West of Scotland Neonatal Guideline Group Draft Minutes 26 th June 2012 Venue PRM Glasgow Attendees Andrew Powls Chair Fiona Tait Neonatal Network Manager Peter Mulholland - Neonatal Pharmacist - SGH Maria Tracey Pharmacist - RAH Fiona Scott Team Leader NICU - SGH Linda Hannah ANNP - FVRH Anne Marie Heuchan Neonatal Consultant - RHSC Heather Armstrong Associate Specialist - D&G David Quine - Neonatal Consultant - SGH Liz Wynne Practice Development PRM By Teleconference Sheena Kinmond - Neonatal Consultant Ayrshire Marie Currie Pharmacist Ayrshire Morag Brown ANNP Ayrshire Kathleen Murray ANNP Ayrshire Fiona Barnes Associate Specialist Apologies Lesley Jackson Una MacFadyen Helen Simmons Tom McEwan Hilary Conetta Jonathan Coutts Hazel Fisher Judith Simpson Karen Creer Andrena Kelly Gregor Walker Liz Callander Chris Lilley Sam Ibhanesebhor Welcome The Chair Andrew Powls welcomed everyone to this inaugural meeting. He apologised for the relative short notice. It has taken a while to get a full membership list but it was still felt important to get this group off the ground before the school break. We will ensure much better notice of the future meetings and this will be assisted by administrative support which has been appointed for the MCN (Jo Reilly). AP indicated that this group was being developed from the pre-existing GG&C guideline group (which was already receiving some support from units outwith
GG&C). This would necessitate the completion of some GG&C guidelines which were in development. However it would not be mandatory for these guidelines to be adopted by non-gg&c units. Future guideline work would be developed collaboratively by the group with the intention of having MCN based guidelines. It was acknowledged that some guidance may not be applicable to all levels of unit. AP indicated that he hoped in most cases a single document could be produced which could acknowledge local variation rather than having multiple guidelines covering the same topic but this would be addressed during the development of each guideline. Membership of the group AP had emailed a list of members prior to the meeting and will recirculate with these minutes. Please can anyone email AP if they are not happy with their job title or if they prefer e-mail to go to another email address (please can we only use health board or NHS email accounts please). The document also included a list of members duties which were accepted with one caveat. It was suggested that it was important that local leads would be responsible for implementing guidelines but that it must be clear in the guideline which level of unit the guideline was applicable to. AP asked whether the membership list should be extended to include any other groups of professionals. FT suggested adding an AHP representative and further suggested that Alison Grant would be the obvious choice. AP will contact her. AP indicated that he would be happy to receive additional names, job titles and contact details for anyone else who wished to be on the mailing list or to attend meetings and contribute to the work of the group. He would intend to keep this list separate from the main membership list to remove any ambiguity about the lead roles Meeting Schedule It was agreed that the meetings would be bimonthly, that the day of the meeting would vary to include Tue Wed and Thu afternoons at 14:30. In order to permit teleconferencing we would hold the meetings in the teleconference suite in RHSC subject to availability. Guidelines for discussion AP had included a list of guidelines which were under development in the preceding GG&C group to which some non-gg&c units were also giving input. AP asked if the group were happy to continue to develop these guidelines with additional editing to ensure applicability to the units joining this group for the first time. It was agreed that this was acceptable. AP asked if there were other guidelines which should be added to this list. Heather Armstrong indicated she was developing a chest drain guideline as D&G were introducing the Seldinger sets from COOK. This can be added to the list when a first draft is available Actions - HA
Enteral Feeding DQ leading This guideline is being developed from an existing East-of-England MCN guideline. A recent draft was circulated prior to the meeting. All units are invited to refer comments to DQ. The availability of DEBM was discussed in the light of an ongoing campaign to ensure this is available for all babies who need it. All units have been requested to respond to an enquiry about the availability in their own unit. There was some discussion around the wording of the section on incremental feed volumes which is expressed in volume/kg/day rather than increments per feed. It was requested that we ensure there is formal dietetic input to the wording of the document. DQ will circulate further amendments. Actions - DQ Cooling AJ leading GG&C have an existing guideline for active whole body cooling. This is in need of a minor revision in light of software changes in the Tecotherm Neo cooling device. The draft revision of this guideline was circulated and all active cooling centres are asked to respond to this document to indicate whether they are happy to adopt this and if so to indicate if they feel any revisions to the text are necessary to suit their local circumstances. (GG&C units need only check the revised Tecotherm Neo instructions). It was agreed that we need to develop a separate piece of guidance covering the passive cooling of babies with HIE in non-cooling centres including level 1 