Background: In our trust, we have specific guidelines and best practice tips for the care of patients with bronchiolitis, which are based on NICE recommendations. We run an annual programme to monitor adherence to the guidelines and improve the quality of care. This has led to changes in high-flow nasal cannula (HFNC) weaning guidance and improved oxygen prescriptions. Recently, staff noted there was a lack of consistency around nasogastric feeding support and oxygen weaning practices. The objective of this year’s review was to determine current practice and identify where improvements could be made to improve patient care and reduce length of stay. Method: We used the hospital electronic patient record (EPR) to identify all infants under 1 year of age diagnosed with bronchiolitis from October 2023 to March 2024. Only those admitted to the inpatient ward were included. We reviewed the EPR individually to ascertain the following: chest x-rays obtained, viral respiratory screens, feeding regimens advised, including NG or oral, and amounts prescribed. We also looked at respiratory support used, i.e. low-flow nasal cannula oxygen (LFNC) or HFNC. We recorded whether oxygen was prescribed and target saturations documented. In addition, we reviewed the weaning regimes utilised for HFNC.Results: Over the aforementioned time period, there were 55 inpatient admissions with a primary diagnosis of bronchiolitis. Median length of stay was 48 hours, with a mean of 54.8 hours. 12 chest x-rays were performed, of which 9 resulted in no change to management. 38 out of 55 (69%) of infants tested positive for RSV.Of the 40 infants given oxygen, 65%(n=26) had oxygen ordered on the EPR, and 55%(n=22) ordered with target saturations in line with trust guidelines. 65% was a notable improvement on 40.7%, the previous winter.41 of the 55 infants were given NG feeds. Of the 41, only 34%(n=14) followed the trust's best practice guidance for feed volumes. 16 infants were given respiratory support through HFNC, and 24 on LFNC. Of the 16 infants managed with HFNC only 4 were weaned based on trust guidelines. 7 demonstrated a slight deviation from guidelines and 5 infants were not stepped down before room air. The mean length of stay on HFNC was 77.8 hours and 58.3 hours for LFNC.Conclusion: The annual quality improvement process has resulted in improved oxygen prescribing. This year it has highlighted significant inconsistencies for feeding support and weaning of HFNC. Nursing staff were therefore not able to proactively manage these infants, potentially lengthening stay.We are aiming to improve our nurse-led discharge numbers to reduce our length of stay. To support this, we have run education sessions for nursing and medical staff to reinforce the best practice tips for feeding support and weaning from HFNC.
