1. Neonatal Audit Day 7 th October 2015 Marita Fernandez – B7 Neonatal Unit RGH

2. Service Improvement Project M.C.L.P. “To promote a positive feeding experience for babies born before 34 weeks gestation through the implementation of a feeding assessment and intervention chart.”

3. SAFE….EFFECTIVE… EXCELLENT EXPERIENCE (Quality Strategy for Cwm Taf 2014-17) EXPERIENCE.... USE OF RESOURCES (Tier 1 Targets of the Delivery Framework 2013-14) TOP OF CLINICAL COMPETENCE (Prudent Healthcare 2014) 29/40 38/40 400 tube feeds

4. Approach to Delivery Benchmarking - national neonatal practices in feed management Force Field Analysis – highlight barriers and aids Ease/Benefits Matrix Process mapping

5. PROCESS MAPPING Define Aim Inform & Engage staff Design & Implement FAIC Results - compliance Effect of Change PDSA cycles

7. A. No Change. If having irregular desats and brady, check that baby is on the right dose of caffeine. B. Body Positioning - Prone and left lateral. (NB apnoea monitoring in prone position/SIDS advice prior to discharge). Head elevation not recommended. Kangaroo care during feeds and to remain in that position for at least 30mins. C. Feeding Strategies - Increase frequency of feeds to reduce volume of milk given. Encourage EBM/BF, Kangaroo care and cue-led feeding. D. Carobel - Prescribe on ICIP and specify scoop to milk volume. Review regularly. Note when stopped. Record on ICIP drug chart every time it is given. E. Gaviscon - Prescribe on ICIP. Record on ICIP every time it is given. Review and chart when discontinued. F. Any other anti-reflux medication (M) including special formula prescribed. Review in 2 weeks or as indicated. Interventions: Describe interventions & evaluate 12 hours (Staff Initials) SCORE LEVEL INTERVENTIONS 0-10 Low A- B 11-14 Medium C 15 -25 High D - F INTERVENTIONS - A Stepwise Approach

8. RESPIRATORY STATUS

9. FEEDING STATUS

10. Measures COMPLIANCE (%) 1.Babies on FAIC : all < 34 wks 2.Assessed at appropriate times - at least once every 12 hours - at every increase in milk volume - during episodes of cardioresp events/possets 3. Evidence of stepwise interventions

11. Results Inclusion of babies < 34 wkson carobel/gaviscon & stepwise approach pre Chart babies on carobel/gaviscon 50% assessed at right time

12. AUDIT Use of Carobel or Gaviscon on babies below 34 weeks gestation before and after the implementation of FAIC Pre FAIC: 50 % of the babies in this group were managed with either Carobel and Gaviscon. None went home on either Carobel or Gaviscon. On FAIC: Using the Charts, 31% of the babies in this group were managed with Carobel. One baby went home on Carobel.

13. What next ? Adapt to electronic nursing chart Use it to promote cue led feeding and in conjunction with the All Wales Enteral Feeding Care Pathway

14. Thank You Any Questions ?