Frequent and sensitive communication from neonatal staff is important to alleviate parental stress and to ensure that parents understand their baby's condition and progress. It also consequently empowers and involves parents in their baby's care. A lack of regular and informative communication from neonatal staff is a common reason for parental complaint. We sought to assess whether the implementation of a baby diary used as a communication tool would improve parent-staff communication and optimise the parental experience of neonatal care.In this study, parents and carers of babies on our neonatal unit were invited to complete a questionnaire to assess their level of satisfaction with communication by neonatal staff before and after the implementation of the diaries. The diary was designed to act as an aid to improve communication to parents about their baby and thereby complementing face-to face communication and encouraging parental involvement.The study design was a retrospective parental satisfaction questionnaire based on the Department of Health [1] and the National Institute for Health and Care Excellence (NICE) [2] quality standards for specialist neonatal care on communication and parental involvement (n=44, response rate 57%). Following implementation of the diary, the questionnaire was repeated on two occasions: one month post implementation (n=17, response rate 23%) and 15 months post implementation (n=44, response rate 65%).More parents in the post-intervention cohort felt they were receiving regular communication from staff, that their questions and concerns were being addressed, and felt involved in their baby's care than in the pre-intervention cohort. In addition, 100% of parents said they liked reading the diary and 94% felt it added to their understanding of how their baby was doing.Our project demonstrates an improvement in parents' satisfaction with communication from neonatal staff following the implementation of individual baby diaries. The diary is a simple, practical, and cost-effective tool to enhance communication between parents and staff in a neonatal unit.

Aim We sought to assess whether the implementation of a baby diary as a communication tool would improve parent-staff communication and optimise the parental experience of neonatal care. Methods In this study, parents and carers of babies on our unit were invited to complete questionnaires to assess their level of satisfaction with communication by neonatal staff before and after the implementation of individual baby diaries. The questionnaires incorporated the Department of Health and NICE quality standards for specialist neonatal care. The diary acts as a tool to aid communication and complements face to face communication. Doctors and nurses write daily updates in the diary about the baby’s progress and well being and parents have space to write notes, questions or concerns. The initial questionnaire was in two parts: a retrospective parental satisfaction questionnaire given out on the day of discharge (n=44, response rate 57%) and a weekly spot questionnaire to gather a ‘point-in-time’ picture of parental views on communication (n = 39, response rate 53%). Following implementation of the diary, a weekly parental questionnaire (n = 17, response rate 23%) was repeated to gather views on its impact. Results More parents in the post-intervention cohort felt they were receiving regular communication from staff (94%) and felt that their questions and concerns were being addressed (100%) than in the pre-intervention cohort (77% and 91% respectively). In addition, 100% of parents said they liked reading the diary and 94% felt it added to their understanding of how their baby was doing. Conclusion Alleviating the emotional burden on parents who have a baby admitted to a neonatal unit requires frequent and sensitive communication from neonatal staff. Good communication empowers and involves parents and is essential in providing family centred care. Improving the quality and quantity of communication is proven to benefit the baby’s care, promotes positive parent-child interaction and improves overall family well-being and satisfaction. We were able to greatly impact parental satisfaction and provide family centred care by implementing a simple, practical and cost-effective tool to enhance communication between parents and staff. This project has been accepted by the Bliss Charity into their Best Practice Bank and is currently being trialled in other hospitals.

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AimsThe management of severe sepsis and septic shock in children is complex and time critical and requires prompt recognition and secondly early administration of antibiotics and fluid resuscitation. The American College of Critical Care Medicine- Paediatric Advanced Life Support (ACCM-APLS 2007) Clinical Guideline for Haemodynamic Support of Neonates and Children with Septic Shock states that within 60 min one should be able to fluid resuscitate up to 60 ml/kg and if needed start inotropes to restore circulation. Therefore the research question we asked is ‘What is the recommended minimal gauge cannula for fluid resuscitation in each patient group to meet the first hour goals set by the American College of Critical Care Medicine (ACCM) for Paediatric Septic Shock?MethodThe study compared the total time taken to administer 60 ml/kg of fluid through different gauge cannula in the four patient groups using a pressurised delivery system. The four patient groups tested had a working weight of; 4 kg, 12 kg, 25 kg and 50 kg. The study was conducted in a non-clinical setting using a model simulating a child in septic shock. Under controlled conditions, one volunteer administered the 60 ml/kg volume in aliquots of 20 ml/kg to the simulated patient. The primary outcome was the total time taken to administer 60 ml/kg of 0.9% saline including time for preparation and re-assessment and secondary outcomes analysed were the flow rate (ml/min), average and fastest time to administer a 20 ml/kg bolus and the time taken to bolus with and without a cannula connector.ResultsTo achieve the ACCM-PALS first hour goal for rapid fluid resuscitation in Paediatric Septic Shock one should aim to use the following recommended minimum size and brand of cannula per patient group as per the table below:Abstract G303(P) Table 1Recommended minimum size and brand of cannula per patient groupPatient WeightRecommended size and brand of cannulaAverage time to administer 20 ml/kg bolus of 0.9% salineTime to administer 60 ml/kg (including time for preparation and standardised re-assessment)4 kgYellow 24G Jelco1 min and 18 s11 min and 10 s12 kgYellow 24G Jelco5 min and 2 s28 min and 56 s25 kgBlue 22G Venflon9 min and 36 s37 min and 41 s50 kgGreen 18G Venflon12 min and 42 s49 min and 4 sDiscussionThis study provides practical recommendations for time-critical fluid resuscitation in sepsis and should lead to further research in the clinical setting. It should also support future iterations of Paediatric Resuscitation Guidelines regarding the optimal Paediatric fluid resuscitation technique.

AimsThe Paediatric Trainee Survey is performed annually in a continuing effort to improve paediatric training across the deanery by anonymously obtaining feedback from all Paediatric trainees about their experiences in training. Every year, this survey highlights a wide variation in quality and practice in training across the deanery. Therefore, this project aims to identify the local practice which makes certain trusts excel in their training feedback and distribute this information across the deanery with the goal of ensuring equal standards and experiences.MethodUsing the 2016 Paediatric Trainee Survey, we analysed the quantitative results and identified the top three performing trusts for each of the selected five survey indicators. These indicators covered the following aspects of training; Induction, Internal and external teaching opportunities, management experience and training, clinical leadership training opportunities and teamwork and morale in the department. The College Tutors and Trainee Representatives for the identified trusts were contacted with specific questions related to their indicator to obtain information about their local practice. This information was collated and distributed on the Deanery bulletin and website and at Deanery training days with feedback obtained through discussions with trainees and trainers.ResultsFeedback was obtained and analysed from the top performing trusts and common themes in local practices were identified for each of the five survey indicators. These themes were named ‘Best Practice’ and shared amongst the trainees and trainers in the deanery.ConclusionThis project has highlighted main themes in practices in five key aspects of Paediatric training which have been shared across the deanery to improve the overall standard and experience of Paediatric Training. Subsequent work is required to obtain the same information amongst the remaining survey indicators highlighted in the annual Paediatric Trainee Survey and in distributing these practices to other deaneries in the United Kingdom.