1st Hour of Care Pre-implementation Audit

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Presentation transcript:

1st Hour of Care Pre-implementation Audit April 2015 Dr Nilesh Agrawal ST4 Paediatrics Watford

Aim of the audit To gauge current practice in the East of England region, around 1st hour Care To identify areas we are doing well at, and current shortfalls To propagate the results within the region, keeping patients and individual unit data confidential, so that the importance of a Standardized First Hour Care protocol/proforma can be realized. To followup with Post implementation audit(s) and assess improvement in care, if any.

Methods An audit proforma was prepared using Microsoft Excel, to be completed electronically with drop down boxes. Babies were selected using blind randomization with the help of their Unique Badgernet identification numbers. 20 babies from level 1 and 2 Units across all gestation, and a further 5 babies under 26 weeks from the 3 tertiary centres. The lists and audit proforma were shared with Neonatal leads in our 17 hospitals, who identified Local audit champions to finish the data compilation. Data that could be pulled from Badgernet was not asked for, to make the process easier for local champions. Amazing response!!!

Demographics

Doing well Plastic bag Availability of blenders Use of saturation monitors Caffeine within 24 hours Maintaining similar standards in and out of hours Senior doctors present at preterm deliveries

Not so well Delaying cord clamping ‘Documenting’ the use of a hat ‘Documenting’ FiO2 at start of resuscitation, and reasons for increasing FiO2 (understanding target saturations in the 1st 10 minutes) Reasons for intubation? Dose of surfactant used Antenatal counseling Parents seen by neonatal nurses prior to delivery Baby shown to parents after stabilization, if possible. Antenatal Magnesium sulphate for appropriate gestations Time from birth fluids and antibiotics are administered.

Moving ahead Implementation of the FHC pathway Audit practice following implentation Demonstrate phenomenal improvements (hopefully) in the care of our little citizens in the first hour, with an impact on long term outcome measures.