Background NICE jaundice guidance was implemented in our postnatal ward in September 2010 using the Drager JM103 transcutaneous bilirubinometer (TcB). The results of a before and after intervention study are presented. Aims (1) To evaluate TcB for acceptability, staff workload and ease of use. (2) To evaluate the impact on laboratory bilirubin estimations, requirement for phototherapy and admissions for jaundice. Methodology Data was collected from hospital records and bilirubin log over an 18 week period (for 9 weeks pre and 9 weeks post introduction of guidance intervention). A staff satisfaction survey was conducted to evaluate the TcB. Results Of the 586 live babies in the pre NICE period, 32 required laboratory estimation of bilirubin and 12 received phototherapy. Of the 651 babies in the post NICE period, 53 needed transcutaneous bilirubin estimations, 6 required laboratory testing and 2 phototherapy. There were no admissions to the neonatal unit or Paediatric Admissions Unit for jaundice. All junior doctors/ANNPs and 80% of midwifes felt the TcB was safe, easy to use, reduced workload and resulted in earlier discharge. Conclusions and recommendations (1) TcB is well accepted by staff and reduces the need for laboratory bilirubin estimations by 5 fold. (2) NICE guidance reduced the need for phototherapy 6 fold. We postulate that this might be due to better support with breast feeding associated with earlier awareness of jaundice. There was no increase in admissions before or after discharge. Larger studies are recommended to evaluate the impact on kernicterus.

Background NICE neonatal jaundice guideline (CG 98) recommends the use of transcutaneous bilirubinometers (TsB) by community midwives to test babies with visible jaundice. Cost and lack of evidence have limited implementation across UK. We report results from a service evaluation project looking at the introduction of bilirubinometers to community in ABMU. Method One midwife of 36 covering Morriston hospital catchment area and 2 of 37 covering POW hospital catchment were provided with TsB and training. Activity monitored between March to August 2013. Care bundle developed and used. Results 184 babies reviewed, 6 tested with TsB and 1 referred for hospital assessment by project midwife to Morriston. 264 babies reviewed, 69 tested and 2 referred to POW.100% of babies referred by the 3 project midwives to hospital required treatment. Of the 38 babies referred to Morriston without TsB testing by other midwives only 40% were admitted. 60% were discharged home after a medical evaluation and blood test for bilirubin. Average waiting time was 4 h 15 min. 26% babies received a second review. All parents reviewed by project midwives were highly satisfied with care. Conclusion Transcutaneous biliribinometers are 100% effective in identifying neonates requiring treatment for jaundice in first 2 weeks in community. Availability of bilirubinometers to community midwives will reduce referrals to secondary care, improve quality of care and reduce parental anxiety and cost. The pilot project helped ABMU win innovative project funding from Welsh Government. TsB and training are now being provided to all midwives in AB.