Mid North Coast - Children's Emergency Care Program - North Coast, Kempsey and Manning Base
This project was arranged to implement the Paediatric Clinical Guideline of Asthma and other guidelines by:
- Setting up the ED to have the pathways/guidelines positioned so that the Triage Nurse/Medical Staff readily use them and incorporate them into patient notes.
- Providing education sessions to ED MOs and RNs on a small group basis.
- Attending audits and other duties associated with pilot sites of the CEC Children's Emergency Care Program.
It has been progressed in the following ways:
- Setting up a "box" called Asthma Paediatric Guidelines, where pathways/patient handouts etc are kept in a prominent work area.
- Subscription to listserv "kidsmerg" to share information with other pilot sites. This site was used to look at all the Asthma Pathways already developed.
- A one-day workshop was attended in Sydney in October 2004. This was also attended by members of working groups for the pilot from both Metro and Rural NSW.
Kempsey
- Purchased Perspex mounted document holders for Triage Room.
- Developed flowcharts for Asthma, Gastro, Recognition of Sick Child, Bronchiolitis and Head Injury.
- Education evening "Launching Night" for implementation of guidelines. Extremely successful with 35 health professionals (GPs, Ambulance RNs, ENs and ED Doctors) attending.
- Presented the CPGs to the Kempsey District Hospital Medical Staff Council meeting, for discussion and suggestions for improvement.
- Regular inservice to new staff to the ED
Coffs Harbour
- Presented CPGs to the Bellingen Medical Council meeting and ran an ED staff inservice
- Inservice to CNE and ED staff at Macksville Hospital
Manning Base
- Six guidelines introduced into MBH (Croup, Asthma, Gastro, Bronchiolitis, Fever and Recognition of The Sick Child)
- Pathways developed and localised in consultation with key stakeholders consisting of a medical and nursing team
- Multiple copies of pathways placed in shelves in triage to be included in patient's notes.
- Inservice to ED Medical and Nursing staff on development and use of pathways and guidelines.
- Inservice to new RMOs at orientation
- Presentation at Paediatric Grand Rounds
- Auditing the effectiveness and compliance of the Guidelines
- Networking with other project officers and hospitals, sharing ideas and information
Discussion
- It has been highlighted that the Asthma pathways have not been successful in their implementation at Kempsey District Hospital (KDH). This is due to a lack of education to RNs and MOs in the use of the pathways.
- For the pathways to be utilised and included into patient notes, it is vital that they are kept in an area that is easily accessed by the Triage Nurse.
- The workshop highlighted that KDH is not alone in their endeavour to successfully implement pathways. Many other sites are having difficulties too.
- An added problem that KDH has is that it does not have a Medical Director of ED. This creates a problem in the education and continuity of monitoring of ED Medical Officers.
- Consultation has occurred with ED Nursing Staff as to the best approach to displaying the pathways.
- The triage tool for the sick child has been implemented but currently on being reviewed due to some interpretation issues
- Barriers such as staff reluctance to change and perceived extra work load have been overcome through education and input from staff members
- Consistency of care for patients presenting with CPG illnesses has been achieved
- Awareness has been gained of guidelines and their use by all ED staff from junior to senior
- Medical and Nursing staff are more confident in the treatment of children
- Compliance remains an issue, often due to staff turnover, as some staff are not aware of CPGs
- Some people are reluctant to use more guidelines
- Good outcomes have been achieved through acknowledgment of staff input and positive team collaboration
- Most staff are accepting of CPGs and are implementing them appropriately if they are educated effectively in their positive use