Phillipa Cordner1, Jacqui Willcox1, Rachael Fairhurst1, Cari Traicos1
1Gold Coast Hospital and Health Service, Australia
Long term tube dependency in paediatric patients has a significant physical, social and psychological impact on children and their families/ carers. There is also a significant economic cost to the health service.
The use of enteral feeding for neonates and paediatric patients within the Gold Coast Health Service over a 5 year period has increased by 170% however there was limited access to a multidisciplinary hunger provocation model which has demonstrated effectiveness within the literature and anecdotally for tube weaning in children under 2 years of age.
The establishment of the Multidisciplinary Netcoaching Rapid Tube Wean Program was initiated following the successful application by Jacqui Willcox and Rachael Fairhurst to the Gold Coast Health Improvers Program. This awarded $100 000 to plan, implement and evaluate the program over a 12 month period.
Method: Referrals for the Rapid Tube Wean Clinic are received from community and hospital based Paediatricians, and a multidisciplinary face-to-face assessment is completed to establish readiness for commencement of a tube wean. Inclusion Criteria: under 2 years of age, medically suitable, growth tracking (with weight ideally 10% greater than Ideal Body Weight) adequate oral skills for eating and drinking, stable social environment, parental engagement and awareness of mealtime strategies.
Results: Seven children have received assessment and intervention since commencement of the clinic, with 5 children weaned, and 2 children currently receiving intervention for tube weaning. One child required reinsertion of tube for hydration in the context of a viral illness. Netcoaching has been utilised with all children and families with positive feedback regarding children interacting in their usual mealtime environment (staff), as well as time and financial practicalities for parents not required to attend hospital for appointments (families).
Discussion: Enabling factors have included the support of the medical, nursing and allied health teams and preliminary cost analysis, whilst barriers to implementation have included staff recruitment and availability. The key learning is the importance for families to have greater understanding of the tube weaning journey, facilitated by support from other families.
Phillipa Cordner graduated from James Cook University with a Bachelor of Occupational Therapy (Hons I) in 2010. She currently works in paediatrics at the Gold Coast University Hospital in the Child Life Therapy program and a multidisciplinary feeding clinic.