The Birth of CEBIS Within Neonatal Care: a Case

Study

Aislinn ConwayClinical Evidence Based Information Service Specialist13th of June, 2011

• Conception

• Labour

• Birth

• Development

Conception

• Jacqui Cox, Clinical Librarian UHCW

2004

• Ophthalmology, Diabetes and Endocrinology and Neonates

• Development and implementation of Evidence in Practice Groups

• Critical Appraisal training

• Business case, 2005 - 2009

• CEBIS, 2010

Conception – triplets!

CEBIS Specialists Division/Specialties

Anna Brown Diagnostic & Services

Mandeep Heer (Aulakh) Medicine• Diabetes &Endocrinology• Gastroenterology• ED• Infectious Diseases

Aislinn Conway Women and Childrens• Neonatology• Paediatrics• Obs & Gynae• CRM

Labour: Stages of the CEBIS Model

Handover or grand / ward round

Scoping search/evidence

summary feedback

Ppt PresentationPpt presentation and discussion

Further action planned / decision to maintain

or change current practice

Actions completed and reviewed

Birth – the Breakthrough Moment

1. Background - SHO/Reg

2. Case History - SHO/Reg

3. Evidence - CEBIS

4. Management - SHO/Reg

5. Discussion - Consultants, ANNP’s, Medical Students, SHOs, Regs, Pathology, Dietitian etc.

Example: Managment and Treatment of Neonatal Gastro-oesophageal Reflux

(GOR)

• Uncomplicated GOR resolves in 90% of infants

• Complications – Gastro-oesophageal Reflux Disease

Difficulties of Diagnosis of GOR

SHO

Investigate if a link exists between other apparent life threatening events (ALTEs) to aid diagnosis

In the vast majority of infants, reflux is not related to pathologic apnea or to apparent life-threatening events,

lthough a clear temporal relationship in individual infants

Positioning

• ANNP

• A systematic review identified an area where practice could change: prone and left lateral lying decreases GOR symptoms

• Risk of Sudden Infant Death Syndrome (SIDS)?

• Safe in preterm infants in hospital receiving cardiorespiratory monitoring

Survey of Practice

• 2 x ANNP’s

• 2009

• Preterm infants >30 wks GA excluded

• £4229 spent on medication, feed thickeners and nurse staffing

• Staff noted prescribing of GOR meds decreased recently

• Approx. 122.6 hrs of nursing time may be designated to other tasks

Putting Evidence into Practice

UHCW Clinical Guideline: Management and Treatment of Gastro-Oesophageal Reflux (GOR) in Neonates

Guideline to promote evidence-based management and treatment of neonates who have presented with symptoms/signs consistent with gastro-oesophageal reflux

Future research: diagnostic tools - pH monitoring and multichannel intralumial impedance

University Hospitals Coventry and Warwickshire NHS Trust Neonatal Department

Management and Treatment of Gastro-oesophageal Reflux in Neonates

Development: keeping it alive and well to encourage growth

NATURE:

CEBIS System – currently at testing stage providing

• a platform on which to submit queries direct from EPR

• Direct link from patient record to CEBIS record on patient case

• A working tool for CEBIS Specialists to coordinate and communicate with clinical teams involved in EPG work

• Direct linkouts to PubMed for search updates

• Complete documentation of all work generated per query including audit trail and outcome measures

• Searchable interface as a standalone system on Intranet

Development: keeping it alive and well to encourage growth

• NURTURE– Know your organisation and seek opportunities in change

– Know your product, be loyal to it and seek to sell it well

– Know your teams, understand their environment and become one of them.

– Know yourself – no baby became an adult in one day!

Thank You!

Contact details:

• Email: aislinn.conway@uhcw.nhs.uk

• Phone: 02476968816

References• Vandenplas, Y et al. Pediatric Gastroesophageal Reflux Practice Guidelines: Joint Recommendations of the North

American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nurtrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009; 49(4):498-547.

• Fox G, Hoque N, Watts T. Oxford Handbook of Neonatology. Oxford: Oxford Medical Publications; 2010.

• Birch JL, Newell SJ. Gastrooesophageal reflux disease in preterm infants: current management and diagnostic dilemmas. Arch Dis Child Fetal Neonatal Ed. 2009; 94: F379-383.

• Guillet R et al. Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants. Pediatrics. 2006; 117:e137-e142.

• British National Formulary for Children [Internet]. London: 2011 [cited 2011, May 23]. Available from: http://bnfc.org/bnfc/bnfc/2010/100063.htm?q=gastro%20oesophageal%20reflux&t=search&ss=text&p=2#_hit

• Hammer D. Gastroesophageal Reflux and Prokinetic Agents. Neonatal Network. 2005; 24(2): 51-58.

References contd.• American Academy Of Pediatrics Policy Statement: Task Force on Sudden Infant Death Syndrome. The Changing

Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics. 2005:116(5); 1245-1255.

• UpToDate Topic: Gastroesophageal reflux in infants. [Internet]. Masachusetts: 2011 [cited 2011, March 9]. Available from http://www.uptodate.com/index

• Dynamed Topic: Gastroesophageal reflux disease (GERD) in infants. [Internet]. Masachusetts: 2011 [cited 2011, March 9]. Available from: http://www.ebscohost.com/dynamed/default.php

• Clinical Review Drug and Therapeutics Bulletin: Managing gastro-oesohageal reflux in infants. BMJ. 2010:341;495-498.

• Huang RC, Forbes D, Davies MW. Feed thickener for newborn infants with gastro-oesophageal reflux. Cochrane Database of Systematic Reviews. 2002, Issue 3. Art. No. CD003211. Available from: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003211/pdf_fs.html