Term Admissions to NICU ST Michaels Hospital, Bristol Corenna Bowers ANNP

Network Report for UHB Based on 2016 badger net admissions 6.3% local term live births were admitted to NICU Regionally 5.5% admitted National aim <5%

Issues Raised Report considered that some admissions could have been cared for on transitional care or post natal ward Hypoglycaemia – 27 (83%) Respiratory – 22 (18%) Monitoring – 9 (64%) Suspected HIE – 10 (31%) Suspected infection – 5 (83%)

Audit of Unexpected Term Admissions Some of the numbers in the Network report did not “ring true” No NICU feel for our unexpected admission but no one thought we were admitting babies for hypoglycaemia or jaundice unnecessarily However there was a feeling we may admit a high number of babies for very short term respiratory support – could these be prevented

Process Retrospective audit admissions using admission book 01/04/17 – 01/07/17 Ongoing prospective audit until 31/03/18 Badger and phillips notes reviewed

Results 234 babies admitted Asphyxia 42 bilious vomits 20 Hypoglycaemia 11 Jaundice 18 Monitoring 30 Respiratory 110 Social 3

Respiratory 110 babies admitted with primary respiratory issues 13/110 did not require respiratory support 27/42 asphyxia babies also received respiratory support 101 babies received CPAP 26 babies intubated and ventilated

Asphyxia 41/42 babies with possible asphyxia had 6hrs CFM monitoring 1/42 was reviewed by registrar and felt not to meet criteria for passive cooling and was sent back to mother on CDS 8/42 received therapeutic hypothermia

Jaundice All babies admitted with jaundice were at or close to exchange line All recieved triple phototherapy 16/18 received IV fluids, 1/18 required exchange transfusion

Hypoglycaemia All babies admitted with hypoglycaemia required IV fluids 6/11 had blood glucose <2, 4 had blood glucose 2 and 1 had blood glucose 2.1

Implemented Actions Attend one of our simulation sessions Development of new guideline : Respiratory Support and Monitoring for Newborsn >/= 37 weeks Attend one of our simulation sessions Access the e-learning package: http://elearningcontent.south.hee.nhs.uk/scsha/062016_RATA/index.htm Updating hypoglycaemia and Jaundice guidelines

Ongoing Monitoring 2018

Other Issues Completion of Admission Badger – primary reason for admission – education junior medical team Exclusion/Inclusion pre-booked admissions Relatively high number HIE most only 6hrs CFM Classification readmissions from home