KSS Paediatrics ST1 Induction Pack

KSS Paediatrics ST1 Induction Pack

Key Contacts

Genevieve Booth, Paediatrics ST2 KSS (genevieve.booth@nhs.net)

KSS Paediatrics Trainee Committee (heksstrainees@gmail.com)

Introduction

Each year the KSS Paediatrics Trainee Committee designs and organises the induction day for new ST1s entering the deanery. For the first time in 2017 we decided to accompany the face to face induction with a written guide for our new starting ST1s, with information on as many aspects of training as possible, and a particular emphasis on what to expect and what to accomplish in ST1 – a challenging time for many trainees, especially those with limited experience and confidence in paediatrics. We wanted the guide to be optimistic, fun and simple to navigate and understand. Each year the induction pack is updated and expands, and will hopefully become more than an induction pack and mould into a trainee led guidance document for paediatric trainees at all levels within KSS.

SMART Objectives

Chiefly our objective was to create a thorough guide to starting a career in paediatrics within KSS, that would adequately prepare and reassure new starting ST1s and serve as a future reference point for frequently asked questions. We wanted the guide to be flexible enough to update and expand in future with current working links to useful resources. We specifically wanted the guide to feel and sound as though it was coming from other trainees, and to be based on experience as well as dry facts. The guide would have to be readable, encouraging and humorous.

We were going to measure the guide’s success on the feedback we received, and whether there are still questions unanswered by it.

The project was always attainable as there are so many resources (both written, and in our colleagues’ experiences and wisdom) available to paediatric trainees; it’s just a matter of taking the time to put those resources together in one place and making them accessible.

Relevance to paediatric ST1s was always paramount, but we hope that as the induction pack evolves, it can be expanded to have relevance to all paediatric trainees within KSS, and that the information within it may form an integral part of our trainee led website (currently in development).

The clear deadline for the ST1 induction pack was in time for the ST1 induction – and the same is true of the updated version we are producing this year!

Progress

The 2017 Induction Pack was well received by those trainees who read it. We were given lots of informal positive feedback on its readability and the usefulness of the content. I’ve learnt such a lot about the structure of training and processes that occur within KSS school of paediatrics from putting it together, and that knowledge has helped me in my role within the committee when answering queries from trainees of all levels. It has also given us a great starting point for the content of the KSS paediatrics trainee website which is in development.

The main learning point is that we need to disseminate the induction pack more, and continue to share and make it accessible throughout the year. Otherwise it risks being lost amongst a dozen other documents handed out at induction. With the 2018 update we will be sharing on social media, and incorporating the information into a website which will hopefully reach a wider readership that can actively engage with its development. As expected, with another year of changes to the administration within the deanery we have plenty to update in the 2018 version; as well as brand new sections.

Take Home Message

Trainees can create valuable and flexible resources for one another that may be shorter, easier and more fun to read than official “top down” resources and documents. Creating resources for one another generates a sense of community and mentorship that is good for the morale of those disseminating the guidance as much as for those receiving it. With KSS deanery going through a very difficult transition period this year which has affected feedback, communication and administration; clear information that is easy to access is more important than ever for trainees.

Resources

RCPCH Website

KSS Paediatrics Trainees Website (in development)

KSS Paediatrics School Website

Postgraduate Training Gold Guide 2016

The collective experiences of the KSS Paediatrics Trainee Committee!

Stop the Seizure

Stop the Seizure

Key contact: Dr Audrey Soo (Paediatric registrar) audrey.soo@nhs.net


Introduction

What is Epilepsy? Epilepsy is the most common significant neurological disorder in children and young people, leading to a tendency to have epileptic seizure.1 More than one in 220 children under the age of 19 years old (approximately 63,400) in the UK have epilepsy.1

What is a seizure? Normally there is electrical activity happening in the brain all the time, sending messages to various parts of the body in a coordinated manner. When a seizure happens, there is a sudden burst of intense activity, causing a temporary disruption to the way the brain normally works.

