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ConclusionThe non-technical skills of task management and decision-making showed a sustained improvement with in-situ simulation and sharing learning. This project highlighted areas of focus (leadership and situation awareness) for future in-situ simulation based NTS learning. Further PDSA cycles targeted to these specific NTS are recommended.

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Background Down syndrome (DS) is one of the commonest chromosomal abnormalities, overall prevalence 10/10 000 live births. Down Syndrome Medical Surveillance guidelines (DSMIG) are designed for optimal care for this group of children. Objectives We audited our clinical practice in line with the guidelines. We also looked at the prevalence of co-morbidities and other important issues in this group in order to develop a locally agreed revised guideline. Methods Children with DS were identified from Electronic records. Study period: January 2018-January 2019.Last two clinic letters (or one if new) were reviewed. Audit components: surveillance of cardiac disease, thyroid disorders, hearing, vision, cervical spine, growth, sleep, coeliac screen. We also looked at the prevalence of co-morbidities, educational placement and acute paediatric input. Results 54 children were identified. Surveillance of Cardiac: Echocardiogram 100%, CVS examination in clinic: 55%. Prevalence of cardiac disorders: 44%; Thyroid: 100% of children < 2 years old vs 89% in > 2 years. 33% had thyroid disorders; Hearing: 100%, prevalence of hearing impairment: 33%; Vision: <4 years: 100%,> 4 years: 90%, prevalence of visual impairment: 81%; Cervical spine: 31% had evidence of discussion of warning signs; Growth: 88% had documented height and weight, 65% were plotted in the DS growth charts. 29% were documented underweight or overweight; Sleep: 70% had documented sleep history, 24% had confirmed obstructive sleep apnoea; Gastrointestinal: 63% had coeliac screen, 1 had a confirmed diagnosis. 11% had congenital GI anomalies; Neurodevelopmental: ADHD (n=1), ASD (n=4), Tic disorder (n=1). Educational placement: School aged children n=80%, 67% at special school. Conclusions In addition to improving our own practice with the DSMIG, we made additional recommendations on surveillance of sleep: complete sleep questionnaire at 3-4 years of age; coeliac screen as per BSPGHAN recommendation; hip X rays if not weight bearing by 2 years of age.