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Quality improvement project to routinely identify sensory and eating challenges in childhood neurodevelopmental
Sandra-Eve Bamigbade1,2, Sara Sopena3, Tammy Hedderly3,4
1University of Hertfordshire Department of Psychology Sport and Geography, Hatfield, UK s.a.bamigbade@herts.ac.uk.
Insights
Routine screening for sensory, eating, and mealtime (SEM) challenges significantly improved documentation in young people with neurodevelopmental movement disorders. This quality improvement project enhanced identification and follow-up care for these common issues.
Area of Science:
- Pediatric Neurology
- Clinical Quality Improvement
- Developmental Pediatrics
Background:
- Sensory, eating, and mealtime (SEM) challenges are prevalent in youth with neurodevelopmental movement disorders.
- These challenges are frequently overlooked during initial clinical assessments.
- Effective identification and management are crucial for improving patient outcomes.
Purpose of the Study:
- To assess the impact of routine SEM screening on identifying challenges in pediatric patients.
- To improve the documentation and follow-up of SEM challenges in a specialist clinic.
- To evaluate the effectiveness of a quality improvement project using the SHIFT-Evidence Framework and Plan-Do-Study-Act (PDSA) cycle.
Main Methods:
- Implementation of a 3-month routine SEM screening trial in a pediatric movement disorder clinic.
- Utilized the SHIFT-Evidence Framework and PDSA cycle for intervention and evaluation.
- Analyzed assessment outcome letters at baseline, during the trial, and in a retention phase to track documentation changes.
Main Results:
- Documentation of SEM challenges increased from 33% at baseline to 71.9% during the trial and 64.3% in the retention phase.
- Actionable recommendations and interventions for SEM challenges were initially limited but improved in the retention phase.
- The project demonstrated increased identification and improved, tailored guidance for SEM challenges.
Conclusions:
- Routine SEM screening is vital for identifying common challenges in youth with neurodevelopmental movement disorders.
- Quality improvement initiatives can enhance clinical documentation and follow-up for SEM issues.
- Standardized assessment tools and protocols are recommended to further support clinicians.
Abstract:
Sensory, eating and mealtime (SEM) challenges are common among young people with neurodevelopmental movement disorders but are rarely assessed during initial clinical consultations. This quality improvement project aimed to evaluate the impact of routine SEM screening on identifying these challenges and improving documentation and follow-up in a specialist paediatric movement disorder clinic in England. Using the SHIFT-Evidence Framework and a Plan-Do-Study-Act approach, the project implemented and evaluated a series of interventions. In the 'PLAN' phase, clinicians participated in a workshop to raise awareness of SEM challenges and inform the development of screening questions to support routine SEM assessment. The 'DO' phase involved implementing routine SEM screening during a 3 month trial, supported by active measures such as project champions, weekly reminders and team discussions to encourage sustained practice. The 'STUDY' phase included analysis of assessment outcome letters from three time points (baseline, trial and outcome retention phases) to evaluate changes in documentation and the sustainability of improvements. In the 'ACT' phase, findings were shared with the team, resulting in improved signposting, targeted recommendations and ongoing collaborations with feeding clinics. Findings demonstrated increased documentation of SEM challenges in assessment letters, with mentions rising from 33% at baseline to 71.9% during the trial and 64.3% in the retention phase. However, actionable recommendations and interventions remained limited during the trial but showed improvement in the retention phase, where letters included more tailored guidance and specific advice for SEM challenges. This project highlights the prevalence of SEM challenges among young people with neurodevelopmental movement disorders and underscores the importance of routine SEM screening. Developing standardised assessment tools and protocols could further aid clinicians in identifying and addressing these challenges during initial assessments.
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