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The Future of Blood To Baby

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The Blood to Baby campaign initially targeted professionals involved in the childbirth continuum, it empowered them in their role as advocates of public health promotion and in turn they helped direct others to the website. The stickers, postcards, posters and the new infographics have now been shipped as far as New Zealand, South Africa and Palestine as well as across the UK. Midwifery societies have also utilised the tools for their study days and conferences.

To date over 15,000 resources have been posted and Twitter reach now stands at over 2 million. New resources have since been added to the Blood To Baby portfolio, particularly an infographic to advise expectant parents about delayed cord clamping and the changes to practice. Enabled by the wide audience reach through Twitter and the website, parents are also now choosing to access the resources themselves. I have also developed an infographic to support professionals in their understanding of the physiology of increased blood volume transition, and many have reported a new understanding and appreciation of the importance of increased blood volume in the adaptation from fetal to neonatal life.

Evidence based practice and woman centred care are the pinnacles of midwifery philosophy. The Blood To Baby educational tools alleviate controversy and enable midwives and parents to offer and receive informed evidence based choice. Resources primed with strong research messages mean health professionals can impart knowledge to women who will understand the benefits for their baby. Perhaps most importantly: the Blood To Baby campaign demonstrates how social media can be utilised in public health promotion, it breaks down barriers between NHS workers, other professionals and service users uniting us all powerfully to share a message.

There is no end to the benefits a campaign like this can have, and this has been recognised now that the resources have now been endorsed by NICE (April 2016). From a public health perspective the campaign has helped to raise awareness about optimal cord clamping. The evidence tells us optimal cord clamping improves scores in fine motor and social domains at 4 years of age when compared to immediate cord clamping (Andersson et al, 2015)*.

Following its amazing success over it short life, plans are now being made for the future of the campaign where we will focus on delayed cord clamping for premature babies and following publication of further expected research: resuscitation of the neonate with the umbilical cord intact.

Physiologically, optimal cord clamping provides gentle pulmonary transition to the neonate and, in a similar way, the Blood To Baby campaign aims to smooth the transition between the evidence and change in practice.

If you have been inspired by Hannah's work you can find out how you can help on the Blood to Baby website.

*Andersson et al. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343:d7157
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The Beginning of Blood to Baby

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The #BloodtoBaby campaign started in March 2015 through social media after sharing self-made Optimal Cord Clamping stickers. Requests for the stickers became overwhelming, realising there was a public desire for tools to inform women about the benefits of delayed cord clamping I started the #BloodtoBaby campaign. Today individuals and Trusts are able to order materials from bloodtobaby.com free of charge. Demand for materials continues and forward plans for the campaign are being made.

Research shows clear proven benefits resulting from the baby receiving its full circulating blood volume from the placenta and we know there are potential harms to the neonate when practicing immediate cord clamping.  In the UK, NICE  guidelines (2014) now recommend delayed or optimal cord clamping, however, it has yet to be implemented as routine practice in all hospital trusts. The term ‘optimal’ cord clamping is used for the campaign because it signifies the importance of practicing in-line with each individual situation, but the delay is usually longer when the umbilical cord is completely drained of blood and has a white appearance. For some babies placental transfusion will take longer and for others it will be shorter; at the moment there is no definitive time to wait before clamping the cord.

Initially the Blood to Baby campaign developed organically: starting with sharing the stickers on social media to then realising that midwives and birth workers wanted clear information about the benefits of delayed cord clamping, and tools they could use and give to women to prove a discussion about delayed cord clamping had taken place. Utilising the power of the social media platform I began to network and collaborate with many passionate like-minded individuals with the aim of sharing important messages about optimal cord clamping.

Understanding that all good campaigns have a brand I developed a logo, kindly assisted by the expertise of my sister, Julia Tizard who was excited about the project idea and also a keen supporter of delayed cord clamping. It was then I started to look for the iconic picture: an image that truly signified what optimal cord clamping is. I wanted a clear visual message and the picture chosen was one that hadn’t been widely seen before. I contacted the owner who, in agreement with the photographer, gave me permission to use it for the campaign. I designed the campaign poster and postcards myself, making sure all the salient points about the evidence for delayed cord clamping were included.

An initial personal investment enabled me to print the campaign poster and postcards. Due to demand, resources quickly ran out but people continued to request the materials. Many generous supporters donated towards further printing costs, but this was not a sustainable option for the future. I had to find a solution and my thoughts turned to finding sponsorship. I made contact with Inspiration Healthcare, manufacturers of the Lifestart resuscitation unit which enables neonatal resuscitation with the umbilical cord intact. I felt that Inspiration Healthcare’s involvement with and support of the campaign could only add to its credibility. Wonderfully, this resulted in official sponsorship which opened doors to new possibilities. The help of Inspiration Healthcare enables the Blood to Baby educational tools to be printed and distributed free of charge.

