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G29(P) Implementing the rcpch palate examination best practice guide leads to fewer delays in diagnosis of cleft palate
  1. H McElroy1,
  2. G Murphy2,
  3. W Tuohy2
  1. 1Oliver Fisher Neonatal Unit, Medway NHS Foundation Trust, Gillingham, UK
  2. 2South Thames Cleft Services, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Abstract

Background The RCPCH best practice guide, published in October 2014 in response to delayed diagnosis of cleft palate in the UK, advocates a change in practice from palpation to visual inspection as the optimal method to diagnose a cleft palate.

Aim To implement the RCPCH guidance and ascertain whether this leads to an improvement in earlier detection of infants with a cleft palate.

Methods An educational package was introduced in November 2014 to support implementation of the guide. The package was aimed at health professionals performing the newborn examination and midwives who are expected, in this hospital, to examine the palate shortly after birth. It was repeated at six-monthly intervals to coincide with induction of new doctors, and included an email shot of the recommendations, presentation of the guide, videos and cleft palate diagnostic models. Details of the timing of detection of all clefts were available from 2009; these were compared with timings after implementation of the guide. A delay in diagnosis was defined as detection after 72 hours age. The method of diagnosis was noted for all cleft palates identified from Nov 2014.

Results Since implementation of the guidance all six cleft palates have been diagnosed within 72 hours age and by visual inspection, an improvement on the previous 5 years (table 1). Half of the clefts were missed at the first examination shortly after birth by staff using the palpation method.

Abstract P29(P) Table 1

Timing of detection of cleft palates, before and after implementation of RCPCH guidance

Conclusion Early results from our hospital suggest that implementation of the RCPCH best practice guide can lead to earlier detection of cleft palates when introduced as part of an educational package lead by a dedicated team. Continued education of all staff is required to achieve a sustained improvement and our next goal of identification of all cleft palates within 24 hours of birth.

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