A N N E T T E W R I G H T 2 0 1 5 L I V E R P O O L H O S P I T A L N I C U

S Y D N E Y N S W

A U S T R A L I A

The devil in the detail: using real time data in the NICU

Liverpool Hospital NICU

Liverpool Hospital - 3100 deliveries each year

900 Nursery admissions/year (300 NICU admissions)

NICU - 31 bed unit (12 ventilated and 19 special care)

No access to human milk bank

Nurses make up feeds at bedside

No dedicated lactation position

Previous Audit Data

Only on NICU babies

Minimal Summary Feeding Data

First breast milk feed

First time at breast

First formula feed ( if any)

At discharge: type of feed and how it was given

Reports were available 2 years later only about NICU babies

2014 Neonatal Database in NSW

Westmead CHW JHH

Gosford

RNSH

SCH

Liverpool

Campbelltown Wollongong

St George

RPA

Blacktown

Nepean

Canberra

RHW

Neonatal Database

Report Server

Web Server

Audit and Clinical module Clinical module only (includes FUP)

Data in the NICU System Function

Hospital systems

PAS Laboratory Imaging eMR Prescribing

ICU systems

Charting

Equipment data feeds

Clinician systems Home grown Tight budget

External Systems

Administration & Financial

Clinical Management

Decision support & Alerts

Benchmarking

Clinical Practice

Improvement

Regional Audit

Local Research

Multi-centre Research

Administration & Financial

Clinical Management

Decision support & Alerts

Benchmarking

Clinical Practice

Improvement (CPI)

Regional Audit

Local Research

Multi-centre Research

Data collected using hand held device since 2012

Bedside Data Collection

Data that is entered by trusted users is analysed for the monthly feeding statistics, from the clinical system

Identifying Kangaroo care

Immediate Feedback = Quality Improvement

Much more than just audit

Many practice changes simultaneously

Continuing re-evaluation

Requires participation of staff

Redefines Unit Culture

Monitoring of results

Timely

Continuing

% of all babies receiving breastmilk 2007

0

10

20

30

40

50

60

70

80

90

100

January February March April May June July August Sept Oct Nov Dec

Partially Breastfed

Breastfed

% of all babies receiving breastmilk 2012

0

10

20

30

40

50

60

70

80

90

100

Jan Feb March April May June July Aug Sep Oct Nov Dec

partial

Breastmilk

intention

% of all babies receiving breastmilk 2014

0

10

20

30

40

50

60

70

80

90

100

Jan Feb March April May June July Aug Sept Oct Nov Dec

EBM/Form

EBM

Intent

Breastmilk use in the NICU 2014 Vs Kangaroo Care <32 weeks

0

10

20

30

40

50

60

70

80

90

100

jan feb mar apr may jun july aug sep oct nov dec

both

ebm

KC

Tracking work of Lactation staff

Working towards BFHI Neonatal.

The data base has assisted us in improving our rates of breastmilk use.

We hope it will assist us in working towards accreditation in BFHI in the future

Kangaroo care; step 4

Time to 1st milk expression;

Lactation support;

Use of nipple shields;

Thank you