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Nurse develops community oxygen-weaning guideline for neonates with chronic lung disease

Joanna Broderick’s award-winning work has improved safety and enhanced patient autonomy

Joanna Broderick’s award-winning work has improved safety and enhanced patient autonomy

Broderick and Oram
 Joanna Broderick with parent Gemma Oram and son Jasper Phillips. Picture: Apex

A community children’s nurse who developed the first guideline for weaning babies off oxygen at home has won the Child Health category of the RCNi Nurse Awards 2019, the profession’s top accolade.

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Joanna Broderick’s work has halved the time taken to wean babies with chronic neonatal lung disease off oxygen while improving the safety and effectiveness of the weaning process. It will help families to return to a normal life more quickly while saving her trust tens of thousands of pounds.

‘Babies were on oxygen much longer than they need to be,’ says Ms Broderick, who works for Children and Family Health Devon.

What a colleague said

Consultant paediatrician David Bartle, who works with Joanna Broderick, says he is ‘so pleased’ she is gaining national recognition for her work.

‘Her drive and enthusiasm have been truly inspirational. She saw an area of care in the community that needed improvement and liaised with the hospital teams to make a transformative change.

‘Jo’s innovation has not only enabled families to begin living a normal life but has saved the NHS tens of thousands of pounds. The guideline is being adopted by other trusts, which validates its effectiveness and family-centred approach.’

‘There were no guidelines and the process was protracted, unstructured and stifled nurse autonomy. Most importantly, it did not provide best baby and family-centred care.

‘Being on oxygen has a big impact on babies and their families. It reduces babies’ mobility and social interaction, which can affect their global development and ability to reach milestones, and is inconvenient for families who have already spent weeks and months in hospital because their babies were premature.

‘These families are often desperate to start a normal life free from lines, tubes and cylinders.’

The process was also wasting resources. ‘Our nurses cover a large geographical area and some visits could take two hours travelling.’

Methodical approach

Ms Broderick’s guideline provides a methodical approach to weaning. It describes when monitoring should take place and sets out clear, incremental steps that should be taken based on oxygen readings.

‘The instructions are unambiguous and, because the information is downloaded at the point of care, the family home, immediate adjustments can be made,’ says Ms Broderick.

She used the limited evidence available and consulted medical and nursing colleagues to secure their support, working closely with a consultant to agree inclusion criteria, criteria for incremental weaning off oxygen and to define when patients should be referred for medical review. 

‘These families are often desperate to start a normal life free from lines, tubes and cylinders’

Joanna Broderick

Joanna Broderick
Joanna Broderick is proud to be a children's community nurse. Picture Apex

She also sought advice from a medical colleague involved in the development of British Thoracic Society guidelines.

Next she wrote a ‘thorough, evidence-based’ business case for the equipment she would need.

‘Nurses need to be able to review oxygen saturation reports in the family’s home, but our existing monitors were unsuitable,’ she says.

The business case was accepted.  ‘All nursing and medical colleagues were trained on the guideline, the equipment and software before implementing the guideline in practice.’

Joanna Broderick's 15 tips for developing and implementing guidelines

  1. Have a passion or dream and follow it
  2. Always remember your patients are at the heart of the change
  3. Eat, sleep and breathe your idea, and believe it can be achieved
  4. Be patient – it takes a long time to bring about change
  5. Involve key stakeholders, including patients, families, consultants and colleagues, from the outset
  6. Gain support and seek agreement from key individuals
  7. Be informed and knowledgeable. Research your subject matter well. Refer to an evidence base
  8. Use a continuous improvement model, such as NHS Improvement's Plan, Do, Study, Act
  9. Don’t be afraid to embark on things you have never done before. This will be a learning curve
  10. Ensure any supporting documentation is simple and easy to understand
  11. Understand the benefits of the change and plan how you will measure the impact. This will be another learning curve
  12. Implement outcome measuring methods
  13. Present findings to keep stakeholders engaged
  14. Be prepared to make further improvements – change is a constant
  15. NEVER GIVE UP

 

Clear understanding

At first, however, not all of Ms Broderick’s colleagues were convinced they should adopt the guideline.

‘A small number of paediatricians preferred to continue their own practice,’ Ms Broderick explains.

j_broderick_david_bartle
Joanna Broderick with her colleague, consultant paediatrician David Bartle. Picture: Apex

‘Some felt uncomfortable with a nurse-led guideline because they were concerned they would not be fully informed about the decisions being made.

‘We acknowledged the concern and agreed to communicate all changes to the consultant to ensure clear understanding.

‘Some remained reluctant so we introduced the guideline at discharge planning meetings, and agreed the approach jointly with parents and colleagues at the outset.’

'Joanna Broderick's drive and enthusiasm have been truly inspirational'

Consultant paediatrician David Bartle

The effect of the guideline has been impressive. Before it was introduced, weaning a baby with chronic neonatal lung disease from oxygen took an average of 21.75 weeks; the guideline has reduced this to 11 weeks.

The nursing hours required to wean a baby reduced from an average of 168 hours to an average of 68 hours.

‘This dramatic reduction has introduced cost efficiencies across the service and the wider NHS, enabling the community children’s nurse specialists to provide care to more patients without increasing resources,’ says Ms Broderick.

Feedback

Families’ feedback has been excellent. ‘The project has empowered families to become involved, educated and resilient at a stressful time in their lives,’ says Ms Broderick. ‘It has given them confidence and taken away their fears.’

Since her work appeared on the Shared Learning Platform for the National Institute of Clinical Evidence, she has been contacted by national and international clinical colleagues asking if they could use the guideline.

‘It appears it is the first of its kind, meets a significant clinical need and is likely to be the basis for weaning programmes throughout the UK and beyond,’ she says. ‘I feel so proud to be a children’s community nurse and proud to be an advocate for my patients and their families.

‘Winning an RCNi Nurse Award makes the three years it took to get my project going so worth it. It has been about the benefit to the patients and families, but this is the icing on the cake. Hopefully it will inspire other nurses.’

Feedback from patients

Sarah Ostler felt emotional in bringing her baby, Edith, who was born at 25+5 weeks, home from hospital on oxygen. She worried how they were going to cope and how the nurses would know they could wean her off. Community children’s nurse Joanna Broderick showed her the oxygen weaning guideline.

‘It took any worries we had away,’ says Ms Ostler. ‘It was so easy and simple to follow. We knew exactly what each step would entail and how we went about it. It went so smoothly and was the easiest process we had to follow out of all of Edith’s time in and out of hospital, which meant the world to us.

‘If we had any problems, or worries, we just referred to the pathway. I honestly believe without this process of weaning Edith definitely wouldn't have come of the oxygen as quickly as she did. We were amazed.’

Lucy Harman’s twins Harry and Katie were born at 26 weeks. Harry came home on oxygen before the weaning guideline had been introduced. ‘The process took six months altogether and the nurses visited two or three times a week,’ Ms Harman recalls. ‘It felt like a long time and a lot of visits.

‘The nurse would have to come to the house with the monitor, set it up collect it the following day, take it back to the office to download, email the trace download to the consultant and wait for a reply, which would never be quick as they are very busy people. Then the nurse would return to the house to turn down the oxygen. The journey could take them up to two hours.’

Ms Harman thinks the new guideline would have made the process quicker and more efficient: ‘As a parent it feels safe and involves the families. It is like a partnership between the parents and the nurses.’


 

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