Nourishing the Sickest Children More Safely

Improving systems to ensure the quality of provision of parenteral nutrition in a regional childrens hospital

Overview of the Project

Royal Manchester Childrens Hospital (RMCH) is the largest childrens hospital in Europe, providing tertiary level care to a population of around five million. Many of these children have complex needs and require intravenous (parenteral) feeding. This is a life saving but costly and potentially hazardous intervention. The project set out to create and implement fail-safe systems for the process of prescribing, preparing and delivering parenteral nutrition that supported clinicians in the care of these challenging patients and ensured that national standards were met consistently.

consensus is vital to the success of the project. This is further complicated by the context of RMCH being recently formed following the closure of three former Childrens Hospitals in Manchester. The merging of cultures and hierarchies is still ongoing and the sharing of good practice across the hospital cannot be assumed.

Results
Using national and international guidelines, a set of indicators for good practice in parenteral nutrition was draw up. Current practice was audited against these standards to determine the scale of the problem. This revealed generally excellent practice but occurring within a system lacking cohesion. A consultation with all the relevant professional groups has lead to the development of a broad consensus on many aspects of the problem. This consensus, along with learning from good practice elsewhere in the trust, is being used to develop possible system improvements. The intention is to implement a new system in the Autumn of 2012.

Leadership Challenges
A significant challenge the project presents is developing the ability to provide leadership to expert clinicians. These clinicians are drawn from many different professions, each with their own cultures, norms and perspectives. Being able to communicate effectively with these professionals and create

Contact Information
Iain Yardley, Specialist Registrar in Paediatric Surgery, Royal Manchester Childrens Hospital. iyardley@doctors.org.uk 07901777079