This then raised another challenge: where would people order the materials? My inbox was already overflowing! I needed a central point of access where people could order the resources and be provided with links to research and other sources of knowledge. Utilising my own web designing experience I built and developed bloodtobaby.com.

Hannah will continue the Blood To Baby success story in a couple of weeks with the concluding part of her blog....

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Interview with Mia Small, winner of the Pamela Harris award

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Nurse Consultant Nutrition & Intestinal Failure

Department of Clinical Nutrition, St Mark’s Hospital

After qualifying as a Registered Nurse at St Thomas’ Hospital in the mid 80’s, Mia worked for a number of years in gastroenterology and colorectal surgery. She began working at St Mark’s Hospital; part of London North West Healthcare NHS Trust, first as a Staff Nurse, then Sister, and became a Clinical Nurse Specialist in Nutrition in 1999.  She has subsequently held lead Nutrition Nurse Specialist posts at Barts and the London and Guy’s and St Thomas’.  She returned to St Mark’s as Nurse Consultant in Nutrition and Intestinal Failure in 2008, and was an Honorary Lecturer at the Burdett Institute of Gastrointestinal Nursing until its closure in 2011.  Mia holds a BSc (Hons) in Colorectal Nursing, a Diploma in Human Nutrition and an MSc in Nutrition Support. 

Using Micrelcare with St Marks patients is a unique and first collaboration between St Marks and Industry.

When and why did you start using the Mini Rythmic PN+ Pump and Micrelcare?

We started the Micrelcare project in 2013, since then we have been able to analyse 6000 data points. From this information it has been possible to determine what the average line pressure is and subsequently what is abnormal. Although clinical benefits are in the infancy we are hopefully developing algarithims which will be able to predict if someone is going to get a line occlusion.

Is there anything else that has been highlighted since you started using Micrelcare?

From my perspective as a nurse it has provided me and my colleagues with an invaluable insight into life on HPN. ( Home Parenteral Nutrition ). Knowing how often people get an alarm may seem very trivial and they cannot tell you how many times the alarm has sounded, however other family members are very aware of the alarms. Some have clusters of alarms, others have alarms over a concentrated period of time up to 45 minutes.

How did you feel about using this technology?

To begin with I was sceptical and worried it may be viewed as an intrusion, however reviewing someone’s infusion history has often been the starting point of a conversation which would not normally taken place. Also it has revealed that sometimes people are not confident to reduce their prescription. Being able to reassure patients that the pump is not over or under infusing.

How have the patients felt about using the technology?

Patients have given very positive feedback to the monitoring as they are reassured that we are able to keep an eye on things. It is not for everybody and some patients have declined using it.

What is the Pamela Harris Award?

The Pamela Harris Award is sponsored by the Nightingale Trust. The Nightingale Trust is a charity whose objective is to educate healthcare professionals in providing good nutritional support through education and training. The award is named after Pamela Harris, one of the founders of the charity, and a patient who is reliant on artificial nutrition support.

I was genuinely surprised to win this award, because you don’t think what you are doing deserves the recognition as it is just your job. It made it extra special as I know the patient who the award is named after.

Harnessing innovative pump technology to improve the experience and outcomes of patients receiving home parenteral nutrition

Home parenteral nutrition (HPN) is a lifesaving therapy for severe intestinal failure.  Infusion pumps play a key role in the life of these patients. They ensure the accurate delivery of fluid and alert patients to potential infusion or catheter related problems.  Pumps have typically not permitted analysis of this information meaning that the nature and frequency of alarms is not known.  In addition, infusion history is a vital part of HPN monitoring. This has traditionally relied on informal methods such as patient recall, measurement of stock used and/or stock ordered.  Collaboration with industry (Micrelcare™) allowed information about alarms, infusion histories and pressures to be exported anonymously to a secure server using GPRS technology.  This was achieved by attaching a special external battery pack to the pump and switching on the device prior to commencing an infusion. This presentation will present our experience with the technology and the potential clinical benefits. The data obtained established normal infusion pressures which alongside the nature of alarms facilitated early intervention for catheter occlusion, and also suggested pressure spikes might indicate an upcoming problem, such as thrombosis.  Reviewing infusion histories assisted in the ongoing assessment of patient's requirements and permitted reduction in the number of nights feeding. Patients also reported feeling reassured by the technology and more involved in their ongoing care.

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A Day in the life of... a Product Specialist

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My role as a Product Specialist takes me in many different directions and gives me opportunities to speak to hospital nutrition teams, homecare companies, homecare nurses, patients, patient’s carers, parents, all on a daily basis! A typical day in my experience puts me in contact with some dedicated and kind people who work tirelessly to make patients and family member’s lives better.

An example of a day would start with a drive from my home in Northampton to Spondon in Derbyshire to carry out training with around 15 nurses on the Micrel PN+ Pump. Clare, one of Inspiration Healthcare’s Support Trainers, meets me for a quick cup of tea, a catch up and to plan the training session.

