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G204 RANDOM SAFETY AUDITS: A LESSON FROM INDUSTRY APPLIED SUCCESSFULLY TO THE NEONATAL INTENSIVE CARE UNIT

L. Lee, S. Girish, E. van den Berg, A. Leas.Neonatal Intensive Care Unit, Southmead Hospital, Bristol, UK

Aim: Random safety audits are process audits used in high risk industry to improve practice in previously identified error prone areas.1 They audit real-time practice and provide immediate feedback for instantaneous change to best practice. This is in direct contrast to traditional audits which suffer from long time scales and feedback often occurring after many of the relevant staff have changed job, making the outcome less pertinent. Their use in clinical medical practice is new.2 Our aim was to introduce random safety audits to our NICU and evaluate their success as a means of improving practice.

Method: We designed straightforward data collection tables to audit 11 infection control and four general neonatal standards. Two audits were performed during each weekly grand round. Strategies for feedback of results were immediate verbal feedback during the ward round, use of the staff communication book and a designated audit board. Based on results, guidelines were reviewed, clarified, and amended as necessary. Educational issues were highlighted for improvement in practice. Each audits was then repeated to close and continue the loop.

Results: Between May and November 2005, we completed three audit cycles for each of the 15 topics. Our percentage compliance with the 11 infection control standards for each consecutive cycle, given as median (range), were 63 (20–100), 95 (75–100), and 95 (66–100) respectively. For the general neonatal standards the results were 60 (25–85), 50 (45–82), and 58 (50–100)

Conclusion: We have shown that random safety audits can fulfil the function of improving practice and therefore patient safety. Their ability to improve real-time practice and sustain this change by immediate feedback is an important tool for optimising patient care.

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