Neonatal Audit

Hannah SpiersSamuel AgabaBwindi Community HospitalNeonatal Audit

PlacementGlobal links volunteer 5 month placementPost ST3August 2014 January 2015Rural placement Private Christian hospital 1st paediatric volunteer 100 admissions a month to paediatrics

Side room on paediatric ward2 incubatorsBubble CPAPOxygen Phototherapy Nurses cover both neonates and paediatrics 1 nurse overnight

Neonatal Unit

IntroductionCombined audit of various aspects of careFocused on 1st 24 hours of admission HistoryTreatmentObservationsOutcomes

StandardsObservations are performed 2 hourly10% Dextrose is given 2 hourly Antibiotics for all babies admittedVitamin K for all babiesDocument risk factors for infectionAll babies who stay for 5 days or more should be reweighed for discharge

MethodsRetrospective case note review All admissions in August 2014Re audit October 2014Re audit December 2014 Results

Final DiagnosisAugust 2014:Sepsis: 5Prematurity: 3HIE: 3Bronchiolitis / URTI :2Phimosis 1Jaundice 1Stable baby 1NEC: 1Foetal Alcohol Syndrome:1Spina Bifida: 1October 2014:Sepsis: 6Prematurity: 8HIE: 5Jaundice 2Pneumonia: 1RDS: 1Coagulopathy: 1Abdo distension: 1

December2014:Sepsis: 15 Prematurity: 3HIE: 4Jaundice: 4Congenital malformation: 2 Meconium aspiration: 2 Oral candida: 2Postmaturity 1Pulmonary haemorrhage: 1Outcomes 2-4 babies died in each audit cycle Mortality rate of 11 24%1 referral for spinal bifida1 patient escaped Baseline audit Vitamin K given to 56%No documentation of risk factors for sepsis Antibiotics given to all babies 2 (out of 4) incorrect doses of Gentamicin as not adjusted for prematurityAminophylline given appropriately Discharge weights are taken in 33%

InterventionsNeonatal PosterMaternity referral formUpdated referral form already in use with lead Midwife Added fields:Mothers condition Maternal infection? Prolonged rupture of membranes? (>18 hours)Chorioamnionitis? Vitamin K.

Encourage follow up of missing information

Antibiotic guidelineStart antibiotics if:RISK FACTORS present DANGER SIGNS present

Observation for well babies with only one of hypothermia OR tachypnoea in first 4 hoursRe-auditsRisk factors for sepsis August 2014: 0 (0%)October 2014: 3 (16%) December 2014: 5 (29%)Old referral sheet continues to be used for most patients

TreatmentsAug 14: Antibiotics given: 18/18 (100%)Oct 14: Antibiotics given:18/19 (95%)Dec 14: Antibiotics given: 17/17 (100%) Neonatal antibiotic policy appears to be being followed

Aug 14: 2 (out of 4) incorrect doses of Gentamicin as not adjusted for prematurityOct 14 & Dec 14: All doses correct SummaryImprovementsVitamin K administrationNeonatal observationsAntibiotic prescribing Recording of discharge weightsSimple low cost interventionsThank you