1. The Birth of CEBIS Within Neonatal Care: a Case Study Aislinn Conway Clinical Evidence Based Information Service Specialist 13th of June, 2011

2. Conception Labour Birth Development

3. Conception Jacqui Cox, Clinical Librarian UHCW 2004 Ophthalmology, Diabetes and Endocrinology and Neonates Development and implementation of Evidence in Practice Groups Critical Appraisal training Business case, 2005 - 2009 CEBIS, 2010

4. Conception – triplets! CEBIS SpecialistsDivision/Specialties Anna BrownDiagnostic & Services Mandeep Heer (Aulakh)Medicine Diabetes &Endocrinology Gastroenterology ED Infectious Diseases Aislinn ConwayWomen and Childrens Neonatology Paediatrics Obs & Gynae CRM

5. Labour: Stages of the CEBIS Model Handover or grand / ward round Scoping search/evidence summary feedback Ppt Presentation Ppt presentation and discussion Further action planned / decision to maintain or change current practice Actions completed and reviewed

6. Birth – the Breakthrough Moment 1.Background - SHO/Reg 2.Case History - SHO/Reg 3.Evidence - CEBIS 4.Management - SHO/Reg 5.Discussion - Consultants, ANNP’s, Medical Students, SHOs, Regs, Pathology, Dietitian etc.

7. Example: Managment and Treatment of Neonatal Gastro-oesophageal Reflux (GOR) Uncomplicated GOR resolves in 90% of infants Complications – Gastro-oesophageal Reflux Disease

8. Difficulties of Diagnosis of GOR SHO Investigate if a link exists between other apparent life threatening events (ALTEs) to aid diagnosis In the vast majority of infants, reflux is not related to pathologic apnea or to apparent life-threatening events, lthough a clear temporal relationship in individual infants

9. Positioning ANNP A systematic review identified an area where practice could change: prone and left lateral lying decreases GOR symptoms Risk of Sudden Infant Death Syndrome (SIDS)? Safe in preterm infants in hospital receiving cardiorespiratory monitoring

10. Survey of Practice 2 x ANNP’s 2009 Preterm infants >30 wks GA excluded £4229 spent on medication, feed thickeners and nurse staffing Staff noted prescribing of GOR meds decreased recently Approx. 122.6 hrs of nursing time may be designated to other tasks

11. Putting Evidence into Practice UHCW Clinical Guideline: Management and Treatment of Gastro-Oesophageal Reflux (GOR) in Neonates Guideline to promote evidence-based management and treatment of neonates who have presented with symptoms/signs consistent with gastro-oesophageal reflux Future research: diagnostic tools - pH monitoring and multichannel intralumial impedance

12. University Hospitals Coventry and Warwickshire NHS Trust Neonatal Department Management and Treatment of Gastro-oesophageal Reflux in Neonates

13. Development: keeping it alive and well to encourage growth NATURE: CEBIS System – currently at testing stage providing a platform on which to submit queries direct from EPR Direct link from patient record to CEBIS record on patient case A working tool for CEBIS Specialists to coordinate and communicate with clinical teams involved in EPG work Direct linkouts to PubMed for search updates Complete documentation of all work generated per query including audit trail and outcome measures Searchable interface as a standalone system on Intranet

14. Development: keeping it alive and well to encourage growth NURTURE – Know your organisation and seek opportunities in change – Know your product, be loyal to it and seek to sell it well – Know your teams, understand their environment and become one of them. – Know yourself – no baby became an adult in one day!

15. Thank You! Contact details: Email: aislinn.conway@uhcw.nhs.ukaislinn.conway@uhcw.nhs.uk Phone: 02476968816

16. References Vandenplas, Y et al. Pediatric Gastroesophageal Reflux Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nurtrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009; 49(4):498-547. Fox G, Hoque N, Watts T. Oxford Handbook of Neonatology. Oxford: Oxford Medical Publications; 2010. Birch JL, Newell SJ. Gastrooesophageal reflux disease in preterm infants: current management and diagnostic dilemmas. Arch Dis Child Fetal Neonatal Ed. 2009; 94: F379-383. Guillet R et al. Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants. Pediatrics. 2006; 117:e137-e142. British National Formulary for Children [Internet]. London: 2011 [cited 2011, May 23]. Available from: http://bnfc.org/bnfc/bnfc/2010/100063.htm?q=gastro%20oesophageal%20reflux&t=search&ss=text&p=2#_hit http://bnfc.org/bnfc/bnfc/2010/100063.htm?q=gastro%20oesophageal%20reflux&t=search&ss=text&p=2#_hit Hammer D. Gastroesophageal Reflux and Prokinetic Agents. Neonatal Network. 2005; 24(2): 51-58.

17. References contd. American Academy Of Pediatrics Policy Statement: Task Force on Sudden Infant Death Syndrome. The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics. 2005:116(5); 1245-1255. UpToDate Topic: Gastroesophageal reflux in infants. [Internet]. Masachusetts: 2011 [cited 2011, March 9]. Available from http://www.uptodate.com/indexhttp://www.uptodate.com/index Dynamed Topic: Gastroesophageal reflux disease (GERD) in infants. [Internet]. Masachusetts: 2011 [cited 2011, March 9]. Available from: http://www.ebscohost.com/dynamed/default.phphttp://www.ebscohost.com/dynamed/default.php Clinical Review Drug and Therapeutics Bulletin: Managing gastro-oesohageal reflux in infants. BMJ. 2010:341;495- 498. Huang RC, Forbes D, Davies MW. Feed thickener for newborn infants with gastro-oesophageal reflux. Cochrane Database of Systematic Reviews. 2002, Issue 3. Art. No. CD003211. Available from: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003211/pdf_fs.html http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003211/pdf_fs.html