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Abstract
Context NICE guidance for prolonged jaundice suggests screening babies with a gestational age of 37 weeks or more with jaundice lasting more than 14 days, and in babies with a gestational age of less than 37 weeks with jaundice lasting more than 21 days. Screening includes key factors in the history and examination along with a number of investigations.¹
Problem Babies referred for prolonged jaundice screening are seen in our paediatric department. Previously these babies had a full admission pack completed by nursing and medical staff which was time consuming and unnecessary. There was also confusion amongst medical and nursing staff regarding which investigations were required.
Assessment of the problem and analysis of its cause An audit also showed a variation in investigations taken. Discussions regarding improvement were held in our multi-disciplinary departmental audit meetings. A re-audit showed there was poor documentation of all results and communication of results to the parents, General Practitioner (GP) and Health Visitor (HV).
Intervention Following the first audit, a shorter, single sheet, prolonged jaundice proforma was introduced with several short PDSA cycles to include feedback from users. Also a standard letter to parents, GP and HV was introduced.
Study design A retrospective audit was carried out using cohort of babies referred by community midwives and general practitioners. After the first intervention a re-audit was performed.
Strategy for change A further PDSA cycle has been commenced with the introduction of a folder which includes all the proformas. Once all the results are back, they are documented and letters sent to parents, GPs, and the HV. This was introduced after multi-disciplinary discussion, feedback and dissemination. After the introduction of the folder, reminders are sent to members of the staff via emails for the changes to be implemented.
Measurement for improvement A third retrospective audit cycle to measure the improvements.
Effects of change Some improvements to the patient pathway were made with an ongoing PDSA cycle. Following the introduction of a proforma, there was no variation in investigations. Further improvements have been made and this will be looked at again as part of the next cycle.
Lessons learnt Improved documentation and communication with PDSA cycle using the feedback from the other members of the department. Constant reminders have to be sent and changes followed through to implement the change.
Messages for others Developing a simple proforma and standard letters to primary care can simplify and streamline usage of the NICE guidance. This has created a pathway which staff users feel comfortable with, resulting in improved guidance adherence. Audits and PDSA cycles can be used to measure changes and then followed through with productive result which improve the patient journey and patient care.