Hannah Spiers Samuel Agaba Bwindi Community Hospital Neonatal Audit

Placement Global links volunteer 5 month placement Post ST3 August 2014 – January 2015 Rural placement Private Christian hospital 1 st paediatric volunteer 100 admissions a month to paediatrics

Side room on paediatric ward 2 incubators Bubble CPAP Oxygen Phototherapy Nurses cover both neonates and paediatrics 1 nurse overnight Neonatal Unit

Introduction Combined audit of various aspects of care Focused on 1 st 24 hours of admission History Treatment Observations Outcomes

Standards Observations are performed 2 hourly 10% Dextrose is given 2 hourly Antibiotics for all babies admitted Vitamin K for all babies Document risk factors for infection All babies who stay for 5 days or more should be reweighed for discharge

Methods Retrospective case note review All admissions in August 2014 Re audit October 2014 Re audit December 2014

Results

Final Diagnosis August 2014: Sepsis: 5 Prematurity: 3 HIE: 3 Bronchiolitis / URTI :2 Phimosis 1 Jaundice 1 Stable baby 1 NEC: 1 Foetal Alcohol Syndrome:1 Spina Bifida: 1 October 2014: Sepsis: 6 Prematurity: 8 HIE: 5 Jaundice 2 Pneumonia: 1 RDS: 1 Coagulopathy: 1 Abdo distension: 1 December2014: Sepsis: 15 Prematurity: 3 HIE: 4 Jaundice: 4 Congenital malformation: 2 Meconium aspiration: 2 Oral candida: 2 Postmaturity 1 Pulmonary haemorrhage: 1

Outcomes 2-4 babies died in each audit cycle Mortality rate of 11 – 24% 1 referral for spinal bifida 1 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 prematurity Aminophylline given appropriately Discharge weights are taken in 33%

Interventions

Neonatal Poster Weigh babies for discharge Gentamicin doses for preterm babies 3mg/kg Check respiratory rate every 2 hours Vitamin K for all babies

Maternity referral form Updated referral form already in use with lead Midwife Added fields: Mother’s condition …………………………………… Maternal infection? …………………………………… Prolonged rupture of membranes? (>18 hours)………… Chorioamnionitis? …………………………………… Vitamin K……………………………………………. Encourage follow up of missing information

Antibiotic guideline Start antibiotics if: RISK FACTORS present DANGER SIGNS present Observation for well babies with only one of hypothermia OR tachypnoea in first 4 hours

Re-audits

Risk 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

Treatments Aug 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 prematurity Oct 14 & Dec 14: All doses correct

Summary

Improvements Vitamin K administration Neonatal observations Antibiotic prescribing Recording of discharge weights Simple low cost interventions

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