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G19(P) Audit of sickle cell outpatient and inpatient management in a single centre against national standards: Working across boundaries with primary care and non-specialists
  1. KE Hooper1,
  2. A Qureshi2
  1. 1Paediatrics, Wexham Park Hospital, Slough, UK
  2. 2Paediatric Haematology, John Radcliffe Hospital, Oxford, UK

Abstract

The care of children with sickle cell anaemia, both in the community by the general practitioner and in a tertiary care centre, was assessed against the recommended standards set out in Sickle Cell Disease in Childhood: Standards and Guidelines for Clinical Care.

Children with sickle cell disease are a high risk of infection and prevention is important with prophylactic antibiotics and immunisations. Audit standards state that 99% of children should be on penicillin (or alternative) by 6 months of age and 95% should have received 23 valent Pneumovax at 2 years of age and then 5 yearly. Patients should be immunised against Hepatitis B and have the annual influenza vaccine.

Data was collected between July and September 2015. Eleven of 11 children under local review were included in the audit. General practitioners were contacted to obtain information on immunisation history and medication history. 10/11 were on recommended penicillin prophylaxis (91%), 10/11 had received 23 valent pneumococcal conjugate vaccine (91%). 10/11 had been given the Hepatitis B vaccination. Three children were not being given the annual influenza vaccine regularly (73% compliance).

For acute management of pain, children should receive analgesia within 30 min of arrival at the hospital. Medical records, including medication prescription charts, were reviewed to obtain information on management of acute painful crises within the preceding 2 year period. Six children had presented with acute painful crisis. Three of 6 children received analgesia within the recommended 30 min of initial assessment.

The community-based management of these children largely meets the national standards. General practitioners were informed if their patient required immunisation or appropriate antibiotics. Re- audit will be done next year to attempt 99% compliance.

Improvement is needed in management of acute painful crisis. Education for the prompt management of painful crisis will be given regularly for nurses and junior doctors involved in assessment of these patients and re-audit of admissions will be done in the near future.

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