1. First Hour of Care: Development of a Clinical Guideline
Dr Paul Cawley
(on behalf of EoE First Hour Care Project Team)
24 February 2019
EOE Neonatal ODN

2. Audit FHOC Audit cycle has enabled close assessment of:
Pre-Project Standards of Care
Which in turn informed areas requiring targeting in the FHOC admission pathway
Post-implementation effect
Improvements made (and to be sustained)
Areas requiring further development

3. FHOC: Audit Through the FHOC project:
Standardised paperwork to improve documentation where concern documentation was inadequate
Standardised paperwork to include prompts for organisation, prioritisation and gold standards of care
Implementation & Education – Launch day and visiting sessions at local units
However, within the first phase, no specific guidance, standards or guideline developed

4. Reminder: Areas for development
Delaying cord clamping (under 10 %)
Magnesium sulphate in LNUs/SCBUs
Admission temperatures (main focus of 2015 NLS guidelines)
Reasons for intubation
Time from birth to administration of fluids and antibiotics
Time to initiation of parental nutrition

5. Areas for development – the next step
Important to reflect on these areas
Consider the barriers preventing appropriate or more timely care
Consider how these barriers can be overcome

6. Areas for development – the next step
What barriers may be present?
Insufficient evidence
Relatively new evidence, poorly disseminated
Staff workload
Staff knowledgebase
Organisation of the team
E.g. Delay in administering Fluids:
- Organisation – Fluids not prescribed
- Knowledge – team unsure what volume is required

7. 24 February 2019
EOE Neonatal ODN

8. Areas for development – the next step
Therefore as part of 2nd phase of FHOC project, evidence based guideline planned
Commissioned to specifically address:
Organisational factors
Latest Evidence base relating to the sick term infant and care of the preterm infant
Target areas where there has been highlighted need for improvement (e.g. antenatal care, fluids, antibiotics)

9. Developing a guideline: Challenges
Specific challenges arise:
FHOC covers a vast selection of topics
Important to consider related areas of ‘ongoing care’ beyond the first hour
The first hour is fast paced and a traditional guideline can be difficult to wade through in an emergency (the region has many very good guidelines which relate to specific aspects of the FHOC)
Care strategies will vary between a level 3/tertiary NICU, a level 2 unit and a level 1 unit

10. Quick Reference Guideline:
Therefore:
Developed a ‘quick reference’ guideline
Salient points of the EoE ODN guidelines, relevant to the FHOC, have been summarised on easy to find pages
Indexed and colour coded to allow fast access
Specifically addresses all important care bundles:
Antenatal
Thermoregulation
Respiratory & Saturation Targeting
First Hour Fluids & Medications
Ongoing Care

11. Quick Reference Guideline:
On the whole: Guidance without ‘new’ standards – to account for variation between the different NNU levels

12. Quick Reference Guideline:
The concept:
A4 Landscape laminated (wipe clean!) & bound
One to two printed copies available to each unit
Online version with indexed ‘hyperlinks’

13. Quick Reference Guideline: Current Progress
For submission for COG & Revision as required
Once revised format approved – will require ratification
Current draft ready for dissemination to COG members
Not yet approved for use in clinical areas

14. Quick Reference Guideline: Demonstration

15. FHOC – What Next?
Further education on key areas for development from expert speakers (cord clamping, fluids, thermoregulation)
Education session in september for all new paediatric trainees joining the region
Quick reference guide will be available in lanyard format (Key pages only!)

16. 24 February 2019
EOE Neonatal ODN