Aim To identify if medical staff in a general paediatrics unit are correctly identifying, classifying and documenting hydration status in gastroenteritis, and to determine if appopriate investigations and treatment were used based on this status and clinical impression. With these findings, to identify ways in which management of gastroenteritis and dehydration in our unit can be improved.
Methods We carried out a retrospective audit, with a target population of children admitted to the paediatrics ward with a working diagnosis of gastroenteritis between January and August 2016. Children included were aged 0 – 14. A criteria form was used to collect our data, and a HIPE database to identify appropriate cases. Initially we audited 130 charts, however following exclusion for a number of reasons 92 were included in the audit. We used guidelines from OLCHC in Dublin to compare our performance against.
Results Documentation: 31.5% of children admitted with a diagnosis of gastroenteritis did not have documentation of hydration status or clinical features regarding hydration. Only 26% had a hydration status documented.
Investigations: 88% of children had blood tests taken, and 30.4% had stool cultured performed.
Treatment: A large number (80%) received IV fluid rehydration, either bolus or maintenance fluids. Only 2 children were managed with Oral Rehydration Solution, and zero received NG tube rehydration. In many cases, the treatment implemented did not correlate with the hydration status or clinical impression given, and as such it was difficult to evaluate if treatment was appropriate.
Conclusions Compliance with OLCHC guidelines as present on the paediatrics ward needed improvement, in all areas including documentation, investigation and management. Documentation was often absent or minimal, and there was variation in the quality of documentation. Many patients had blood tests done where it was not felt appropriate and did not influence the management of the patient. Our results suggested a greater role for the enteral route of rehydration within the department, and that we are overusing IV fluids in most instances. Based on these conclusions, we have carried out education sessions and also plan to make changes to our admission proforma and use more updated guidelines in our management of gastroenteritis. With these changes in place we hope to re-audit in 3 months time.
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