What is status epilepticus? A proportion of children who have seizures present with or develop status epilepticus. Status epilepticus is a condition resulting from:

a) the failure of the mechanisms for seizure termination or

b) the initiation of mechanisms which lead to abnormally prolonged seizures2

The prolonged seizure can have long term consequences, including brain cell death, brain cell injury and alteration of brain networks, depending on the type and duration of seizures.2


SMART objectives

To reduce the seizure duration in children/young people presenting to A&E with status epilepticus

To ensure the right medications are given and interventions made at recommended time points during status epilepticus [as per the UK Resuscitation Council’s Advanced Paediatric Life Support (APLS) guidelines or as per the child’s individual epilepsy care plan]


Progress made: What have you learned from doing this?

Results: Data was compared between paediatric status epilepticus episodes at West Middlesex Hospital during time period July2016-June2017 versus July2017-April2018. We were able to achieve a 35 minutes reduction in average seizure duration in children presenting to A&E with status epilepticus (from 108 minutes to 78 minutes). There was also a reduction in time taken from hospital arrival to Step 2 (delivering 2nd benzodiazepine) and Step 3 (administering phenytoin or phenobarbitone) by 2 minutes and 21 minutes respectively. 

There were also other positive consequences which were not anticipated from this project. This include less emergency hospital attendances with status epilepticus, less children needing intubations for status epilepticus and more proportion of children with status epilepticus having had the first benzodiazepine dose administered by parent/carer at home.

Interventions:

  1. Designing and delivering regular multidisciplinary simulation scenarios incorporating status epilepticus into in situ simulation sessions [attended by nursing and medical teams (paediatric, emergency medicine, anaesthetics)]
  2. Ensure copies of latest APLS status epilepticus algorithms are available in paediatric A&E
  3. Working with paediatric secretarial team and neurophysiology teams to identify how they can be better supported in streamlining phone calls, requests and referrals
  4. Presenting data at trust clinical governance meeting and departmental teaching sessions
  5. Improving epilepsy care locally as a whole (as per NICE guidelines and Epilepsy12 Audit standards) through education and other smaller Quality Improvement projects
  6. (In progress) Submission of business case for paediatric epilepsy clinical nurse specialist

Lessions from project: Improvements are rarely the result of a single intervention or person/team. Every intervention has marginal gains leading to overall improvement and effect. Involve every member of the MDT who might be involved in a patient’s journey (remember secretaries, nurses, administrators, managers).


What’s your take home message?

Status epilepticus is a medical emergency that requires the concerted efforts of parents/carer and health professionals to deliver the right intervention at the right time. Multiple small interventions can lead to overall larger sustainable improvements in reducing episodes of prolonged seizure or duration of seizure.


Resources?

  • Epilepsy Action – What is Epilepsy? (link here)
  • Epilepsy Action – Treatment and care for seizures that last longer than 5 minutes (link here)
  • UK Resuscitation Council Advanced Paediatric Life Support algorithm for Status Epilepticus (see page 2 – link here)
  • American guidelines for Treatment of Convulsive Status Epilepticus  (link here)

References

  1. Royal College of Paediatrics and Child Health’s 2017 State of Child Health Report – Epilepsy subsection. Accessible from here 
  2. Trinka E, Cock H, et al. A definition and classification of status epilepticus of the ILAE task force on classification of status epilepticus. 2015. Epilepsiea, 56 (10): 1515-1523

Rabbit Remedy: the impact of having a pet rabbit on a paediatric inpatient unit

Rabbit Remedy: the impact of having a pet rabbit on a paediatric inpatient unit

Key contacts

Tami Benzaken, Rebekah Short, Sarah Crew, Joseph Machta, Kerry Robinson, Caroline Fertleman.

Introduction

An increasing evidence base has shown contact with animals to have positive health impacts on children, both physically and emotionally1-2. In particular, there is increasing research into the use of Animal Assisted Therapy as a therapeutic adjunct in a variety of healthcare settings3.

In October 2017 we introduced a very important new member to the general paediatrics team at the Whittington Hospital, Holly the rabbit. To our knowledge we are the only hospital inpatient department in London with a pet on site.

