Transcript Slide 1
Healthy Start Implementation Process Eulalee Green
Health Development Manager Registered Dietitian [email protected]
07939 831 821
Overview
Background The Project Plan Future Plans
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Background
2005-2008: 35 children with rickets
2007-2009: 20/22 children with tuberculosis had vit D deficiency
2004-2007: 17 hypocalcaemic seizures at 1-2 months old
2 required PICU, 1 long term complications 2008: 2 infant: cardiac failure due to vit D deficiency
20% of paediatric fracture patients are vit D deficient
Source: Dr Michie, Consultant Senior Lecturer in Paediatrics, Ealing Hospital 07/03/2011
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Background
Rates over 5 years (2003 – 2008) 23 electoral wards Average Number Congenital Malformations Children 0-5 yrs old In Each Electoral Expected Actual Ratio Actual: Expected 14 (range 9 - 23) 70 (range 41 - 114) 5
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Healthy Start Project
Early 2009: DoH identified high seizure rates in Ealing June 2009: HS project started Aim:
Reduce neonatal hypocalcaemic seizures (vitamin D) Reduce congenital malformation rates (folic acid)
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Milestones
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Baseline data Stakeholder Interviews Map current processes System redesign Implement and monitor Health Staff training Community Publicity Monitoring Outcome evaluation Roll-out to non-PCT sites
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Baseline Data
8 sites over 3 neighbourhoods 20,750 Children: 0-4 yrs 11,000 women: pregnant or with a child <12mths old Area Uptake 2007 – 2008 Acton, Central Ealing & Hanwell Northolt & Greenford Southall Adult Sold 1 5 0 Adult Free 0 10 0 Child Sold Child Free 42 224 27 133 140 170 Total for Ealing 6 10 209 527
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Stakeholder Interviews
Public Health – Strategic Lead Universal Children Services – client advice Maternity Services – client advice Family Nurse Partnership GP Services & Paediatricians – client advice Health Centres – supplement sales & budget Children Centres – client advice Supplies Department – distribution to centres
Accounts Department- reporting to DoH & reclaim funds
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The Process (July 2009)
Account Department had unwritten process Centres had different processes Quarterly returns not submitted Monies banked incorrectly Wrong account and supply codes used Staff confused about recommendations GP & MW not involved
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System Redesign (Aug 2009)
Draft: Flow Chart, FAQ, Leaflet Key stakeholders meeting Prepare final documents Pilot at one site Roll-out to other PCT sites Deliver training for Reception Staff Implement system and monitoring
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Health Staff Training (Sept 2009)
Practice Managers – 25 managers Pharmacists – 2 sessions, about 40 pharmacists Health Visiting Team – 4 neighbourhood meetings – 40 staff Midwives –Queen Charlottes & Ealing Hospital – about 30 staff
am to 6:00 pm - up to 135 staff Clinic administrators – 10 staff
Dietitians) Corum outreach team – 30 staff
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Community Publicity (Sept 2009)
Baby TV film Poster
Talk Core Brief, and Nutrition Today Weaning Groups 6x a week – CCD Breastfeeding Peer Supports – CCD Switch-Script on GP system
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Monitoring (2009 – 2010)
PH collates HS uptake Vouchers held by the centre for 12 months Every month figures and copies of banking slip Compile quarterly sheets Quarterly figures sent to Accounts
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Uptake Data
Uptake 2007 – 2008 Uptake 2009 – 2010 Area Acton, Central Ealing & Hanwell Northolt & Greenford Southall Total for Ealing
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Adult Sold Adult Free Child Sold 1 5 0 6 0 Child Free 42 224 Area Acton, Central Ealing & Hanwell 10 27 133 Northolt & Greenford 0 140 170 Southall Total for 10 209 527 Ealing Healthy Start Implementation Process Adult Sold Adult Free Child Sold 49 39 661 749 144 73 83 300 437 164 819 Child Free 378 327 309 1,420 1,014
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Outcome Evaluation
Difficult to obtain and time consuming Hospital coding errors, so need to hand search patient records Hypocalcaemic seizures – only 2 between 1 Sept 2010 to 28 Feb 2011
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Process in 2010
Written Process (FAQ & Flow Charts) Distribution sites submitting correct information HV, CNN & MW understand vitamin recommendations Accounts Department – some problems GP – some problems Not distributing from non-PCT sites
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Problems
Process monitoring Outcome monitoring Accounts department not including HS as one of its priority Distribution of refund HS vouchers – infant vitamin voucher not from 1 mth
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Future Plans
Investigate how families are using vouchers Access GP training programme Re-look at non-PCT sites Write in to the SOP for:
GP antenatal booking 1 st Antenatal appointment New birth visit
Training staff at birth registration offices Children Information Services website Local library services
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Plea to the DoH
Children vitamin vouchers from 1 mth Constant messages on HS sites and leaflets to include drops from 1 month for African, Afro Caribbean, Middle Eastern and Asian babies Request hospitals to remove ‘paediatric’ as diagnostic code Request GP, midwifery and health visitor IT systems, include auditable fields for vitamin D, folic acid, and breastfeeding
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