Improving HEADSSS screening of adolescents using a novel multidisciplinary teaching program

Improving HEADSSS screening of adolescents using a novel multidisciplinary teaching program

Key contacts

Dr Katherine Malbon (Paediatric Consultant, Imperial Healthcare NHS Trust)

Dr Kate Sullivan (Paediatric Registrar, Imperial Healthcare NHS Trust)

Dr Harsh Samarendra (Paediatric SHO, Imperial Healthcare NHS Trust)

Introduction

In 2016, The Lancet Commission declared that there is a “triple benefit” to be gained from investment in adolescent health, as improvement is seen in their current health and wellbeing, and extends into adulthood, which benefits the next generation (Patton et al, 2016). During adolescence, significant changes in biological and psychosocial development occur concurrent with increased morbidity related to risk-taking behaviour and psychosocial distress (Currie et al, 2009). These issues are amenable to prevention efforts; longitudinal studies suggest that identifying psychosocial issues and referring appropriately has a positive impact on adolescent wellbeing (Walker et al 2002; Ozer et al 2005).

Research suggests that it is difficult for adolescents to access healthcare that adequately addresses their psychosocial needs; and they may resist discussing these sensitive issues unless they are asked directly and confidentially (Sanci et al, 2005). Early identification of concerns enables health professionals to deliver education and implement timely and appropriate interventions, and reduce the associated harm (Patton et al, 2016). Psychosocial screening tools such as HEADSSS, an acronym detailing aspects of an adolescent’s life to be explored through a series of screening questions, are one method of enabling this (Smith & McGuinness, 2017).

Despite the importance of HEADSSS screening, a recent audit we conducted demonstrated room for improvement in this practice. Approximately 5000 young people aged 13 to 20 years present annually to St Mary’s Hospital Emergency Department (Sullivan, Samarendra & Malbon, 2019). Of these, 12% attend following drug use, alcohol intoxication, self-harm or assault; yet recent quantitative audit data reveals low rates of adolescent psychosocial screening (Sullivan, Samarendra & Malbon, 2019). A qualitative study exploring barriers and perceptions of HEADSSS amongst Imperial staff revealed lack of knowledge around HEADSSS screening as a significant barrier. We sought to address this barrier by designing and conducting a multidisciplinary adolescent health teaching program, including a multidisciplinary sequential simulation afternoon in conjunction Imperial College patient Experience Hub.

SMART objectives

We delivered a weekly Adolescent Health teaching program over a 4 week period during March 2019, targeting Paediatric and Adult Emergency staff, paediatric doctors, nurses and allied health staff. The teaching program culminated in a 3 hour multidisciplinary sequential simulation afternoon in which staff put these skills into practice. To assess the success of the program, we collected feedback from participants and are in the process of re-auditing rates of HEADSSS screening in St Mary’s Emergency Department.

Progress made: What have you learned from doing this?

Lack of knowledge is one important barrier affecting HEADSSS screening and warrants targeted teaching programs to specifically address this problem. The multidisciplinary teaching sessions received excellent feedback from staff and are a promising way to increase knowledge and culture change around adolescent health and HEADSSS screening. However, knowledge is not the only barrier to conducting HEADSSS screening, and the impact of our teaching program on HEADSSS screening rates remains to be seen.

What’s your take home message?

Risk assessment using a psychosocial screening tool is an essential part of developmentally appropriate holistic care for young people and should be the responsibility of all patient facing healthcare professionals. 

Resources

Currie, C., Zanotti, C., Morgan, A., Currie, D., De Looze, M., Roberts, C., … & Barnekow, V. (2009). Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the, 2010, 271.

Ozer, E. M., Adams, S. H., Lustig, J. L., Gee, S., Garber, A. K., Gardner, L. R., … & Irwin, C. E. (2005). Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention. Pediatrics, 115(4), 960-968.

Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., … & Kakuma, R. (2016). Our future: a Lancet commission on adolescent health and wellbeing. The Lancet, 387(10036), 2423-2478.

Sanci, L. A., Sawyer, S. M., Kang, M. S., Haller, D. M., & Patten, G. C. (2005). Confidential health care for adolescents: reconciling clinical evidence with family values. Medical journal of Australia, 183(8), 410.

Smith, G. L., & McGuinness, T. M. (2017). Adolescent Psychosocial Assessment: The HEEADSSS. Journal of psychosocial nursing and mental health services, 55(5), 24-27.

Sullivan, K., Samarendra, H., & Malbon, K. (2019). Adolescent Psychosocial History using HEADSSS in a tertiary paediatric emergency department. Manuscript submitted for publication, Imperial NHS Healthcare Trust, London.

