Aim The Paediatric High Dependency Audit was commissioned by the regional network to identify paediatric high dependency (PHD) activity within a specific region that has 4 funded HDU beds. Method Details of patients fulfilling the HDU criteria were collected on each site. The anonymised data was analysed centrally. Each site was visited by the lead nurse for quality purposes. Each patient fulfilling audit criteria was confirmed by the local investigator and final data checked by the lead nurse and lead clinician. PHD activity was recorded by type, diagnosis, location and length of stay (LoS) according to HRG criteria (Paediatric Minimal Care Dataset 2007) and additional criteria agreed relevant by the nine network Hospitals. A lead audit nurse was employed for audit development, analysis and data collection. A similar audit has been performed in the South West region of England. Results The network covers a paediatric population of approximately 500 000 children with nine hospitals all referring to one Paediatric Intensive Care Unit. The network crosses the SHA boundaries. Over a 12 month period, 2500 HDU activities were recorded. Within the HRG criteria the commonest indication for HDU care was oxygen therapy with saturation recording (1100). Within this group 210 had this identified as a single HDU criteria. The remainder had other interventions noted. For example, intravenous or continuous nebulised salbutamol (708), high oxygen requirements exceeding 40% (707), prolonged or recurrent convulsions (110), DKA with electrolyte abnormalities (96) and meningococcal sepsis (57) were identified most frequently as HDU activity by diagnosis. We believe there was significant underreporting of isolated oxygen therapy. LoS per patient varied between units with the individual unit median times ranging between 21.5 and 45 h. Over 1600 episodes were managed on the general paediatric ward or HDU areas utilizing the ward based staff. Conclusions HDU activity is common on general paediatric wards. It is underrecognised and better recording of activity is a prerequisite to improved funding. Training and organisational needs are apparent.
AimsOur Paediatric Sepsis Working Group was formed as a result of a number of timely drivers: local learning from clinical cases, the Government Sepsis CQUIN and imminent publication of NICE guidance on sepsis. Our local Academic Health Sciences Network held a sepsis-focussed breakthrough Collaborative and we agreed to join as a regional group. This was based on our assumption that the well-established Regional Paediatric Critical Care Network would be in an excellent position to successfully deliver regional system change.MethodOver 14 PDSA cycles, a regional Paediatric Sepsis Screening Tool was developed and tested by members of the multi-professional team across the region, gaining point-of-care feedback at each stage and analysing collective data. The Tool was piloted in 5 hospitals within the network before being rolled out region-wide. The tool has also been through two large audits, comprising of the study of 930 acute admission records. User feedback was collected throughout.ResultsOur newly developed Regional Paediatric Sepsis Screening Tool (RPSST) reliably detected all blood culture positive septic patients and those with severe bacterial infections causing physical compromise. User feedback has proven that it is quick and easy to use. The RPSST was also shown to trigger 50% less patients than the current NICE guidance recommends for immediate senior review. There was concern that the introduction of a trigger tool may adversely affect our antibiotic prescribing. Analysis of our local antibiotic prescribing data has not shown an increase in Ceftriaxone prescribing since the Tool’s introduction (static at 6%), demonstrating that the new RPSST is being used effectively within the clinical context.ConclusionsThis Tool has been successfully incorporated into our acute paperwork across the region, enabling Trusts to address the CQUIN targets whilst highlighting this important clinical problem. The Regional PSST compares favourably with the NICE guidance. Collaborative working has reduced the burden of individual working and enabled wider regional engagement, sharing knowledge and expertise and reducing variation in practice. This is supported by the PIER network locally (www.piernetwork.org). We would encourage other regions to explore collaborative working to improve outcomes for patients.
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