What is DDH?
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Multimedia Health Education Can It Change Clinical Practice? Assoc Prof Leo Donnan Director of Orthopaedics Chief of Surgery RCH
description
Multimedia Health Education Can It Change Clinical Practice? Assoc Prof Leo Donnan Director of Orthopaedics Chief of Surgery RCH. What is DDH?. A condition of the childs hip where there is incomplete development Range of disorders including - instability, subluxation and dislocation. - PowerPoint PPT Presentation
Transcript of What is DDH?
Multimedia Health Education Can It Change Clinical Practice?
Assoc Prof Leo DonnanDirector of OrthopaedicsChief of Surgery RCH
What is DDH?
■ A condition of the childs hip where there is incomplete development
■ Range of disorders including - instability, subluxation and dislocation
■ If unstable hips are not detected and treated they may
- not develop properly and eventually fail
The Impetus to do something
■ In Victoria children are still presenting with a late diagnosis of hip dislocation despite screening programs and use of ultrasound
■ Children facing lifelong disability from a condition that is easily managed if detected early
Victorian Screening Program
■ 72,000 births per year
■ Geographically Spread 4.0 million in Melbourne 2.0 million in the “bush”
■ Clinical examination at birth six weeks regular intervals up to age two
■ Ultrasound abnormal clinical findings risk factors at six weeks
The Problem
■ Poor documentation
■ No uniform standard of examination
■ Inconsistency in terminology
■ Increased reliance on imaging
■ Unclear referral mechanisms
■ Multiple examiners
The Scale of things
■ 72,000 births per year■ Expect
72 frank dislocations 720 unstable hips ???? dysplastic hips
■ 1012 MCH nurses in full/part time positions large work force dispersed will see very low rates of dislocation hrad to maintain skills
The Solution ?
■ Target the front line clinicians
■ Understand their difficulties
■ Define the barriers to early detection
■ Develop evidence based practice guidelines
■ Standardise the clinical examination
■ Apply education theory principles
Objectives
■ Knowledge - terminology, anatomy, pathology, associations, risk factors, examination, imaging
■ Change practice - improve clinical skills, confidence and referral procedures
■ Standardise approach - consistency across all health professionals
Learning Ability
■ Education level■ Cultural background■ Social class■ Literacy skills■ Trust in the information■ Emotional state
info
rmat
ion
flow
Challenge
SkillLow High
High
ANXIETY
BOREDOM
■ Visual■ Auditory■ Written■ Kinesthetic
Learning Types
Words
Pictures
SoundSound
Developing the Module
■ Focus groups■ Literature review■ Educational objectives■ Outcome measures■ Script development■ Story board■ Animation■ Testing
Testing the Module
■ Maternal and Child Health Nurses■ Range of municipalities■ 203 recruited
Information easy to understand
Recommend the use of the module
Module met educational needs
Knowledge
P< 0.001
P< 0.001
Confidence
p < 0.001
Change in Clinical Practice
Desired Change
Pre Three Months
Two Years
How frequently do you examine for DDH? (n=164)
99% 100% 100%
How often do you perform the examination from the side of the infant? (n=164)
34% 23%
>0.05
21%
>0.01
Do you refer all infants with “clicks” in isolation for further assessment? (n=162)
88% 46%
>0.001
34%
>0.001
Do you fully unclothe infants to examine their hips? (n=162)
99% 91%
>0.001
90%
0.003
Desired Change
Pre Three Months
Two Years
Desired Change
Pre Three Months
Two Years
Hip creases are the most important physical feature of DDH (n=164)
42% 24%
>0.01
19%
>0.01
In a relaxed baby it is important to push firmly in testing for hip instability (n=162)
43% 60%
>0.01
46%
0.77
The relationship between delayed motor development and untreated DDH is very strong (n=161)
57% 60%
0.5
58%
0.5
Desired Change
Pre Three Months
Two Years
What now?
■ Increase accessibility of module online resource roll out to other clinical groups
general practitionersmidwivespaediatricians
■ Update the module response to feedback
■ Watch for changes swaddling module developed
Swaddling
■ Recent trend for settling babies■ What’s old is new again!!
■ High risk for DDH if not practiced safely
■ Navaho Indians
Has it made a difference?
MOR at RCH (year to
date)
Summary
■ This initiative is aimed at improving the health and well being of children by facilitating early diagnosis and referral of DDH
■ The module significantly improves the clinicians knowledge, skills and confidence in making the diagnosis
■ Aim to ultimately reduce the need for complex surgery due to late diagnosis
Take Home
■ Refresh your knowledge■ Update your skills■ Use the resources
