This paper highlights the dearth of research related to enteral feeding in critically ill children. We found that the use of feeding guidelines improved calorie delivery and so units should be encouraged to develop their own guidelines based on the best evidence available.

To date, the Government has not issued any national ethical guidance to support clinical decision-making in England during periods of potentially reduced healthcare resources in the context of the evolving COVID-19 1 pandemic at the time of writing. In the ensuing vacuum left by a lack of national guidance, ethical frameworks and approaches have been drafted by professional bodies, individual hospitals and trusts. It is clear that in delivering healthcare during this pandemic, more specific guidance is needed to ensure fair and consistent allocation policies, to attain public trust and confidence and to support clinicians so that decisions do not fall on them to make alone and unsupported. This article sets out how we in our institution, a UK tertiary and secondary level stand-alone paediatric provider Trust, set up a Clinical Decision-Making Committee to inform proactive clinical and ethical decision-making, to ensure that all patients are treated appropriately and fairly during these unprecedented times.

Aims The aims of the audit were to:Assess the level of adherence to hospital prescribing guidelines in the Paediatric Intensive Care Unit (PICU). Identify the areas of greatest and least adherence. Identify any possible patient factors that could impact on prescribing adherence levels. Methods A prospective, observational audit of all prescription items written each day, for patients newly admitted to and remaining on PICU during a two week audit period. Patient prescriptions were reviewed at the bedside and prescribing adherence information was captured using a data collection sheet. The data collection sheet was developed to ensure that recommendations dictated by hospital prescribing guidelines were audited. Additional patient data was also collected, in order to determine whether there were any patient factors that could influence the degree of prescribing adherence and consequently the level of prescribing errors. Arch Dis Child 2014;99:e3 7 of 21 Abstracts group.bmj.com on March 22, 2015 -Published by http://adc.bmj.com/ Downloaded fromResults Data was collected for 50 patients during the audit period. 988 prescription items were reviewed, comprising a mean of 20 prescription items per patient, with a mean of 24 drug administrations per patient over a 24 hour period. The audit showed an overall adherence level of 91.62% to prescribing recommendations. No correlation was demonstrated between prescribing adherence and patient factors such as the patient's Paediatric Multiple Organ Deficiency Score (P-MODS). Prescribers had 100% adherence to the recommendation to record the patient's weight on the front of the prescription chart, but only a 14% compliance level with the recommendation to record the date of discontinuation of a drug. During the audit period the level of reported PICU errors entered onto the hospital critical incident database were 5.06 errors per 1000 prescription items; none of these reported errors caused permanent harm to patients due to staff vigilance allowing early detection and avoidance of harm.Conclusions The audit demonstrated that there is currently a high level of adherence to prescribing recommendations by prescribers in PICU. However, the audit has identified areas and prescribing practices that can be targeted in order to further improve adherence levels for prescribers working in the challenging environment of PICU. REFERENCES 1 Wong IC, Ghaleb MA, Franklin BD, et al. Incidence and nature of dosing errors in paediatric medications: a systematic review.

Oral Abstracts 62 girth measurements were identified from the Patient Data Management System and their records were analyzed. Results:Over the study period 36 children (19 male) with a mean age of 23 months (±49.3) underwent IAP measurements and 175 underwent three or more abdominal girth measurements. Both measurements were performed in 23 children. IAP measurements were mostly performed in neonates (52.8%) after closure of abdominal wall defects. The median number of IAP measurements was 14 (range 3-79); the median IAP was 8 mmHg (range 1-44). Eleven children (31%) had an IAP > 20 mmHg, indicating abdominal compartment syndrome. Most patients were treated conservatively and three underwent a surgical intervention. Conclusions:This study shows that after implementation of the IAP protocol nurses most often applied abdominal girth measurements in cases of suspected increased intra-abdominal pressure. We can conclude the nurses' compliance is moderate with IAP protocol. Strategies should be used to improve this.