G346(P) Care pathways and electronic patient records: Computer says no?

Abstract

AimsOver the last seven years we have undertaken an annual audit of our management of bronchiolitis. Over this time, several interventions have been introduced as part of a clinical improvement programme. Following the introduction of a ‘paperless’ hospital in October 2014, we have re-audited this year, to see whether the loss of paper-based guidelines had altered practice.MethodsHospital admissions of infants <1 year old over the period 1/10/2014–31/03/2015, with a clinical diagnosis of bronchiolitis, were included. Notes were individually reviewed using the hospital computer system. Targets for investigations and managements were set, in accordance with previous years: nasopharyngeal aspirate (NPA) at <5%; chest x-ray at 10%; blood cultures at 10% and bloods at 10%. NPAs are no longer used routinely as data from previous years has indicated that it does not change our management. Data was also collected on steroid, antibiotic, salbutamol, ipratropium, saline nebulisers and IV fluids. PICU/HDU admissions were excluded from this cohort, but were reviewed separately. All results were compared to previous years’ audit results.Results65 patients met our inclusion criteria. There was an overall increase in each investigation compared to last year (Figure 1). There was an increase in steroid and salbutamol treatment. Steroid treatment increased to 9% (Figure 2) and salbutamol treatment increased to 25% (Figure 3). There was also an increase in PICU/HDU admissions to 19 (previous year: 8). 11 of these were admitted to PICU/HDU for treatment with optiflow.Abstract G346(P) Figure 1Percentage of admissions investigated with NPAs, blood cultures, bloods or chest X-ray (CXR) over seven yearsAbstract G346(P) Figure 2Percentage of admissions treated with antibiotics or steroids over seven yearsAbstract G346(P) Figure 3Percentage of admissions treated with salbutamol, ipratropium, saline nebulisers or IV fluids over three yearsConclusionAlthough not statistically significant, the increase in inappropriate management of bronchiolitis this year suggests the need to ensure protocols previously implemented via integrated care pathways are still being followed adequately when changing to an electronic system. This may apply to other management protocols. It has been decided to produce monthly progress posters to remind staff of appropriate management, in addition to embedding the original integrated care pathway into the electronic record system.