Conclusion Simply identifying the change of practice required is insufficient to ensure it happens. Changing practice is challenging and requires persistence. Factors that need to be considered are how to implement the change and then how to sustain the change. Junior doctors' rotations have a negative impact on this. We have demonstrated that through repeated audit cycles change can be initiated, but to be sustained it requires on-going input and encouragement.Aims To reduce the time taken from birth to administration of vitamin K in preterm infants (<35 wks) where the standard 1 mg dose cannot be safely administered. Methods PDSA cycles put in place as part of the wider Neo-Prem QI project running locally. Initial intervention involved including Vitamin K administration as part of a care-bundle for all preterm infants which did reduced the time from 90 min to 48 min. However there were still barriers to administration within delivery suite (which is the ideal setting for it to be given to minimise risks of doses being missed). We hypothesised that a gestational prescription would reduce time to administration if this could be safely implemented.Following this our lead pharmacist used the WHO weight charts for weight estimations per gestation and then compared this to 5 years of local hospital data on the weights of all babies born at varying gestations to ensure the WHO weight estimates were an accurate estimation of weights of babies locally. Using a combination of the two we then produced dose estimates by gestation and introduced a new prescription chart which allows prescription on either gestation or recent estimated fetal weight, with an aim for doses of vitamin K to be given in delivery suite prior to transfer to SCBU. We have publicised the new prescription charts to hopefully improve uptake. Results Initial PDSA implementation has reduced time to administration from 90 to 48 min. We have introduced the new prescription charts at the beginning of September 2018 and hope to see further improvement with these over the next few months. Initial results are promising with current time to administration around 30 min from delivery, but we need to monitor over time to see if this trend can be sustained or improved further.
Twenty-nine patients (55.7%) had sleep studies. 28.8% of the last sleep studies performed were normal, 13.4% showed mild OSA, 9.6% showed mixed disorder (OSA and Hypoventilation) and 3.8% had central events. Conclusion Aortopexy, as a curative treatment for tracheomalacia produced by tracheal compression, is effective and has low morbidity and mortality from a young age.
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