Walker, Z., Townsend, J., Oakley, L., Donovan, C., Smith, H., Hurst, Z., … & Marshall, S. (2002). Health promotion for adolescents in primary care: randomised controlled trial. bmj, 325(7363), 524.

T4: Time Taken To Treat

T4: Time Taken To Treat

Key contacts

Dr Benjamin Carter, ST3 Paediatrics, Brighton General Hospital

Dr Dannika Buckley-Denton, ST3 Paediatrics, Worthing General Hospital

Dr Rob Bomont, Consultant Neonatalogist, Trevor Mann Baby Unit

Introduction

NICE guidance for the treatment of presumed or proven early neonatal sepsis stipulates that antibiotic therapy should be commenced within 1 hour of decision to treat. Around the time of delivery it is generally well recognised that there are difficulties in initiating antibiotics when necessary and in a timely manner due to the other demands on the professionals involved. It was felt likely that at the Trevor Mann Baby Unit in Brighton (a tertiary care centre), that missing the NICE mandated target was commonplace. This project was aimed at identifying the timeframes of treatment, where the rate limiting steps lie and then formulating solutions to optimise the care and ensure the standards are better met.

SMART objectives

 S: To identify

  • Average time taken to administer empirical antibiotic therapy for early neonatal sepsis
  • Individual times taken for key steps in patient journey to antibiotic administration
  • Differences between care categories for babies, specifically when the decision to treat is in the immediate post natal period on the postnatal wards, after this period, or when babies are admitted to the neonatal unit.
  • What improvements can be made to the execution of rate limiting steps

M: All times will be logged through auditing and will give clear indication of total timeframes

A: The project has been planned out for each unit and staff made aware of the audit process. No significant barriers to data collection are anticipated

R: NICE guidelines are set with realistic goals in mind, there is no reason that improvements should not be able to be made to optimise care and bring it to the expected standard

T: The data will be collected over at least a 1 month period or at least until a set of at least 30 patients have been identified

Progress made: What have you learned from doing this?

 The initial data shows:

Less than 50% of all patient care groups had antibiotics administered within 1 hour of decision to treat

The average time to administration was 121 mins for decisions within 1hr of birth, 76 mins for decisions after 1hr from birth and 77 mins for babies admitted to the neonatal unit

When the decision to treat was within 1 hour of birth the longest delays were noted in the times taken to generate hospital numbers for the babies – without which antibiotics can not be given (according to hospital policy)

For the post 1hr and NNU groups, the time taken from cannulation to administration appeared to be the rate limiting step – indicating that different approaches are required to improved compliance with NICE guidance in different patient groups.

However this also indicates that there is scope to improve the timing for all steps of the administration pathway – as there is significant ‘knock on effect’ – performing tasks in parallel (similar to methods suggested as part of ARNI course training) may help this.

Effective communication between care teams (doctors, nurses, midwifery) is likely to improve delays by way of making sure the team are aware of tasks that need doing in a prompt fashion. This can be achieved both through new policy and guidelines, but also through maintaining positive teamworking skills.

Work is ongoing to implement new practices to aim to improve timings and then reaudit the data to monitor for progress

NeoMate Smartphone App

NeoMate Smartphone App

Key people involved in the project

Organisation: London NTS

Christopher Kelly, Syed Mohinuddin

Motivation

The idea came about after a difficult neonatal resuscitation situation in my first paediatric ST1 job, where I became somewhat overwhelmed and couldn’t think clearly. I wanted to avoid this happening in the future, both for me and for others, and so NeoMate was born.

Plan

Specific: to create a smartphone app to help with common calculations, concise reference information and easy-to-follow checklists for common emergency situations.

Measurable: to create an accurate and safe app, launch it onto the app stores, and for people to enjoy using it.

Attainable: free time was the main constraint on this project!

Relevant: the NeoMate project was very relevant to everything in my paediatric job.

Time bound: I wanted this to be ready as soon as possible, for me to use in my job – i.e. within a few months. 

Progress since introducing the idea

The app is released on iPhone and Android, and has been downloaded over 60,000 times.

What we have learned

I’ve learned that even simple apps take a huge amount of time to create, and to maintain. Apps that involve crucial calculations need to be 100% correct – the amount of effort required to ensure this is much greater than you would ever initially imagine.

Take home message

Despite the hurdles, the project has been a huge amount of fun and very satifying. If nothing else, NeoMate has certainly made me safer at work in a stressful situation.

Contacts and Links

http://www.neomate.org