units. Allan Jackson will coordinate this with input from Heather Armstrong, Linda Hannah and?hilary Conetta. Fiona Tait suggested input from a level 1 unit and she will seek a representative Actions AJ, HA, LH, HC, FT Cranial USS AP leading GG&C have been developing a guideline for cranial USS which includes advice about technique and reporting. One of the goals is to better standardise the quality of the images produced and the reporting of the findings especially for the high risk group of infants <30 weeks gestation. The guideline seeks to recommend that formal scans are performed after 7 days and after 1 month of age in this group which should be used to define the degree of PVH and the presence or absence of PVL. Discussion occurred about who should perform these scans as they have traditionally been done in-house and frequently by trainees without any formal training in USS technique or interpretation. GG&C have recently achieved the goal of getting sufficient radiology input to ensure that these scans can be done by a radiologist / reporting radiographer. It is clear that this level of input is not universally available. As the MCN standards document is likely to recommend that level 3 units have radiology input we should see this as a goal for these units. In the meantime, and for level 2 units, we should try to ensure that a paediatrician with
sufficient experience performs these two scans to improve the consistency of reporting. AP will try to seek an appropriate form of words for this. There has been some disagreement about which scoring system should be utilised for PVH. There is no consistent agreement even within radiology. However we need consistency for benchmarking purposes and AP suggested using the same system adopted by the Vermont Oxford Network. He has put this suggestion to radiology at RHSC but has not yet had a response. As with the other guidelines can all units comment on this document to AP Actions AP Parenteral Nutrition PM leading PM outlined the issues around a recent national standards document for the preparation and administration of TPN and outlined some of the areas that could be addressed through the development of local guidelines and some areas which will remain problematic whilst units have only 5 day access to a sterile product suite (or no access for some peripheral units). It was confirmed that many units are using the Scottish national contract bags for TPN and there are a few units with existing written guidelines (PRM and WGH) which could be assimilated to form the basis of a WoS guideline. PM will try to pull together a small group to try to draft a guideline including representatives from level 3 and level 2 units. The GG&C group have done some work trying to standardise the TPN giving sets in use with a view to negotiating a WoS contract to supply a common set for all WoS units at a competitive price. Fiona had asked representatives from the nursing group to comment on the different company offerings but was awaiting responses. AP urged representatives form that group to respond so we can take this forward. We would hope to be able to reduce costs and standardise sets for consistency when transferring patients between units and for education and training purposes. Actions- PM, FT Jaundice AJ Leading AP had circulated a draft guideline from AJ based on the NICE guideline. AJ indicated that one of the biggest problems in introducing management based on NICE was the need to ensure that all jaundiced babies had an objective rather than subjective assessment of their degree of jaundice. It would be, relatively, easy to ensure that all inpatient babies with jaundice had an assessment by blood test or bilimeter reading but far more difficult to ensure that this occurs in the community. This would require the provision of large numbers of bilimeters in the community or the transportation of many babies to a local unit for testing both of which will require significant levels of investment. AJ is trying to get a better assessment of costs in conjunction with Obstetric / midwifery colleagues. It was noted that the obstetric departments in many hospitals are trying to achieve earlier discharge from hospital, which will result in more jaundiced babies in the community. There may be an opportunity here to indicate that these plans should be developed to include pathways for the assessment of these babies in the community. FT indicated she would look to get an MCN contract price for the purchase of Bilimeters.
Can all units comment, to AJ, on the initial draft of this document including insight about current local practice in their unit. Actions - AJ, FT Capillary sampling- Lynne Raeside had drafted a document for GG&C for capillary sampling. It is clear in the meeting that a number of units have existing guidelines for this also, most of which will be very similar. Fiona Scott volunteered to pull together the guidelines from different units and work with Lynn to unify guidance Action FS Peripheral Arterial Line insertion & Care Lynne Raeside has drafted a document for GG&C for the insertion and care of peripheral arterial lines. There was not time for discussion of the content of the document but it was indicated that the document is probably over-long. DQ volunteered to work with Lynne to edit the document. Comments from all are welcome Action DQ Date and Time of future meetings AP indicated that we would hope to circulate dates for the next few meetings in advance. The next meeting will be on Wed 29 th Aug subject to the availability of the Telemedicine suite