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P0370* THE MANAGEMENT OF ENCEPHALOPATHY IN PATIENTS WITH ACUTE LIVER FAILURE: A COLLABORATION BETWEEN PAEDIATRIC AND ADULT SERVICES

Day, H.1; Landers, H.2; Sargent, S.2; Wendon, J.2; Dhawan, A.2

Journal of Pediatric Gastroenterology and Nutrition: June 2004 - Volume 39 - Issue - p S197
ABSTRACTS: Poster Session Abstracts
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1Paediatric Intensive Care,2Institute of Liver Studies, King’s College Hospital, London, United Kingdom

Submitted by: helen.day@kingsch.nhs.uk

Introduction: In the UK there has been increased importance placed upon clinical effectiveness and evidence based practice. This information facilitates the development of clinical guidelines to ensure best practice. Evidence based practice in paediatrics is difficult. Adult based research is adopted for older children. However, those providing care for children continue to argue the importance of providing a separate service to adults but the evidence base is not always available. While there is enthusiasm for conducting research on which to base practice, there are areas where engaging children in research may not be ethical or be in the child’s best interests.

Methods: One such area is the management of encephalopathy in children with acute liver failure (ALF). Therefore a multidisciplinary collaboration between paediatric and adult services was adopted. The aim of the guideline was to provide the nursing, medical and surgical practitioner with a systematic evidence based approach to the management of encephalopathy in ALF. The Clinical Educators took responsibility for writing the guideline following an initial meeting with key members of the intensive care, hepatology and surgical teams. Draft guidelines were issued and feedback sought until a final guideline was defined. Randomised controlled trials (RCTs) are regarded by many as the ‘gold standard’ in terms of evidence for practice. The references cited are a mix of RCTs, and articles journals located on MEDLINE.

Results: The guideline covers all aspects of clinical care of the encephalopathic patient including effective referral and safe transfer or retrieval of patients in ALF. This is a vital but often overlooked aspect of care. The monitoring and management of the encephalopathic patient is based on the medical model using a biological systems approach.

Conclusion: For some children’s nurses, this approach refutes the philosophy that children are different to adults. Two strategies have been adopted to overcome this. Firstly, children and adults are acknowledged as different at appropriate points in the guideline. Secondly, appropriate change management strategies have been adopted to ensure the guideline is implemented effectively. For example, rationale, education and information was provided to all those involved in the care of these patients. The development of a collaborative guideline with adult colleagues has not only provided evidence base for the management of encephalopathy in children with ALF but can be used as an educational tool and highlights areas for audit and further research. It also gave the opportunity to increase collaboration and improve communication between the paediatric and adult Hepatology services.

© 2004 Lippincott Williams & Wilkins, Inc.