IntroductionIt is recognised that children and their resident carers sleep poorly in hospital wards. Qualitative research in a children’s hospital found that parents identify noise at night other patients or parents, noise from hospital equipment, and noise from staff as significant causes of poor sleep. Parents have reported that staff talk too loud overnight, affecting sleep.We believe parents on our children’s ward have a similar experience, and the group overseeing this work have noticed noise at night-time. We are therefore hoping to improve patient experience through improving sleep at night by decreasing unnecessary noise.MethodsWe are making changes to decrease noise at night, primarily by educating staff on the importance of keeping the ward quiet overnight. We have started displaying posters with the slogan ‘no speaking, children sleeping’ requesting staff to be quiet after 8 pm. This has recently been changed to 9 pm to accommodate the timing of nursing bedside handover. We will be making further efforts to educate staff about noise at night, including creating a ward display board, and to inform parents about our work.We have conducted a short survey of parents to ask their feedback on sleep and noise. We intend to repeat the survey at intervals to evaluate the effect of our changes, taking a plan-do-studyact approach.ResultsOf 8 parents, 3 reported their child had poor or very poor sleep the night before completion of the survey. 4 felt there was unnecessary noise, and parents reported beeping machines, doors, and staff talking as contributing factors to the noise levels. Results from repeat surveys will be presented.The Friends and Family Survey results also guide our work. Our ward has over 95% positive feedback in the Friends and Family Survey, but noise at night is one of the main negatives. Discussion Noise at night is an important contributor to sleep quantity and quality of children and their resident carers on the paediatric ward. Effecting changes in noise is difficult as some of the noise is clinically necessary, and because of staff’s reluctance to change their behaviour. We hypothesise that we will overcome this with further staff education on sleep.
Median age (range) at start of treatment was 14.8 yrs (9.7,18.0) and this remained unchanged during 2011-2018 (p=0.543). GnRHa was discontinued in 5/65 (8%) YP [1 (2%) birth-assigned female, 4 (19%) birthassigned males, p=0.018] after a median (range) duration of 0.8 yrs (0.5,1.5). Twenty-two YP started gender-affirming hormones (17 birth-assigned females, 5 birth-assigned males). Median age (range) at start was 16.21 yrs (16.04,17.13). In one YP, this was discontinued, after a period of 0.33 yrs. Overall, 3/74 (4%) YP (1 birth-assigned female, 2 birth-assigned males) were no longer experiencing gender dysphoria during the period of attending paediatric endocrinology and discontinued treatment. Conclusion There has been a marked increase from 2016 onward in prevalence of YP with GD referred to paediatric endocrinology, requiring an evolution in the structure of a whole service. Pursuit of fertility preservation has been poor and requires closer consideration.
ContextA multidisciplinary Diabetes Education Afternoon was held at a Hospital School for children with diabetes aged 10–12 yrs. The team included the deputy head teacher, play therapists, diabetes team (consultants, dietician) and a junior paediatric trainee.ProblemThe National Diabetes Service Improvement Delivery Plan 2013–2018 highlighted that there was need and desire by patients, families and practitioners for self-directed management through structured patient education programmes.In particular the transition from primary to secondary school is an especially difficult change where they undergo significant biopyschosocial changes and are expected to understand and self-manage greater aspects of their diabetes.Assessment of problem and analysis of its causesIn a meeting with the diabetes team we found that whilst we deliver education through annual review clinics and one-to-one sessions, there is no formal social educational programme. There are 12 children between 8–12 yrs with diabetes looked after by the team. Subsequently we approached the School and play therapists to discuss the issue and design a joint educational afternoon.Intervention4 stations, each lasting 20 mins: Apps and other resources: Uploaded on an iPad. Used to make insulin calculations. Know your carbs: Using food models to divide food into carbohydrates and non-carbohydrates. Conquering Labels: Interpreting nutritional labels on food. Food Kitchen: Measuring and estimating carbohydrate foodstuffs. 5 mins presentation from Diabetes UK. (Figure 1)Abstract G532 Figure 1Study designqualitativeStrategy for changeUsing the Model for Improvement, the first PDSA cycle tested the training with children at the school. We then adapted it in response to the feedback from participants. A revised lesson plan was made and used in our second cycle. We invited 6 patients with diabetes, aged between 10–11 years, and their families on an afternoon during school holidays. The whole multidiscipplinary team was involved on the day.Measurement of improvementThe children and their parents filled in pre- and post- session feedback forms. These were followed by telephone interviews a week later.Effects of changesThere was measurable improvement in the children’s confidence and knowledge of their own insulin: carbohydrate, identifying and measuring carbohydrates as well as calculating their insulin requirements (INSERT Graph). Interviews a week later revealed that more children were self-managing their insulin calculations.Parents felt that the session was empowering for themselves and their children. All highlighted they liked the opportunity to meet other families with children with diabetes and that it was beneficial for the siblings (INSERT Diagram).We are now in discussion with our colleagues leading diabetes services in the region with a view to organise regular education training events in the local community.The main challenges encountered were the session running over time and that parents felt they would like more time for interaction with eachother.Lesso...
