NDAU National Neonatal Audit Programme Mike Watkinson

National Neonatal Audit Programme Communication Identity Consolidation Change Two year follow up data Outliers

National Neonatal Audit Programme Communication with contributors – Not just one way – Not just with NNAP leads – Data checking – Clearer definitions and guides

National Neonatal Audit Programme Communication with parents – Not just one way – PREMS and PROMS – how do we achieve them?

National Neonatal Audit Programme Identity NDAU

National Neonatal Audit Programme Identity BUT is notis not NDAU

National Neonatal Audit Programme Consolidation – Existing Audit Questions: Nail them down Clarify fields used for data Use of ad hoc fields – New Questions Fewer Reduce lag between introduction & flagging on screen

National Neonatal Audit Programme Change – From without: Not everyone will always use Badger Challenges of clarity and data mapping – From within: Different questions Completing the audit cycle

National Neonatal Audit Programme Different questions – 2012 – Catheter related blood stream infections – ad hoc fields for data collection

National Neonatal Audit Programme DATAEXAMPLE Staticbirth weight, gestation DailyHRG, CPAP, neurological status, presence of long line Ad hocscans, ROP screening, blood culture Episodicdischarge destination, milk at discharge

National Neonatal Audit Programme Ca DATAEXAMPLE Staticbirth weight, gestation DailyHRG, CPAP, neurological status, presence of long line Ad hocscans, ROP screening, infection Episodicdischarge destination, milk at discharge catheter Stay/episode days

National Neonatal Audit Programme Ca DATAEXAMPLE Staticbirth weight, gestation DailyHRG, CPAP, neurological status, presence of long line Ad hocscans, ROP screening, infection Episodicdischarge destination, milk at discharge catheter Stay/episode days

National Neonatal Audit Programme catheter Stay/episode + - The wrong use of episodic data days

National Neonatal Audit Programme catheter Stay/episode days The correct use of ad hoc data

National Neonatal Audit Programme Outliers The National Clinical Audit Advisory Group (NCAAG) has requested that national audits identify outliers.

National Neonatal Audit Programme Outliers NNAP will identify outliers starting with the 2011 report. Detection of potential outliers NNAP will create funnel plots of outcomes and approach units whose performance is >2 SDs below the mean with an ‘alert’ and those >3 SDs below the mean with an ‘alarm’. NNAP may also approach units >2 SDs above the mean to check their data, and to learn from their good practice.

National Neonatal Audit Programme Some audit measures may be more robust than others, and these will be used for the detection of outliers: 1.Measurement of temperature within an hour of birth in babies <28 +6 weeks 2.First ROP screening within one week of the window designated by national guidelines 3.Breast milk feeding at discharge home for babies who stay in one unit all the time 4.First consultation with parents within 24 hours of a baby’s admission

National Neonatal Audit Programme Funnel plots will show the percentage of babies for whom the audit standard is achieved in each NNU. For each audit standard, some units will fall 2 SDs below the mean on a purely statistical basis. As there are 4 audit standards, individual units will fall >2 SDs below the national mean 0 to 4 times. NNAP will approach those under-performing on 4 standards, and possibly some underperforming on 3 standards if their performance raised alarms (>3 SD below mean) in any of the 4 individual audit standards. Using this approach, NNAP expects that those units with a broad range of difficulties will be recognised and helped first.

National Neonatal Audit Programme Management of a potential outlier:

NDAU NNAP Project Board members 2011 Mike Watkinson Alan Fenton BAPM Neena Modi RCPCH / NDAU Andrew Wilkinson BAPM Roshan Adappa Wales Jane Abbott BLISS Mary PassantNetworks representative Eugene Statnikov NDAU Sridevi Nagarajan NDAU Yvonne Silove HQIP Kim DavisRCPCH Rita RanmarRCPCH

NDAU Any questions? Comments?