Not For Play, Keep Them away launched in NHS Greater Glasgow & Clyde Health Board (NHSGGC) area in July 2013. NHSGGC Health Improvement, Public Health leads on the programme and works closely with RoSPA, The Royal Hospital for Children in Glasgow, Health Visiting Teams, Health Improvement Teams in HSCP’s and with families of young children.
The initiative aims to provide every parent/carer in NHSGGC, with baby at approximately 12–16 weeks of age, with a small resource pack and information during a brief discussion about keeping children safe and the risks of poisoning from liquid laundry pods or tabs and other household cleaning products. Parents/carers are encouraged to fit the cupboard catch in the kitchen to help prevent access to liquid laundry pods or tabs and other household cleaning products or to move them into a storage area that is not accessible by children.
In 2012, a new trend in unintentional injuries was reported by clinicians at the Royal Hospital for Sick Children in Glasgow. Very young children, averaging 18 months of age, were being brought into the Accident and Emergency department as a result of ingestion of liquid laundry pods or tabs. Before implementation of the campaign across NHSGGC nine children, over one year, were admitted to Yorkhill Hospital’s Ear Nose and Throat (ENT) Department for specialist treatment.
The team also identified that in most cases the child had access to liquid laundry pods stored under the kitchen sink in the family home, within reach and sight of children and that their parents/carers were unaware of the dangers of liquid laundry pods or tabs. These injuries can be life threatening, cause considerable distress to both the child and their family and are costly to treat. Their treatment involves intubation (a machine breathing for the child), surgery and a lengthy stay in our children’s hospital as well as
follow up appointments and in some cases further surgery.
In order to progress a plan to prevent these types of injuries and to consider a way forward, two multi-disciplinary workshops were facilitated. The aim of these workshops was to explore the issues in relation to liquid pod or tab ingestion, the epidemiology, what current standards were in place regarding packaging and how, and if these injuries could be prevented. The focus for the workshops was to consider the evidence base, E’s of injury prevention, and how these might be applied to a preventative programme.
The programme aims to:
Not For Play is delivered in the family home by Health Visiting Teams across NHSGGC. Health Visiting Teams raise the issue, have a discussion with the family about keeping children safe, provide a small home safety pack and ask each family to complete a short evaluation. The teams will also discuss when alternative options to storage are preferred e.g. if the home is rented and the family are unable to fit a cupboard catch. In this case the family will be encouraged to store their liquid laundry pods or tabs in a high cupboard or a cupboard that young children cannot access.
Across NHSGGC the numbers of children admitted to the children’s hospital has been monitored. This has demonstrated a consistent reduction in the numbers of children admitted to hospital as a result of ingestion of liquid laundry pods or tabs, which also represents a significant year on year cost saving to NHSGGC.
The programme continues to raise awareness with staff and parents/ carers and it also played its part in alerting the UK Trading Standards which in turn, meant revised European Standards came into force for the packaging of liquid laundry pods/tabs in 2015. This meant that all packaging had to meet the revised guidelines set out in the Standards.
Challenges have involved continuing to fund the programme as a result of reduced budgets. This is an ongoing issue, however contingency plans have been put in place to allow the programme to continue without distribution of the small packs as staff will continue to raise awareness and as the packaging standards have been changed. Briefing notes have been developed and updated to ensure communication about the programme.
The programme has run over almost 6 years and at times it has been challenging to ensure that the evaluation returns were completed. Continuous communication about the programme has been required via briefing notes and via the strategic group for NHSGGC where all partners are members.
At point of distribution of the small pack a short evaluation card is completed. This allows monitoring of the programme reach, numbers of packs distributed and also allows us to gather parents/carers self reported information about prior knowledge of risks, current storage in the home, if they have experienced a child playing with liquid laundry pods or tabs and if their child has previously swallowed a laundry pod or tab or other household cleaning products. This has allowed continuous year on year monitoring and reporting of Not For Play. Evaluation reports are available on the web link to the RoSPA website in Additional Information.
On reflection, key learning from Not For Play has been the various benefits of a partnership approach. Without this true partnership the programme may not have reached its full potential. Not For Play also benefits from the application of evidence based practice in that it employs a range of E’s for prevention and does not apply these in isolation.
The RoSPA website includes information on the initiative, including evaluation reports. Find out more here.
Mrs Uzma Rehman
Public Health Programme Manager
NHS Greater Glasgow & Clyde.
Mrs Lesley Nish
Health Improvement Lead
NHS Greater Glasgow & Clyde