The nurses we are training have a mixture of knowledge, some nurses are using the pump on a regular basis others are new to the device. I give an overview of both Inspiration Healthcare and Micrel then go through the pump showing how to operate it and talk about the different settings; pumps will be passed round for the nurses to put what they have been shown in to practice. I will then discuss the different giving sets and which hospitals use which sets followed by talking through the various alarms that can be triggered and how to troubleshoot them. Training sessions are usually very informal as nurses often want to discuss specific issues they may be having with particular patients. I explain that the session is very much the nurses’ chance to discuss any concerns they may have regarding the pump whether they be good or bad!

The training goes well with lots of questions being asked and lively discussions around Parenteral Nutrition and the Rythmic PN+ Pump in particular. At the end of the session all the nurses are happy to use the pump, they leave clutching my business card “just in case”!

I then drive to South Normanton to visit a young boy and his mum, who have been using a different pump and now want to try the Micrel Rythmic PN+ Pump. The young boy has been having HPN (Home Parenteral Nutrition) since birth and is now 10 years old, he is in a wheelchair and has limited speech. Mum does all his care including the connection every night and disconnection of his feed every morning. Following both these procedures properly is highly important as it is imperative that no infection gets in to the CVC (Central Venous Cathether) which goes in to the patient’s heart.

I spend about 2 hours with the family carrying out the training on how to use the Rythmic PN+ and answering any questions they have. Then its back in the car with a stop on the motorway for a quick coffee and to answer a couple of emails before heading for home!

Moira Kallis started her career in nursing at 16 years old as a Cadet Nurse, and qualified as a State Enrolled Nurse in 1982. She subsequently qualified as a Registered General Nurse in 1996 and worked for 18 years as a Community Nurse and  for Hospice at Home in Cumbria. Moira worked for CALEA, a private Home Care Company for 10 years as a Nurse Manager, managing a team of 12 full time nurses and 30 support nurses before joining Inspiration Healthcare five years ago where she focuses on Parenteral Nutrition and Infusion Therapies.

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A Day in the life of... an ICU Nurse

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A morning shift would start at 7am. A gentle walk onto the unit would reveal how the land was lying: what sort of nightshift had passed? Was the defibrillator out of position? Were the phones going unanswered? Was there a Consultant on the unit? Was there a transfer trolley out of its store room? Was the place looking like Notting Hill Carnival the day after the Bank Holiday? Were there gaunt faces, so glad to see the next shift that they danced about, delirious that the end of their night was almost over? They’d survived the last 12 hours.

…Alternatively what mostly happened was the night staff would just be writing and signing their nursing documentation and be ready to head home.

A summary of the quantity and quality of the patients on the unit would be given; “a hand over” given by the Nurse in Charge to the incoming staff: an overview about each patient and any admissions pending.  Staff were then allocated to patients with skill mixes, patient condition and quantity of staff taken into consideration; ideally there would be enough staff for a ratio of 1 Nurse to 1.

A longer handover was then given by the night staff to the day staff at the bedside of each patient. That handover is broken down into nine systems related to the patient as a whole: Respiratory, Cardiovascular, Neurological, Pain & Sedation, Elimination, Personal Care, Nutrition, Mobility, Skin and Communication.

A visual check of the infusions and drugs, ventilator settings, chest drains, wound drains, drug chart, or anything worthy of “handing over” by both the incoming and departing nurse would be the cue for the nights to go home (skipping and running) and the day staff to get started in earnest.

A further individual check of all equipment then occurred: recalibrating machines, checking of emergency equipment, suctioning and your emergency ventilation oxygen and bag, just in case. Then work a plan for the day. That plan would be to shoe horn in a wash, fresh sheets, 4 hourly turns to avoid pressure sores, a drug chart to co-ordinate, relatives to keep updated, breaks to fit in, infusions to anticipate replenishing, mouthcare, eyecare, a ward round with Doctors changing your plans or if it really wasn’t your day: a trip to CT scan or to get the kidney machine out.

Being in charge of the shift brought a slightly different pace to it. A more detailed report of all patients from the nurse in charge of the night shift, a check of the controlled drugs cupboard, a check of the emergency equipment, co-ordination of staff breaks, a chat with the Matron and join in the ward round which usually started at 8am.

The “In Charge” tag had its own challenges and tests not limited to juggling staff shortages, skill mixes, well patients who “get broken”, challenging relatives, complaints, student teaching, stock levels, drug ordering, being the discharge and admission liaison and throw into that the odd Cardiac Arrest, occasionally a patient who wants to self-discharge, an organ donation to help organize, relatives to speak to or even deal with a girlfriend and wife turning up to visit the same patient at the same time….there was never a dull moment!

Owen Wainwright qualified from York School of Nursing in 1995. He worked for 2 and a half years in Urology Nursing, followed by 9 years in ICU Nursing across Yorkshire and West London, and overseas in Australia and New Zealand. Owen’s last post in nursing was as a QMC AICU Charge Nurse; he joined Inspiration Healthcare in 2006.

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