Core Care Plan Project

1. Core Care PlanProject Catherine Daly

2. Background In 2016, the ICHN Child and Family Health Interest Group undertook a project in the area of developing core care plans. Outcome = 36 Child, maternal and family health care plans developed.

3. Project To implement and evaluate 36 core child maternal and family health care plans developed for PHN practice to safely support a safe, effective and quality child health core screening and surveillance service.

4. Rationale By using a core care plan, it is envisaged that a bench mark exists for quality care, underpinned by evidence and research, thus supporting the delivery of best practice.

5. Methodology

6. Underpinning assumption

7. Evidence

8. Context The context concerns the environment in which the change is implemented and is divided into culture, leadership and evaluation.

9. Facilitation Facilitation refers to processes aimed at implementing knowledge in a practical setting and requires a person (the facilitator) to assist the implementation in terms of aims, roles, skills and characteristic features.

10. The PARIHS framework Measuring the intervention (core care plan) • Measuring the dependent variable directly involved based on the interaction between evidence, context and facilitation • Must work out a measurement strategy with the people responsible – PHNs decide what will represent ‘worth’ - continued use of core care plan • Evaluate the relative worth – is the core care plan fit for purpose – definition “success” and “failure” – modification.

11. 36 Core Care Plans 36 Core care plans

12. The PARIHS framework Roll out • Three sites identified • Link person identified in each site. • Workshops to brief PHNs • Resource pack allocated with; • Information leaflet • Guideline for implementation • Consent Form • Core Care Plans • Evaluation Form.

13. Sample

15. Evidence Core Care Plan 1 - Jaundice at first postnatal visit Evidence

16. Evidence Core Care Plan 1 - Jaundice at first postnatal visit Context

17. Evidence Core Care Plan 1 - Jaundice at first postnatal visit Facilitation

18. Fit for Purpose Fit for Purpose Modifications

19. Fit for Purpose Modifications • Needs to be more detailed in relation to assessing level of jaundice and follow up required. Exceptions LBW / SFR / Infections history / needs to be a priority of review. • Add specific guidance to mothers who are breast feeding as per NICE. Post-natal care up to 8 weeks after. • Under action plan instead of observing for signs of alertness, add “To refer to maternity hospital if increase in sleeping difficulty to feed. To add advising 3 hourly feeds until jaundice resolved. All PHN’s familiar with Kramer’s rule (non-midwives).

20. Modifications • “Observe for signs of alertness” if baby is lethargic importance of perhaps seeking medical attention if not alert, not feeding, sleepy or hard to arouse/wake. PHN’s may not be midwives or know “use of Kramer tool “however aids prompting to look up same. • If continue with Kramer’s rule as part of the care plan could we add a picture of the rule in practice to show mum? The picture could be on the back page of the jaundice care plan. • Small diagram of a baby for Kramer’s rule would be beneficial. Require training on Kramer’s rule. Common theme Kramer’s rule diagram of Kramer’s rule and training.

21. Summary 22 Public Health Nurses participated 264 Evaluation forms were returned Dublin West =DW Kildare/West Wicklow =KWW Laois/Offaly =LO

22. 17 Core Care Plans had ≥ 5 evaluation forms deemed fit for purpose (with modifications)

24. Develop additional Core Care Plans non-vaccinating parents SALT jaundice in pre-term infants torticollis older child not toilet trained at night soiling fussy eating for the older child oral thrush obesity slow weight gain support to the mother for child with disability facial body spots from discharge balanced nutritious food for infant planning to wean of milk speech cradle cap communication milestones.

25. Recommendations • 1. The findings to be returned to the Child & Family Health Interest Group to review the 17 Core Care Plans (≥ 5 evaluation forms returned, deemed fit for purpose) in terms of modification commentary • 2. Each Core Care Plan adopted to be viewed as a live document with regular review and updates undertaken to incorporate new evidence and research into the detail to reflect best practice

26. Recommendations • 3. Consultation to be undertaken with interested stakeholder to elicit their perspective and input into the findings • 4. Due consideration to be given to the suggested development of additional Core Care Plans • 5. In utilising Core Care Plans, it is imperative that practitioners use their clinical skills in assessing and delivering care, to ensure that no oversight occurs in meeting the ‘nursing problems’.

27. Thank you