The devil in the detail
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ANNETTE WRIGHT 2015 LIVERPOOL HOSPITAL NICU SYDNEY NSW AUSTRALIA The devil in the detail: using real time data in the NICU
Transcript of The devil in the detail
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