recommendations for treating hypoglycaemic episodes with 0.3 g/kg of fast acting carbohydrates. Aim The aim of this audit was to evaluate patients' management of hypoglycaemia in accordance to BSPED guidance and to assess the impact of standardising advice on patient management and patients' HbA1c. Patient population The target population was children and young people managed for Type 1 diabetes mellitus in the NHS trust. Method Between January and March 2018, patients' management of hypoglycaemia was reviewed with a questionnaire when they attended a multidisciplinary clinic. They were educated and given a patient leaflet including an individualised plan in line with BSPED guidance. Their management of hypoglycaemic episodes was subsequently re-evaluated at future clinic appointments. Results Of the 121 patients initially assessed, 83% used the correct threshold of blood glucose <4 mmol/L to treat hypoglycaemia and 34% managed hypoglycaemic episodes appropriately. After education in clinic and the provision of a patient leaflet this improved to 90% of patients using the correct threshold. For the 52 patients who were assessed pre and post education, initially 23% had appropriate management of hypoglycaemic episodes and this improved to 60%. Over the audit period the average HbA1c dropped from 66.6 to 64.7 mmol/ mol on one site and 70 to 66 mmol/mol on the other. Conclusion This audit shows that verbal and written education on management of hypoglycaemic episodes in paediatric patients with T1DM is effective in improving the diagnosis and treatment of hypoglycaemic episodes and therefore can enhance patient care.
AimsOur aim is to improve communication with patients and parents on our general paediatric ward. We have a large multidisciplinary team who have frequent patient contact. Plans on ward rounds are discussed by the medical team and quickly communicated to the family. However, there is often no reference point for this family and young person to refer back to later. The focus of the work involved capturing these interactions and communicating the daily plan for each individual clearly.MethodUsing the model for improvement we tested out the use of bedside whiteboards to record daily plans. Small whiteboards above each bed existed to record ‘patient name, consultant, nurse, allergies’ but were seldom used. Our play specialists laminated decorated card to fix to the boards. A dry marker was used to summarise the daily plan from the medical ward round and encourage conversation with nurses and patients/parents to clarify or review this plan. Posters show a picture of the whiteboards, explaining their and encouraging both families and staff to use them, promoted with the slogan, 'BETTER COMMUNICATION BETTER CARE'.ResultsPatients/parents on the first PDSA cycle (week 1) said they found the board empowering but wanted space to record their feelings and visiting times. We laminated larger card and spread for PDSA cycle 2 but the nursing staff were concerned about confidentiality on the open ward. We asked the parents and they didn't agree since only the information discussed with them is recorded (i.e. they can determine what is written). One consultant, although at first sceptical, noticed it helped organise a busy ward.Feedback forms, given out to patients and staff, filled in anonymously and posted into our ward feedback box, showed:75% of patients found the boards helpful (agreed/strongly agreed)25% were neutral. Reasons: they already felt they had good face to face communication with staff.Comments included: 'Helps a lot to know plan for the day', 'Both me and my husband know what is happening', 'The staff know the families plan', 'Everyone is on the same page', 'know how long we gonna be here'The rest of our department have become interested in our white boards and our Special Care Baby Unit has asked if we will help them implement it.ConclusionThis system helps make the patients experience a more positive one. When rolling out this type of project it is important to have all multi-disciplines engaged and appoint champions to promote it.
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