To use the audit cycle to assess and improve the standard of neonatal thermoregulatory care.
To demonstrate the usefulness of clinical audit in a resource-limited setting.
Methods A prospective audit was undertaken on the Neonatal Unit at a University Hospital in Ethiopia. During a two week period in October 2012, the temperature of each baby on the daily ward round was recorded using a standard thermometer. Thermoregulatory care was assessed against two standards based on World Health Organisation guidance. These were a) all babies should have an axillary temperature between 36 and 37°C and b) all babies should wear a hat.
Following presentation of the audit to the paediatric department, strategies for improving neonatal thermoregulation were agreed and implemented. These included publication of a thermoregulation guideline, new observation charts, staff training, repair of equipment and provision of individual thermometers for nurses. A second audit was undertaken six months after the first.
Results Sixteen babies (45 temperature measurements) were included in the first audit and 19 babies (62 temperature measurements) in the second audit. The number of axillary temperatures in the target range (36–37°C) increased from 19/45 (42%) in the first audit to 37/62 (60%) in the second audit. The number of hypothermic babies (temperature less than 36°C) decreased from 22/45 (49%) in the first audit to 14/62 (23%) in the second audit. Hat wearing increased from 22/45 (49%) in the first audit to 36/62 (58%) in the second audit.
Conclusions Whilst there has been good progress in reducing under-five child mortality in Ethiopia, neonatal mortality rates have essentially remained static over recent years. Interventions to reduce rates of neonatal hypothermia have been shown to lead to significant reductions in mortality in low and middle-income countries. Very high rates of neonatal hypothermia were observed during this study but simple, low-cost measures improved thermoregulatory care.
This study has demonstrated the successful implementation of the clinical audit cycle in a resource-limited environment. Undergraduate and postgraduate medical curricula in all settings should include training in the use of clinical governance tools such as audit.
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