PRACTICE GUIDELINES FOR THE CARE OF PATIENTS UNDERGOING MANDIBULAR DISTRACTION OSTEOGENESIS

Background The purpose of this project was to develop evidence-based multidisciplinary clinical practice guidelines to direct the post-operative care of children with Robin sequence (RS) who undergo mandibular distraction osteogenesis (MDO). The care of the patient with RS who undergoes MDO is a very complex process, and one that requires multiple disciplines and pediatric subspecialists. The goal of this project was to use evidence-based strategies and expert opinion (where evidence was not available) to improve the clinical care of this complex population of children who have RS. The Iowa Model provided the necessary structure to develop the RS practice guidelines. Methods This project took place at a private, non-profit tertiary children’s hospital located in an urban area of Los Angeles. This hospital subscribes to the concept of familycentered care. Children with RS requiring MDO receive care in the newborn and infant critical care unit (NICCU) and pediatric intensive care unit (PICU). The guidelines were developed for children with RS younger than 6 months with airway obstruction caused by micrognathia. Approximately twelve to fifteen patients with RS undergo MDO yearly at this institution. The stakeholders for this project included a multidisciplinary team of providers and the families of patients undergoing MDO. Results The successful post-operative management of complex patients requires clear guidelines. In developing practice guidelines that mitigate variability in care, it was essential to involve the entire multidisciplinary team. Nursing has an opportunity to participate in the development of multidisciplinary practice guidelines to insure comprehensive care. The resulting clinical practice guidelines are comprehensive and inclusive of all stakeholders. Stakeholders have approved the proposed guidelines and they are now ready for piloting. Discussion/Conclusion It is projected that utilizing evidence-based interdisciplinary clinical practice guidelines to direct the post-operative care of children with RS who undergo MDO will significantly improve the quality and care coordination of these complex children. The next steps will be to pilot the guidelines on two to three infants. Feedback from all of the key stakeholders will be critical during this stage, as having their support will help ensure that these proposed guidelines become the new standard of care for the RS population. Once in place, an ongoing evaluation of this new standard of practice will be part of the plan, as well as the dissemination of our results on a national and international level