1280 Don't lose your HEEADSSS – a student quality improvement project. (17th August 2022)

• Record Type: Journal Article
• Authors: Patel, Prachi; Wilmshurst, Lucas; Appleton, Laura; Qamar, Zaynah; Butler, Mark
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A483
• Page End: A484
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.781
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: HEEADSSS (Home, Education/employment, Eating, Activities, Drugs/drinking, Sexuality, Self-harm/depression/suicide and Safety/social media) is a tool used to structure the psychosocial assessment of adolescents in order to encourage a more holistic understanding of adolescent patients' health needs, and to build rapport between staff and patients. 1 However, a previous internal audit on the usage of the HEEADSSS assessment on our general paediatric ward found that only 1/97 young patients (aged 11-16 years) admitted between 01/02/20 to 20/05/20 had received a formal HEEADSSS assessment. This Quality Improvement Project therefore aimed to increase the proportion of HEEADSSS assessments completed for eligible adolescent patients (aged 11-17 years) admitted onto the general paediatrics ward between 15/10/21 to 15/02/22 to 50%. Methods: Quantitative data: A baseline value for the number of HEEADSSS assessments performed on patients admitted to the ward was measured from 01/09/21 to 14/10/21. Three interventions were then trialled to educate staff on the importance of HEEADSSS and how best to conduct the assessment. The first intervention involved two circular email reminders sent on 15/11/21 and 03/12/21. The second intervention involved the use of staff-facing and patient-facing posters promoting the use of HEEADSSS placed on 15/12/21. For the third intervention, a HEEADSSS teaching session was delivered as part of the junior doctor teaching programme on 02/02/22. The number of HEEADSSS assessments performed on patients admitted to the ward was continuously audited from 15/10/21 to 15/02/22. Qualitative data: Supplemental qualitative data was obtained from staff and patients (11-17 years) via survey responses and interviews, respectively, to understand attitudes towards the HEEADSSS assessment and identify potential barriers. Results: Quantitative results: For the retrospective baseline data collection (01/09/21 to 14/10/21), 1/30 patients received a formal HEEADSSS assessment (3.3%) [ figure 1 ]. For the continuous data collection (15/10/21 to 15/02/22), 5/81 patients received a formal HEEADSSS assessment (6.2 % ) [ figure 2 ]. Qualitative results: Staff noted time constraints, lack of privacy on the ward/difficulty getting the patient alone and discomfort asking personal questions as key barriers to performing a HEEADSSS assessment. However, the majority of respondents (9/13) agreed a HEEADSSS assessment should be performed. Adolescent patients showed a willingness to engage with this assessment. Those who had received a comprehensive HEEADSSS assessment noted the positive impact it made on their well-being and the strengthening of rapport between themselves and the responsible clinician. Conclusion: There was no significant increase in the number of HEEADSSS assessments performed on the ward compared to baseline. Furthermore, the three trialled interventions did not lead to a sustained increase in the number of HEEADSSS assessments performed on the ward, demonstrating the difficulty in enacting cultural change and the prevalence of existing barriers. However, the qualitative results show the importance of engaging with this assessment, and that there is a willingness amongst staff and patients to do so. Further steps should be taken to enact long-lasting change and make HEEADSSS a part of routine clinical practice. Reference: Goldenring JM, Rosen DS. Getting into adolescent heads: an essential update. Contemp Pediatr . 2004;21(1):64-90.