Surgical Benchmarking Meeting

Date: Friday 10th April 2015

Time: 09:30-16:00

Venue: Birmingham Children’s Hospital

MINUTES

Present: Cassie Aldridge – St Marys, Manchester

Alison Broadbent – Leeds Children’s Hospital

Jane Cooper – Leeds Children’s Hospital

Yvonne Cousins – St Thomas’, London

Jodie Davies – Squirrel Ward, GOSH, London

Caroline Gainsbury – Squirrel Ward, GOSH, London

Penny Heap –St Mary’s, Manchester

Rhiannon Jones – St Thomas’, London

Andrena Kelly – RHSC, Glasgow

Angie Laker – Oxford Children’s Hospital

Fiona Mills – Oxford Children’s Hospital

Kate Mills – St Mary’s, Bristol

Bernadette Reda – Birmingham Children’s Hospital

Maggie Reeves - Glasgow

Sue Payne – Sheffield Children’s Hospital

Apologies: Sarah Bradley – St Georges, London

Sue Braithwaite – St Michael’s, Bristol

Maricar Callueng – Royal London Hospital, London

Melanie Haughan - Newcastle

Christie Hanson - Kings College

Karen Marchant – Brighton

Gillian Parsons – Chelsea and Westminster Hospital, London

Thank you to Bernadette for hosting us and organising lunch through Advancis Rep - Suzanne.

Minutes.

Minutes of the last meeting were read and recorded as accurate.

Introductions around the table were made and we welcomed Caroline and Jodie from GOSH and Fiona and Angie from Oxford. We also welcomed Kate back from Maternity leave. We are now represented at 16 units in the UK. 6 units who specialise in Neonatal Surgery were identified as still no representation or contact so Rhiannon will re-invite them to be involved.

Scoring of Benchmarks:

Alternative Feeding (Sue but presented by Rhiannon)

Received from 5 units.

Benchmark
and Units
total score / A / B / C / D / E
1 (14) / A (14) / B (12) / A (14) / A (14) / B (13)
2 (6) / A (6) / A (6) / A (6) / A (6) / A (6)
3 (10) / A (10) / B (8) / A (10) / B (9) / A (10)
4 (12) / B (10) / B (10) / A (12) / B (10) / B (10)
5 (12) / B (10) / D (4) / B (9) / C (6) / B (9)

Common areas to develop:

1.  Developing guideline specifically continuous feeding.

2.  None

3.  Staff Education and recording staff competencies.

4.  Referral documentation

5.  Parental satisfaction survey/audit

Lingual and cultural needs

Pain (Rhiannon)

Received from 6 units.

Benchmark
and Units
total score / A / B / C / D / E / F
1 (8) / B (7) / B (7) / A (8) / B (7) / B (7) / B (6)
2 (18) / A (17) / A (18) / A (18) / B (16) / B (16)
3 (14) / B (13) / B (11) / A (14) / B (12) / B (13) / A (14)
4 (8) / A (8) / B (4) / B (4) / C (2) / B (5) / A (7)
5 (12) / C (6) / C (7) / B (9) / D (2) / B (8) / C (6)

Common areas to develop:

1.  Develop/ratify guidelines

2.  Documentation and record keeping

Swaddling/medication

3.  Educational resources

No CIVAS service

4.  Recording staff competencies

No database

5.  Parent information

Cultural and ethical needs

Parent access to information

Parental satisfaction audit

Gastrostomy

Benchmark
and Units
total score / A / B / C / D / E / F
1 (12) / C (6-8) / A (12) / B(9-11) / A (12) / C (7) / A (12)
2 (12) / A (12) / A (12) / A (12) / C (5) / C (8) / A (12)
3 (10) / C (5-6) / D (3-4) / C (5-6) / A (9) / D (3) / B (7-8)
4 (12) / B (9-11) / B (9-11) / A (12) / A (12) / B (11) / A (12)
5 (12) / C (8-10) / A (14) / B(11-13) / B (11) / D (7) / C (8-10)

Common areas to be developed:

Teaching pack for parents

Surgeons to review choose for catheters

Very few infants require long-term use of gastrostomy tube

Improve ongoing training

Update competency

Parent satisfaction

Information needed in different languages

Database to record staff training

Alison brought in information on a gastrostomy discharge pack from GB UK Enteral. www.gbukenteral.com 01757282945. If you buy their products you can get them free. (Pictures will be on website).

Updated benchmarks:

Rectal washouts

Stoma refeeding

Central Venous lines

All need new references.

To be scored and sent to feed-backers by end of July 2015.

Advancis Medical

Rep Suzanne gave us an excellent presentation on its products and the use of Manuka honey dressings. Lots of people took the information.

http://www.advancis.co.uk

They have a free elearning site http://www.advancis.co.uk/our-resources/elearning

on wound care. It is free to join and has sections on tissue viability and wound healing.

Bliss and Nottingham University hospital have been doing a study on the use of the honey and preterm skin – watch this space for an update.

Bernadette – presented a case example of the use of Manuka honey dressings on an exomphalus major and how they manage their babies. With excellent pictures.

Honey gel – honey gauze – gauze – crepe bandage.

Lots of discussion about how different units manage their babies, and when they get closed.

An area to be developed – it the use of a corset once healed and at home.

Discussions:

Medicina have microwavable bags to sterilise dummies/gastrostomy parts etc. http://www.medela.com/UK/en/breastfeeding/products/breastmilk-management/quick-clean-bag.html

Replogle Tubes:

Birmingham and Leeds have both been having issues with them since the company changed manufacturing method/design. The narrow suction end which connects to wall suction doesn’t fit well and the holes in the patient end are smaller. No-one else is having issues.

Remember to remind staff to watch saline flow through replogle and out of patient into suction tubing before walking away from patient. If it won’t flush and suction with saline flush with air!

Cassie found a new journal, which may of interest to us. “Journal of Neonatal surgery” Free to join.

BAPM dash board and the lack of surgical procedures included on it and how babies with surgical nursing needs are officially recorded as a SCBU baby. – to be talked about again at future meeting when more information/ideas are available.

Roterex vaccine and its use with surgical patients. Different units do different practice. Mostly all give it whether at correct part of vaccination schedule or on discharge.

In the news/articles:

·  1st Neonatal transplant (kidneys and Liver)

·  Bilious vomiting article with “what colour is bile”

·  RCPCH “Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a frame work for practice”.

Study days/days to note:

Bernadette – Nursing the surgical neonate clinical module at Staffordshire University. – information booklet given.

Yvonne and Gill are running a free stoma study day (twice a year) next one Friday 15th May at Chelsea and Westminster Hospital. Please email Gill for more information ()

Alison gave us advanced warning about the BAPS conference in Cardiff on 24th July. A day at end of the conference for nurses on Short Bowel Syndrome.

To do:

All: Please send Rhiannon any information/Guideline/care plans etc on stoma refeeding

Share wound care dressing posters/information

Please bring surgical feeding guidelines/protocols to next meeting to discuss differences.

Bernedatte – send out pre-operative broviac line care plan

Kate: Intranasal analgesia guideline (Sue thought she had one)

Rhiannon: Send out Pain assessment tool article from Manchester.

Invite Anne to present her Spinabifida pathway in London.

Invite reps from Proshield and Prontosan to London meeting.

Next Meeting: Friday 18th September 2015, St Thomas’s Hospital, London