Background Delayed treatment of hypoglycaemia can result in neurological sequelae, and death in babies. Over a decade, 79 claims have resulted in payouts of £300,000 to £7million.1 In July 2012 11% of at risk babies (tertiary neonatal centre) missed out on sugar monitoring, 32% had it done incorrectly and 4 neonates had low sugars untreated for unacceptable durations. Familiarity of medical, midwifery, and nursing staff regarding 4 pertinent areas of management was very poor.
Intervention A programme based on Deming’s cycle (Plan-Do-Check-Act) was developed using point of care posters and nurse champions to cascade education to over 200 multidisciplinary staff (Doctors, Midwives, Nurses and SCHA’s) using an innovative acronym and logo. The RHINO Project involved nursery nurses championing Referral of Hypoglycaemia detected In Newborn Observations. The focus was recognition of symptoms, prompt referral and intervention.
Results Prospective audit at 1, and 4 months after implementation reveals 100% compliance in blood sugar monitoring, and review of neonates at risk of hypoglycaemia. Improvements in documentation (89% to 100%), skin to skin care (86% to 100%) and early feeding of at risk neonates (89% to 100%) have been seen. In the first 6 months after implementation 12/13 (92%) of neonates admitted with hypoglycaemia to the neonatal unit complied with the guidance of early review and intervention.
Conclusion The RHINO Project highlights how a simple cost-effective reproducible innovative campaign with a human touch can result in improvements in quality of care and service delivery for an area of high medico legal risk and litigation.
NHS Litigation Authority sets aside £235.4m to settle 60 cases in which hospital staff failed to spot hypoglycaemia in newborns’, Guardian, 9 April 2012 http://www.guardian.co.uk/society/2012/apr/09/nhs-blunders-babiesbrain-damage accessed 28th August 2013
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