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Healthy Start Implementation Process

Healthy Start Implementation Process. Eulalee Green Health Development Manager Registered Dietitian eulalee.green@nhs.net 07939 831 821. Overview. Background The Project Plan Future Plans. Background . 2005-2008: 35 children with rickets

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Healthy Start Implementation Process

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  1. Healthy StartImplementation Process Eulalee Green Health Development Manager Registered Dietitian eulalee.green@nhs.net 07939 831 821

  2. Overview • Background • The Project Plan • Future Plans Healthy StartImplementation Process

  3. 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 Healthy StartImplementation Process

  4. Background • Rates over 5 years (2003 – 2008) • 23 electoral wards Healthy StartImplementation Process

  5. 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) Healthy StartImplementation Process

  6. Milestones • 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 Healthy StartImplementation Process

  7. Baseline Data • 8 sites over 3 neighbourhoods • 20,750 Children: 0-4 yrs • 11,000 women: pregnant or with a child <12mths old Healthy StartImplementation Process

  8. 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 Healthy StartImplementation Process

  9. 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 Healthy StartImplementation Process

  10. 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 Healthy StartImplementation Process

  11. 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 • Ealing Hospital – 45 minute presentation hour from 9:00 am to 6:00 pm - up to 135 staff • Clinic administrators – 10 staff • Children Centre Staff (delivered by the Children Centre Dietitians) • Corum outreach team – 30 staff Healthy StartImplementation Process

  12. Community Publicity (Sept 2009) • Baby TV film • Poster • Two articles a year, in Ealing Matters, Team Talk Core Brief, and Nutrition Today • Weaning Groups 6x a week – CCD • Breastfeeding Peer Supports – CCD • Switch-Script on GP system Healthy StartImplementation Process

  13. 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 Healthy StartImplementation Process

  14. Uptake Data Healthy StartImplementation Process

  15. 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 Healthy StartImplementation Process

  16. 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 Healthy StartImplementation Process

  17. 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 Healthy StartImplementation Process

  18. 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 • 1st Antenatal appointment • New birth visit • Training staff at birth registration offices • Children Information Services website • Local library services Healthy StartImplementation Process

  19. 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 Healthy StartImplementation Process

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