Shared Learning Awards 2020 runner up - Bronchiolitis: when less is more

The Maynard Sinclair children's ward at Ulster Hospital wanted to ensure that care provided to babies with bronchiolitis was always evidence-based.

They wanted to reduce unnecessary distress caused to children and their families by limiting inappropriate interventions or admission to hospital.

Introducing the NICE guidelines on bronchiolitis within our department as part of a SQE project has been both interesting and rewarding. As part of a multidisciplinary approach, it was an effective and enjoyable way of engaging staff in implementing the guidelines and ultimately providing a better standard of care for our patients.

Working as a team and learning the roles of others, helped ensure that the guidelines were introduced across multiple departments simultaneously, ensuring all patients receive the same care no matter what department they attend. 

Alison Smyth, deputy sister, Maynard Sinclair Ward.

Contact
Joanne McClune
ward sister
Maynard Sinclair Ward, Ulster Hospital, South Eastern Health and Social Care Trust Northern Ireland
email: joanne.mcclune@setrust.hscni.net

What was done and why

Bronchiolitis has a big impact on acute paediatric services across the South Eastern Health and Social Care Trust Northern Ireland during the winter months. The trust found that more babies were being admitted and staying longer in hospital. Often having to be weaned off oxygen at the end of their stay.

Recommendations from our guideline on bronchiolitis in children were looked at to improve the overall efficiency of their service and delivery of care for babies.

The team aimed for:

  • An increase in staff adherence to the guideline by 50% by March 2019.
  • A decrease in unnecessary interventions on infants under 1 year old with bronchiolitis by 50% by March 2019.

Three clinical areas were targeted: the emergency department, children’s short stay unit and the children’s medical ward. A team was put together, covering different levels of experience from each of the clinical areas.

They used the guidance to determine better admission criteria and what red flag advice to give to parents. This would allow for more babies to be cared for at home.

They also put together 7 PDSA (plan, do, study, act) cycles for staff which promoted the guideline around the clinical areas.

Outcomes and impact

All the team’s aims were achieved and exceeded. By January 2019, all unnecessary clinical interventions on babies with bronchiolitis had stopped. This was achieved by applying the recommendations in the guideline.

One key benefit of using the recommendations was increased bed availability. Improving patient flow by spending less nursing time on unnecessary interventions which also led to cost savings.

This meant: 

  • The percentage of babies admitted to the inpatient ward decreased from 43.8% to 32%.
  • There were 43 fewer babies admitted in winter 2018 to19 leading to a financial saving of over £70,000.
  • A decrease in unnecessary interventions creating further financial savings.

Within the inpatient ward, regular teaching sessions are provided for nursing and medical students as well as new staff nurses. Feedback from parent service users has helped to co-produce a new bronchiolitis leaflet.

What was learnt

The team at the trust developed and used a quality improvement method to make positive changes in their practice and for their patients. This has been important in helping to make changes in a consistent and sustainable way.

During the implementation of the new way of working the bronchiolitis season started and peaked quickly. This resulted in the team having to consistently reinforce the new guidelines in a variety of ways.

Having nursing and medical staff on the project team with different roles and levels of experience really helped share information effectively.

See the full example