the birth of cebis within neonatal care: a case study aislinn conway clinical evidence based...
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The Birth of CEBIS Within Neonatal Care: a Case
Study
Aislinn ConwayClinical Evidence Based Information Service Specialist13th of June, 2011
• Conception
• Labour
• Birth
• Development
Conception
• Jacqui Cox, Clinical Librarian UHCW
2004
• Ophthalmology, Diabetes and Endocrinology and Neonates
• Development and implementation of Evidence in Practice Groups
• Critical Appraisal training
• Business case, 2005 - 2009
• CEBIS, 2010
Conception – triplets!
CEBIS Specialists Division/Specialties
Anna Brown Diagnostic & Services
Mandeep Heer (Aulakh) Medicine• Diabetes &Endocrinology• Gastroenterology• ED• Infectious Diseases
Aislinn Conway Women and Childrens• Neonatology• Paediatrics• Obs & Gynae• CRM
Labour: Stages of the CEBIS Model
Handover or grand / ward round
Scoping search/evidence
summary feedback
Ppt PresentationPpt presentation and discussion
Further action planned / decision to maintain
or change current practice
Actions completed and reviewed
Birth – the Breakthrough Moment
1. Background - SHO/Reg
2. Case History - SHO/Reg
3. Evidence - CEBIS
4. Management - SHO/Reg
5. Discussion - Consultants, ANNP’s, Medical Students, SHOs, Regs, Pathology, Dietitian etc.
Example: Managment and Treatment of Neonatal Gastro-oesophageal Reflux
(GOR)
• Uncomplicated GOR resolves in 90% of infants
• Complications – Gastro-oesophageal Reflux Disease
Difficulties of Diagnosis of GOR
SHO
Investigate if a link exists between other apparent life threatening events (ALTEs) to aid diagnosis
In the vast majority of infants, reflux is not related to pathologic apnea or to apparent life-threatening events,
lthough a clear temporal relationship in individual infants
Positioning
• ANNP
• A systematic review identified an area where practice could change: prone and left lateral lying decreases GOR symptoms
• Risk of Sudden Infant Death Syndrome (SIDS)?
• Safe in preterm infants in hospital receiving cardiorespiratory monitoring
Survey of Practice
• 2 x ANNP’s
• 2009
• Preterm infants >30 wks GA excluded
• £4229 spent on medication, feed thickeners and nurse staffing
• Staff noted prescribing of GOR meds decreased recently
• Approx. 122.6 hrs of nursing time may be designated to other tasks
Putting Evidence into Practice
UHCW Clinical Guideline: Management and Treatment of Gastro-Oesophageal Reflux (GOR) in Neonates
Guideline to promote evidence-based management and treatment of neonates who have presented with symptoms/signs consistent with gastro-oesophageal reflux
Future research: diagnostic tools - pH monitoring and multichannel intralumial impedance
University Hospitals Coventry and Warwickshire NHS Trust Neonatal Department
Management and Treatment of Gastro-oesophageal Reflux in Neonates
Development: keeping it alive and well to encourage growth
NATURE:
CEBIS System – currently at testing stage providing
• a platform on which to submit queries direct from EPR
• Direct link from patient record to CEBIS record on patient case
• A working tool for CEBIS Specialists to coordinate and communicate with clinical teams involved in EPG work
• Direct linkouts to PubMed for search updates
• Complete documentation of all work generated per query including audit trail and outcome measures
• Searchable interface as a standalone system on Intranet
Development: keeping it alive and well to encourage growth
• NURTURE– Know your organisation and seek opportunities in change
– Know your product, be loyal to it and seek to sell it well
– Know your teams, understand their environment and become one of them.
– Know yourself – no baby became an adult in one day!
References• Vandenplas, Y et al. Pediatric Gastroesophageal Reflux Practice Guidelines: Joint Recommendations of the North
American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nurtrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009; 49(4):498-547.
• Fox G, Hoque N, Watts T. Oxford Handbook of Neonatology. Oxford: Oxford Medical Publications; 2010.
• Birch JL, Newell SJ. Gastrooesophageal reflux disease in preterm infants: current management and diagnostic dilemmas. Arch Dis Child Fetal Neonatal Ed. 2009; 94: F379-383.
• Guillet R et al. Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants. Pediatrics. 2006; 117:e137-e142.
• British National Formulary for Children [Internet]. London: 2011 [cited 2011, May 23]. Available from: http://bnfc.org/bnfc/bnfc/2010/100063.htm?q=gastro%20oesophageal%20reflux&t=search&ss=text&p=2#_hit
• Hammer D. Gastroesophageal Reflux and Prokinetic Agents. Neonatal Network. 2005; 24(2): 51-58.
References contd.• American Academy Of Pediatrics Policy Statement: Task Force on Sudden Infant Death Syndrome. The Changing
Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics. 2005:116(5); 1245-1255.
• UpToDate Topic: Gastroesophageal reflux in infants. [Internet]. Masachusetts: 2011 [cited 2011, March 9]. Available from http://www.uptodate.com/index
• Dynamed Topic: Gastroesophageal reflux disease (GERD) in infants. [Internet]. Masachusetts: 2011 [cited 2011, March 9]. Available from: http://www.ebscohost.com/dynamed/default.php
• Clinical Review Drug and Therapeutics Bulletin: Managing gastro-oesohageal reflux in infants. BMJ. 2010:341;495-498.
• Huang RC, Forbes D, Davies MW. Feed thickener for newborn infants with gastro-oesophageal reflux. Cochrane Database of Systematic Reviews. 2002, Issue 3. Art. No. CD003211. Available from: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003211/pdf_fs.html