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Evaluation of Advanced Neonatal Nurse Practitioners: Confidential Enquiry into the management of sentinel cases

Presented at the Neonatal Society 2002 Summer Meeting (programme).

Ward Platt MP, Brown K (on behalf of the Ashington Advanced Neonatal Nurse Practitioner Evaluation Group)

Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK

Purpose of the study: To evaluate the quality of care delivered by Advanced Neonatal Nurse Practitioners at Ashington Hospital.

Methods: A novel methodology for confidential enquiry was developed, which allowed aspects of high quality practice to be captured as well as suboptimal care. Sentinel cases included all babies who within the first postnatal week either died, or were transferred out, or who developed convulsions. Five other hospitals, all with different models of neonatal care, but all based on hierachies of medical staff, were chosen as comparators. Eight dimensions of care were each rated on a scale of 0 to 4 (from seriously deficient to exemplary). Case notes for babies born between April 1998 and March 1999 were anonymised and assessed blind by four raters. If predefined standards of concordance were not met, the notes were rated by a panel independent of any of the participating hospitals, and this rating was taken as definitive. Arithmetical means of the scores were taken for each relevant dimension of care for each case, and the mean for each case was averaged for each hospital.

Results: 82 cases were analysed. The dimension relating to terminal care had insufficient numbers for inclusion. The lowest score for any single case was 0.49 and the highest 3.07; neither case was from Ashington. Mean scores for the comparator hospitals were 1.80, 2.13, 2.32, 2.23, 2.43. The mean for Ashington was 2.35. Results for each dimension for Ashington are related to themeans for all the comparator hospitals in the table below. Ashington scored above average on six out of the seven dimensions.

Conclusions: The quality of care of these sentinel cases appeared to be at least as good when provided by Advanced Neonatal Nurse Practitioners alone as when delivered by medical models of neonatal care. These data support the contention that good quality neonatal care can be delivered by Advanced Neonatal Nurse Practitioners alone, and does not require the presence of resident junior paediatricians.

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