ABSTRACT
Across clinical specialties, the use of clinical guidelines is integral to maintaining patient safety, reducing variation in clinical practice and optimising patient care. Identifying specific barriers to the effective use of guidelines within individual healthcare settings allows for the implementation of effective strategies to overcome them, and ultimately improvements in patient care. Here, we report a single-centre survey of paediatric doctors and nurses, which formed part of a quality improvement project within the Acute Paediatrics Department of an NHS district general hospital. The primary aim of the study was to explore the perspective and resource barriers paediatrics healthcare staff experience when using local and national clinical guidelines. The secondary aim of the study was to examine the impact of the Covid-19 pandemic on local and national clinical guideline use. We found that local and national guidelines are frequently used by paediatric doctors and nurses, and that they have positive perceptions of guidelines, overall. However, the NHS Trust's Intranet system was identified as a direct barrier to the use of local paediatric clinical guidelines. Staff throughout the UK in the NHS rely on their Intranet system in order to access local guidelines. Our results provide an impetus for interventions within this NHS Trust, and in the many other NHS Trusts with similar Intranet systems, to increase clinical guideline use and, ultimately, improve patient care.
ABSTRACT
BackgroundSickle cell disease (SCD) results in functional hyposplenism and impaired immunity with risk of respiratory infections and pulmonary complications.1 During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, patients with SCD were identified as ‘high risk’ and received shielding advice.2 Health related anxiety in the general population has been great throughout this unprecedented global health crisis, and this survey was carried out to evaluate how these anxieties have affected a specific vulnerable patient group with SCD.ObjectivesThis project aimed to gain an understanding of parent’s views and experiences of the COVID-19 pandemic when they have a child with an immunocompromising health condition such as SCD. The secondary aims were to encourage timely hospital presentation by allaying their fears through explaining new infection control set up.MethodsA telephone survey of the local cohort of families with one or more children with a diagnosis of SCD was carried out between April and August 2020 at a district general hospital using a questionnaire entitled ‘COVID-19 - How are you doing and how can we help you?’. 11 questions were asked of one parent from each family and the answers collated and analysed. Additional responses were obtained during the clinic consultations, virtually or in person.Results45 families with 54 children (27 male) were successfully contacted and supported during the pandemic. 32 of these families gave responses on behalf of 42 children to all 11 survey questions. The age of patients ranged from 10 months to 16 years, 15 were adolescents and contributed to responses. 57% had HbSS genotype, of which 16 were on hydroxycarbamide and 28% had HbSC. 53% of families reported worrying about attending hospital during the coronavirus outbreak, 34% felt significantly isolated and half felt that the virus outbreak had significantly changed how vigilant they are regarding their child’s symptoms. However, no family made unscheduled changes to their child’s regular medications in response to the virus, with no significant difference between HbSS or HbSC cohorts found (p-value >0.05). All but one participating family felt that they had received sufficient information about the pandemic from the clinical team and 81% felt no additional support was required. In particular, those on hydroxycarbamide were satisfied with the provision of home blood monitoring and prescription delivery. 7 families reported trusting information provided through social media, however they verified this with known hospital teams. During the study period there were 3 admissions for sickle crises, all testing negative for coronavirus.ConclusionsThe survey indicated the positive role that the community sickle cell nurse specialist played in liaising with the families throughout the pandemic, informing and educating them and attempting to resolve any anxieties or concerns that they had. It further helped to identify any specific queries regarding prescriptions and missed appointments and allowed the community team and the local consultant paediatrician with haematology expertise to provide extra support and information where needed, helping to reduce hospital attendance related anxiety and minimise delays in presentation throughout the COVID-19 pandemic.ReferencesWare RE, Montalembert M, Tshilolo L, et al. Sickle cell disease. The Lancet 2017;390:15–21.Roy NBA, Telfer P, Eleftheriou P, et al. Protecting vulnerable patients with inherited anaemias from unnecessary death during the COVID‐19 pandemic. Br J Haematol 2020;189:635–639.