Diarrhoea and vomiting – nurse led pathway and public health information

Attending the paediatric emergency department (ED) due to gastroenteritis accounts for a significant number of attendances. The majority of these patients do not require hospital admission and many may be safely discharged from the PED without the need for any intervention beyond simple reassurance and advice. Providing adequate health promotion to Families in the PED setting is challenging due to a variety of factors including acuity and language.

The aim of the project was 2 fold firstly to create a nurse led guideline to enable the safe identification and discharge of suitable patients attending PED with symptoms of diarrhoea and vomiting and secondly to produce a multi lingual health promotion video to enable families to manage their child's condition at home.

 

We undertook a retrospective audit of 503 attendances to PED with gastroenteritis as a diagnosis. Through review of the medical records we were able to identify factors which increased the risk of admission in order to produce a guideline incorporating a local evidence base. Having established the inclusion and exclusion criteria of the guideline it was then retrospectively applied to the same patient group to identify any patients for whom it would not be sensitive and may pose a clinical risk. Once satisfied that the guideline would compromise patient safety, a training programme for nurses was rolled out.

 

Nurses were required to achieve an assessed level of competence before being able to utilise the guideline, however once completed the nursing team were empowered to safely identify and discharge patients presenting with gastroenteritis symptoms from triage. This was supported by directing families to a multilingual video providing supportive health promotion on how to manage their child's condition. This could be viewed both within the PED and via a link provided on the Internet.

 

Success was measured by recording the number of patients managed using the guideline and rates of reattendance to PED. We were able to demonstrate a reduction in the reattendance rate in patients with gastroenteritis, an increase in the number of patients being discharged utilising the guideline as well as no incidents where safety had been compromised as a result of discharging a patient home.

Work is now underway to identify other conditions where health promotion delivered via video would be of benefit to patients and could be used to augment discharge from the PED.

Vomiting and Diarrhoea Guideline for Children

Nurse-led assessment and criteria-based discharge pathway https://www.dropbox.com/s/7p6g75mid3ko47i/D%26V_Policy_document%20final%20copy.doc?dl=0