Search

We describe our experience of using High Flow Nasal Cannula (HFNC) Oxygen on the paediatric wards during a 4 year period from January 2014 to October 2017. A standard operating procedure (SOP) provided instructions and guidance for the use of HFNC. Retrospective analysis of demographic data,clinical conditions, indications, HFNC settings, adherence to SOP, adverse events and safety profile was undertaken over the 4 year period. HFNC was used in 124 babies and children, for a variety of conditions requiring respiratory assistance. Bronchiolitis was the commonest indication for the use of HFNC, followed by pneumonia, viral induced wheeze, asthma, and for alleviation of respiratory distress at the end of life in palliative care situations. Relatively high flow rates compared to other centres of upto 4 Litres/kg was used, with no adverse effects such as air leaks. Conversion to NIV modalities such as CPAP and BiPap and intubation rates was comparable to other centres. Our findings agreed with previous studies that HFNC failure rates could be predicted by the lack of repsonse of respiratory distress and oxygen requirement, 60–90 min after commenicng HFNC. Incremental expansion of the use of HFNC was seen over the study period as well as extension of its use to a variety of clinical conditions. This was achieved without additional medical resources, but by nursing empowerment through training for the safe initiation, weaning and cessation of HFNC, as well as timely escalation.Our experience of the use of HFNC is unique in using high flow rates in large numbers of children with a wide variety of respiratory conditions, in a non-paediatric intensive care setting.

AimsThe general paediatric team at our hospital provides secondary paediatric care as well as tertiary and quaternary services. Our inpatient numbers vary from 40 to 120 across 15 wards. Our team comprises of over 20 junior members with varying levels of training needs. We are thus challenged to provide safe high quality patient care while maintaining situational awareness and addressing trainee needs.Briefing and debriefing are important tools used in other safety critical industries with some data from within healthcare. Our aim was to analyse if the introduction of a structured briefing and debriefing would effect the number of supervised learning events (SLEs), non-ward based work (such as clinic letters), attendance at educational meetings, team morale and perceived consultant situational awareness.MethodsThis prospective study ran over six weeks, with alternate weeks of briefing and not briefing (control). Briefings occurred after the morning handover and debriefings before the evening handover.At briefing, white boards were used to answer pre-defined questions regarding trainee need for SLEs, identification of educational opportunities and situational awareness issues (such as staff numbers). At debriefing, the team compared the outcomes with aims, and suggestions for improvements were carried forward.We obtained qualitative data from consultants using a SWOT analysis. The junior team completed anonymised questionnaires daily. The questions used Likert scaling and ‘Yes/No’ responses with an opportunity for free text.ResultsThe qualitative feedback was generally positive. Overall, more SLEs were completed during briefing weeks:(Table 1)More aims were met during briefing weeks:(Table 2)Team morale, colleague support and situational awareness were rated as being higher during briefing compared with non-briefing weeks.ConclusionsThe introduction of briefing and debriefing space improved learning needs even when service demands were high. The exploration of reasons for not completing SLEs lead to better awareness of how to improve this. We now plan to develop our briefing tool as part of a quality improvement project to improve other outcomes such as patient flow.