SMART objectives

  1. Encourage interaction between patients and Holly to help improve their experience in hospital (in both in the inpatient and outpatient setting).
  2. Facilitate staff interaction with Holly and her participation in staff meetings, to help improve inter-team working and boost morale.
  3. Review Holly’s impact on both patients, carers and staff through free text questionnaires and independent feedback.

Progress made: What have you learned from doing this?

Holly has been a wonderful addition to our team and our recent survey results are a testament to that. She lives in the play area of Ifor ward and is often visited by both our inpatients, outpatients, their families and staff.

Out of the total of 37 patients and parents who responded to the survey, the entire cohort responded positively regarding their experience with Holly and her impact on their stay. When exploring the feelings she evoked in patients, happiness (n=15) and calm (n=17) were reported in 86% of respondents. One 10-year-old inpatient reported that, ‘meeting the rabbit made me happy, when I go to hospital I’m always sad’.

A parent of one of our patients seen in the out-patient department describes their first experience of meeting Holly, ‘We were soothed and calmed by sitting outside and running our hands through her soft and fluffy fur as she sat contently on our laps. In a time of advanced medicine and complicated technology, I was moved by such a simple yet insightful way of caring for children (and their parents!).’

As part of our project we aimed to survey staff’s attitudes towards the introduction of a pet into a hospital environment, a novel concept for most of our staff. Out of the 19 staff surveyed, 15 cited a positive therapeutic response on patients. Other reported benefits included her calming effect on patients, her being a great distraction, boosting staff morale and improving team working. One member of staff summarises her experience of Holly, ‘Holly is the best thing that has happened to paediatrics in years. She has a positive effect on enhancing working relationships between nursing and medical staff’.

A few issues raised by staff included concern regarding infection control and caring for Holly. The introduction of Holly to Ifor ward has been approved by our infection control and microbiology team. At times looking after Holly has been challenging, especially during busy periods on the ward when there has been a lack of ownership over her care. We have have addressed these issues by discussing her care as part of our daily safety huddle to ensure she has been fed, watered and cleaned on a daily basis.

Finally, a theme that consistently emerged from both patient and staff questionnaire responses, was the effect Holly has had in improving experience for mental health patients admitted to the ward. Twenty percent of patients who responded identified a mental health complaint as their reason for admission (including depression, self harm and intentional drug overdose). They all cited Holly’s positive impact on their stay. One patient wrote that Holly made her stay, ‘more relaxed and happier to be in hospital’. Another staff member recounts one experience she had with Holly and a patient, ‘One time in particular Holly helped a mental health patient suffering from depression, low self esteem and lack of self-worth. She often said to the nursing staff, ‘why would anyone love me?’. Her mood changed remarkably when in the rabbit’s company… it was almost as if her depression left the room once the rabbit was there’.

What’s your take home message?

Introducing Holly to the ward has been shown to have beneficial effects on both patients and staff, as demonstrated by both our qualitative questionnaire as well as independent feedback. She has made patients’ stay more enjoyable, improved staff morale (especially important in a time of increasing stress levels reported amongst NHS staff4), and in particular has positively impacted the stay of patients admitted with mental health complaints.

We feel this project’s benefits could be replicated in other paediatric units to improve the care we provide and impact positively on patient experience of the healthcare system.

Resources?

  1. Vagnoli, L., Caprilli, S., Vernucci, C., Zagni, S., Mugnai, F., & Messeri, A. Can presence of a dog reduce pain and distress in children during venipuncture?. Pain Management Nursing, 16(2), 89-95.
  2. Lima, M., Silva, K., Amaral, I., Magalhães, A., & Sousa, L. 2014. Can you help when it hurts? Dogs as potential pain relief stimuli for children with profound intellectual and multiple disabilities. Pain Medicine, 15(11), 1983- 1986.
  3. Calcaterra et al. 2015. Post-operative benefits of animal-assisted therapy in pediatric surgery: a randomised study. PLoS One. 2015 Jun 3;10(6):e0125813.
  4. Rimmer. 2018. Staff stress levels reflect rising pressure on NHS, says NHS leaders. BMJ2018; 36

 

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