PC.55 Impact on neonatal hospital referrals from the introduction of transcutaneous bilirubinometers to the community midwifery team in ABMU Health Board in South Wales

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Abstract

Background

NICE neonatal jaundice guideline (CG 98) recommends the use of transcutaneous bilirubinometers (TsB) by community midwives to test babies with visible jaundice. Cost and lack of evidence have limited implementation across UK. We report results from a service evaluation project looking at the introduction of bilirubinometers to community in ABMU.

Method

One midwife of 36 covering Morriston hospital catchment area and 2 of 37 covering POW hospital catchment were provided with TsB and training. Activity monitored between March to August 2013. Care bundle developed and used.

Results

184 babies reviewed, 6 tested with TsB and 1 referred for hospital assessment by project midwife to Morriston. 264 babies reviewed, 69 tested and 2 referred to POW.100% of babies referred by the 3 project midwives to hospital required treatment. Of the 38 babies referred to Morriston without TsB testing by other midwives only 40% were admitted. 60% were discharged home after a medical evaluation and blood test for bilirubin. Average waiting time was 4 h 15 min. 26% babies received a second review. All parents reviewed by project midwives were highly satisfied with care.

Conclusion

Transcutaneous biliribinometers are 100% effective in identifying neonates requiring treatment for jaundice in first 2 weeks in community. Availability of bilirubinometers to community midwives will reduce referrals to secondary care, improve quality of care and reduce parental anxiety and cost. The pilot project helped ABMU win innovative project funding from Welsh Government. TsB and training are now being provided to all midwives in AB.

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