Name: Tendai Nzirawa
Job title: Quality Improvement Manager
Speciality: Children’s nursing
Organisation: NHS England and NHS Improvement - East of England. Maternity Clinical Network
What is the initiative or project you are involved in?
Paediatric Pan London Oxygen Group (PPLOG) Discharge Bundle has been shared through study days and workshops in order to make the transition from hospital to home of every child on oxygen therapy seamless.
Since July 2018, a total of three study days that include workshops have been run in London (Whittington, St Thomas and Mile End Hospitals). The study days have been well attended. On record about 160 health professionals so far and about 100 health professionals participating either by group/one to one workshops within their clinical area facilitated by a PPLOG member. Prior to the study days, a survey was conducted in 2017/2018 and highlighted that there were various practices in each area on how parents and staff are taught about home oxygen. Furthermore, the results found some areas had guidelines that were either out of date or not evidence based.
What prompted you to do this work?
The Paediatric Pan London Oxygen Group (PPLOG) was founded in 2016 with the aim to bring knowledge and experience of Respiratory Nurses, Community Children's Nurses and Community Neonatal Nurses together, and set standard guidelines that will ensure the management of children on oxygen therapy is safe and uniform within the London region.
The PPLOG members include: Emilie Maughan (Co-Chair), Rebecca Smith (Co-Chair), Abigail Beddow (Secretary), Tendai Nzirawa (Treasurer), Caroline Lock (Air Liquide), Alison Camden, Sook Lin Yap, Nichola Starkowitz, Ceara Turner, Samantha Ahern, Tamsyn Hernandez and Billie Coverly.
The PPLOG discharge bundle contains seven separate documents to aid the safe and timely discharge of a child requiring home oxygen across Greater London. The BTS guidelines for home oxygen in children have been used however the limitation is that there were published 10 years ago therefore slightly out of date based on the current practices.
How did you initiate the work?
PPLOG came together after a Respiratory Clinical Nurse Advisor set a forum to share concerns and find solutions to make the baby's or child's journey from hospital to home as safe as possible however using evidence based practice.
The barriers were trying to find a location to run the quarterly meetings and setting a meeting date that was convenient for every member. However, this was overcome by routinizing the venues and ensuring as long 70% of members attended the meeting would be held. PPLOG has been run for the past three years with no grants from any organisation, only occasional sponsorship during study days. PPLOG has been peer reviewed and endorsed by WellChild the national charity for sick children, London Neonatal Operational Delivery Network, London Clinical Oxygen Network and Respiratory Futures.
What have the challenges to implementing the service/intervention been? And what has enabled the implementation of the service/intervention?
The challenges of implementing PPLOG have been lack of support from some organisations to implement change that would be beneficial for the staff and families. However, through the support of NHS London, London Clinical Oxygen Network, Contract Management Board and Clinical Commissioners Groups, there has been a lot of collaborative working and changes.
Has the initiative or project made a difference to patients/service users and or staff?
There has been written feedback from post-study days surveys that indicates that staff found the PPLOG discharge bundle and the study days usefully to implement positive change within their organisation. The plan would be to conduct a larger feedback survey prior to the PPLOG discharge bundle review in 2020.
- Finalist (Respiratory Nursing) Nursing Times Awards 2018
- Finalist (Primary Care Innovation) Health Care Transformation Award 2018 NHS England
- Various poster presentations.
Each study has been attended by 50-55 health professionals involved in the discharge process of children requiring home oxygen daily and includes medical, nursing and educational representation from community, tertiary hospital, neonatal intensive care and commissioned oxygen provider settings. There is now a demand for PPLOG to be shared outside London. There are three study days set for November 2019.
Follow up conclusions and next steps: - What are the long-term aims for the work?
The aims and objectives of PPLOG would be:
- To review the PPLOG discharge bundle in 2020 and make changes based on survey and peer feedback
- To establish standard guidelines for home oxygen weaning within tertiary and community settings
- To streamline the discharge process for children on home oxygen therapy
- To continue facilitating educational programmes for hospital staff preparing to discharge a child on home oxygen therapy
- To support the families with evidence-based information on how to care for their child on home oxygen therapy
- To set a platform and create a Pan London Oxygen protocol for education and management of all children on oxygen therapy within tertiary and community settings
- The PPLOG to audit every setting using the guidelines/pathways annually through staff, parents and children satisfaction feedback
- Guidelines and pathways to be reviewed every three years or earlier if advised of new evidence-based practices.