G252 Improving neonatal care in the first 24 h of admission: a completed audit cycle

Aims Neonatal death accounts for 24% of under 5 mortality inUganda, making it the largest cause. In a community hospital in ruralUganda, we aimed to review the care provided in the first 24 h of admission on the neonatal unit and identify areas to improve. We looked at history taken, treatment given, observations performed and outcomes. We used standards from World Health Organisation guidelines and hospital protocols. Method A retrospective case note review was performed on all admissions to the neonatal unit in August 2014. Interventions were undertaken including staff education, updating of the referral form used by maternity staff and development of a neonatal antibiotic protocol. A re-audit was done in October 2014. Results 18 babies were included in the initial audit and 19 babies on re-audit. Vitamin K administration increased from 56% to 100%. Antibiotics were given to 100% of babies in August 2014 as per hospital policy and to 95% of babies in October 2014 following the introduction of a neonatal antibiotic protocol. Half of gentamicin doses (2/4) given to preterm babies were incorrect in Aug 2014 but all were correct (9/9) on re-audit. History of risk factors for sepsis was taken in 0% of admissions in August 2014. In October 2014 this increased to 16%. The updated referral sheet which includes risk factors for infection is not yet widely used by maternity staff. All observations were performed more frequently on re-audit, with respiratory rate recording improving from an average of 4.7 recordings in the first 24 h in August 2014 to 11.9 recordings in October 2014. Recording of discharge weights in babies, who were discharged after 5 days or more, improved from 33% to 92%. Conclusions Improvements in Vitamin K administration, neonatal observations, antibiotic prescribing and recording of discharge weights have been achieved through the audit process. Simple low cost interventions can result in better patient care in a low income setting. There are challenges in implementing changes. Moving forward we hope to improve the history and documentation of risk factors for infection, by more consistent use of the updated referral sheet.