcome more of this type of training. A number of equipment and drug issues were identified and a written report was provided to the relevant senior staff. For example we identified that 3% hypertonic saline is not available at ward level and takes several minutes to be obtained from PICU.
Conclusions:
We believe that multi professional in-situ simulation is feasible, acceptable and can identify systems failures as part of a paediatric quality improvement initiative. We are continuing to conduct and evaluate monthly in situ simulation sessions and would recommend this approach to other units.
Ulster Med J. 2018 May 30;87(2):143.
Abstract
Background:
There is currently no regional guideline for the administration of IV fluids in infants less than 28 days old admitted to a paediatric or surgical ward in Northern Ireland. A retrospective audit of these patients in our unit revealed enormous variations in fluid types, volumes and monitoring. We wished to develop an evidence based guideline to address this key gap.
Method:
We carried out a literature review to identify current evidence based practice. We obtained guidelines from five paediatric units across the world. The guideline development group used these data to formulate a draft guideline which was circulated for multidisciplinary consultation. NICE subsequently released a guideline on paediatric inpatient fluids1, which included neonates, and the document was updated accordingly.
Results:
Our guideline recommends using 0.9% saline with 10% dextrose as a starting fluid in these patients at volumes increasing from 60ml/kg/day on day one to 150ml/kg/ day on day five. In this paper we will present the scientific justification for these recommendations.
Conclusions:
Our previous audit data clearly demonstrated that there is an urgent need for a guideline for the administration of IV fluids in infants less than 28 days of age. We believe the guideline described here uses the best available current evidence and consensus approach, and should be considered for use throughout Northern Ireland.