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G34 Clinical audit: The management of gastro-oesphageal reflux in infants presenting to childrens accident and emergency
  1. A Lant,
  2. K Holloran
  1. Accident and Emergency, Alder Hey Childrens Hospital, Liverpool, UK

Abstract

Aims Gastro-oesophageal reflux (GOR) symptoms in infants are a common. NICE Guidelines published in January 2015, offer guidance on how to differentiate between GOR and gastro-oesophageal reflux disease (GORD) and recommendations on management. The existing practice in a large Children’s Accident and Emergency unit was audited against the following recommendations:

Weight should be recorded.

Feed history should be reviewed.

Symptoms and history should be reviewed to differentiate between GOR and GORD.

Patients with symptoms of GORD should receive a trial of PPI or H2RA.

Bottle fed babies should have feed amounts calculated.

Alginate therapy should be offered once measures such as smaller, more frequent feeds and breast feeding assessments have been unsuccessful.

Parents should be given advice.

Method Notes reviewed for 100 presentations to the Emergency department for patients:

Coded as ‘GOR’ or ‘GORD’ as diagnosis in A&E notes

Age < 1 year

Representations excluded

Results A&E documentation available for 68 of 100 patients.

Number of Patients:

Abstract G34 Table 1

Conclusion There is a lot of variation in the way reflux is currently investigated and managed in the department. The audit standards as per NICE guidelines are currently not being met. Current weight, faltering growth and feeding amounts are not being routinely reviewed. A large proportion of patients have been started on medication without documented indication. Incorporating these standards into practice may improve diagnosis, symptom control and reduce the need for medications.

A pro forma has been developed for patients with suspected reflux. This incorporates the NICE recommendations. As a large proportion of patients had no documented advice, a parent information leaflet has been developed.

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