{"id":1439,"date":"2019-03-08T20:17:59","date_gmt":"2019-03-08T19:17:59","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc\/?p=1439"},"modified":"2019-03-08T22:22:20","modified_gmt":"2019-03-08T21:22:20","slug":"guest-post-is-sitting-on-your-hands-an-option-these-days-for-babies-with-bronchiolitis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2019\/03\/08\/guest-post-is-sitting-on-your-hands-an-option-these-days-for-babies-with-bronchiolitis\/","title":{"rendered":"GUEST POST: Is \u201csitting on your hands\u201d an option these days for babies with bronchiolitis?"},"content":{"rendered":"

\"\" Paediatric doctors and nurses have long been dismayed that we have no useful interventions (other than supportive therapy) for babies with bronchiolitis. We have known for decades that using nebulisers, doing chest x-rays, and starting antibiotics are generally pointless for most infants with bronchiolitis \u2013 they are more likely to lead to overtreatment and harm than provide any useful benefit. The current generation of consultants, when we started as registrars, were told that most babies with bronchiolitis get better, some get worse, and the best thing to do is monitor closely, support the baby, and \u2018sit on your hands\u2019 unless you have to do something. This generally works pretty well, and we have tried to engrain this ethos in our juniors.
\n<\/p>\n

Every year centres around the UK do audits which show that we do too many investigations and start too many interventions, despite our guidelines telling us not to. At least, that has been the case in our centre. Our regional children\u2019s hospital is one of the largest and busiest paediatric hospitals in Europe, and we pride ourselves on being a centre of excellence. When we audited our management of bronchiolitis we realised that maybe we weren\u2019t being excellent – there was a disconnect between what is written in our guidelines and what was being done in practice. We, fortunately, work in a hospital in which we are able to openly question each other to learn where we are going wrong, and in an environment where we want to hear from nursing staff, parents, and junior doctors. In this blog we wanted to share an anecdote that has led to improvements in our service.<\/p>\n

When revamping our bronchiolitis guideline our general paediatricians echoed the results of our audits \u2013 they felt we were using too many nebulisers and doing too many chest x-rays. So we asked \u201cwhy are you doing these things, when you know they don\u2019t help?\u201d. We found that most were being done out-of-hours, so we asked the junior doctors \u201cwhy are you doing these things, when you know they don\u2019t help?\u201d. They told us that sometimes the nursing staff were insistent that they had to do something imminently \u2013 \u2018sitting on your hands\u2019 didn\u2019t seem like the done thing any more. So we asked the nurses \u201cwhy are you doing these things, when you know they don\u2019t help?\u201d. They told us that parents, all night, were insisting that they should try something \u2013 sitting on your hands isn\u2019t an option any more.<\/p>\n

So we spoke to the parents of babies currently on the ward, who agreed that they had been pushing for interventions all night. We asked them their understanding of \u201csupportive treatment\u201d. Their perception was that when they came through the hospital they were told \u201cthere\u2019s nothing you can do for bronchiolitis, and if you think they are bad now\u2026.. just wait till three days time\u201d.<\/p>\n

 <\/p>\n

(and now … their solution … sorry for missing this earlier … Bob)<\/p>\n

<\/div>\n
We realised that the reason we were using too many interventions was because we had been, inadvertently, disempowering parents. We have now changed the way we approach parents with bronchiolitis \u2013 we try to tell them that their baby may well get worse but there are lots of things they can do to try and ameliorate that deterioration: \u201cpick up your baby if they are crying\u201d (physiotherapy), \u201cmake sure people wash their hands before they examine your baby\u201d (infection control), \u201cmonitor how much your baby is feeding and let the nurses know if you are worried\u201d (nutrition). According to our business intelligence unit we saved hundreds of thousands of pounds in that bronchiolitis season.<\/div>\n
<\/div>\n
I still think \u2018sitting on your hands\u2019 is the right thing to do:<\/div>\n
<\/div>\n
\u2018Sitting on your hands\u2019 involves a complex multidisciplinary approach to monitoring and managing babies<\/div>\n
<\/div>\n
\u2018Sitting on your hands\u2019 means protecting babies from harmful, useless interventions and investigations<\/div>\n
<\/div>\n
\u2018Sitting on your hands\u2019 requires an up to date understanding of current evidence, and pathophysiology, and being able to communicate that with colleagues and parents.<\/div>\n
<\/div>\n
\u2018Sitting on your hands\u2019 requires us to train and empower nursing staff to ensure they know they are central to that care.<\/div>\n
<\/div>\n
And \u2018sitting on your hands\u2019 requires us to brave enough to draw on the skills and resources of parents. Only then will they realise how effective \u2018sitting on your hands\u2019 can be, and we can provide the supportive therapy that babies with bronchiolitis need.<\/div>\n

 <\/p>\n

 <\/p>\n

Ian Sinha, consultant respiratory paediatrician, Alder Hey Children\u2019s Hospital, Liverpool<\/p>\n

Jennifer Holden, Advanced Nurse Practitioner, Alder Hey Children\u2019s Hospital, Liverpool<\/p>\n

Helen Cibinda, Senior Manager, Alder Hey Children\u2019s Hospital, Liverpool<\/p>\n

 <\/p>\n

iansinha@liv.ac.uk<\/a>, Twitter: @iansinha<\/p>\n","protected":false},"excerpt":{"rendered":"

Paediatric doctors and nurses have long been dismayed that we have no useful interventions (other than supportive therapy) for babies with bronchiolitis. We have known for decades that using nebulisers, doing chest x-rays, and starting antibiotics are generally pointless for most infants with bronchiolitis \u2013 they are more likely to lead to overtreatment and harm […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2675],"tags":[],"class_list":["post-1439","post","type-post","status-publish","format-standard","hentry","category-guest-post"],"yoast_head":"\nGUEST POST: Is \u201csitting on your hands\u201d an option these days for babies with bronchiolitis? - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2019\/03\/08\/guest-post-is-sitting-on-your-hands-an-option-these-days-for-babies-with-bronchiolitis\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"GUEST POST: Is \u201csitting on your hands\u201d an option these days for babies with bronchiolitis? - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"Paediatric doctors and nurses have long been dismayed that we have no useful interventions (other than supportive therapy) for babies with bronchiolitis. 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