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

2. 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.

3. 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!!!

4. Demographics

37. 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

38. 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.

39. 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.