Abbreviations LPT Leicestershire Partnership NHS Trust NMC Nursing and Midwifery Council NICE National Institute for Health and Clinical Excellence UHL University Hospitals of Leicester NHS Trust Background Between 2007 and 2010 there were a number of guidelines published by NICE that were relevant to the clinical practice of Health Visitor and School Nursing Teams. These guidelines were disseminated to all members of staff by the senior nurse via locality managers. Health visitors, school nurses and registered nurses have a professional responsibility to keep up to date with current knowledge in order to ensure they are using evidence based practice (NMC 2008). An audit was carried out of health visitor and school nurse teams in the former county localities in 2011 which highlighted gaps in the knowledge of key issues within these NICE guidelines. A re-audit was recommended for 1 year following this, and additional recommendations were made about the design of the audit tool. There has been an unpublished audit also carried out in 2011 by Dr Forster, consultant paediatrician at UHL, showing that referral rates for prolonged jaundice screens to the children’s day ward had increased. This suggested that staff were more aware of the recommendations of CG98 Neonatal jaundice, although it also identified unexpectedly low referral rates for babies of African-Caribbean ethnicity. It was suggested that there was a reliance on skin colour for diagnosis rather than colour of the sclera or gums, both of which are key features in the identification of jaundice in many of the ethnic groups which comprise a significant proportion of the local population. This new baseline audit measured Health Visitor and School Nursing team members’ knowledge of key areas within the 5 NICE guidelines across Health Visitor and School Nursing teams in the county and city. It was considered to be a new audit as it used new questionnaire as the audit tool, and was carried out across city and county localities within a new organisation. Prior to the audit the quick reference guide for each of the 5 guidelines were circulated by email to all staff via the senior nurse and locality managers. The aim of this was to remind staff of their professional responsibilities to read and be familiar with the content. They were sent out over 5 months, one per
Question 9: Which of the following is a Red Flag symptom in a child with feverish illness (which would cause you to refer to a paediatric specialist urgently)? Weak or high pitched cry. 95% 22 61% Question 10: Which of the following is a correct piece of advice for parents of a child with a fever (with no red or amber symptoms)? Look for signs of dehydration, non-blanching rash, encourage more fluids than usual and to seek further advice if they feel the child is getting worse. 95% 24 67% Question 11: A diagnosis of atopic eczema can be made when a child has an itchy skin condition and which of the following? History of dry skin in the last 12 months, visible flexural dermatitis involving skin creases and allergic rhinitis. 95% 34 94% Question 12: A referral to specialist dermatological advice is necessary if: Atopic eczema is associated with severe or recurrent infections. 95% 34 94% Question 13: Which of the following describes the correct management for a 2 year old with dry skin, and occasional appearance of red patches of itchy skin behind the knees? Emollients, mild topical corticosteroids only where and when the skin is red and itchy, and continue with emollients even when fully resolved. 95% 23 64% Question 14: Which of the following children is constipated? A 3 year old who passes 2 hard large stools per week, straining to do so and who has had constipation in the past. 95% 34 94% Question 15: When assessing a child, which of the following findings is a Red Flag indicating an underlying disorder rather than idiopathic constipation? Ribbon-shaped stool and abdominal distension with vomiting. 95% 35 97% Question 16: Which of the following describes the most appropriate dietary and lifestyle advice for parents of a 5 year old child with idiopathic constipation (in addition to management with laxatives)? Fluid intake of at least 1200ml as drinks daily, recommend foods such as fruit and vegetables, high-fibre bread and wholegrain cereals, daily physical activity and negotiated follow-up and support. 95% 36 100% Question 17: Are you aware of where to access the NICE guidelines quick reference guides? Yes 100% 29 81%
Distribution list Target audience To (for action) Senior Clinical Quality Group For information FYPC Clinical Audit Group For approval Action plan Objective Level of Risk L|M|H Agreed Action By Whom By When Improve knowledge of the diagnosis of neonatal jaundice M Staff to be reminded of the correct criteria for referral & of the ways to diagnose jaundice in the mandatory training session. Summary of key learning points to be circulated to managers Key learning points, along with recommendations about advice to parents, to be recirculated by team leaders, who will provide evidence that this has been done. Practice educators Sheila Gulley & Nicy Turney Sheila Gulley and Nicy Turney To be included in mandatory training for new starters as from February 2014 April 2013 March 2014 Improve compliance regarding the management of neonatal jaundice M Information about the correct referral route included as an appendix in the Standard Operating Procedures for the Family Health Visiting Health Child Programme, document to be circulated to HV team Team leaders Circulated by team leads in March 2013 – action complete
Improve compliance in the management of fever (Question 10) L To be included in key learning points to be circulated at team meeting & email out by team leaders Training programme for Health Visitors to include session on the management of minor ailments, will cover management of fever and of diarrhoea and vomiting. Team leaders Facilitated by practice educators. April 2013 On new starter induction programme starting September 2013 and for all staff starting October 2013. Improve compliance in the management of eczema L Guidelines about eczema treatments to be included in annual clinical update sessions for nurse prescribers 2013 Chris Brooks, Clinical team leader & Lead Pharmacist Already on training programme