VERSION 5 - ACHS · 1.1 Registered nurses with paediatric basic life support ... registered nurses...

PAEDIATRICS VERSION 5

Retrospective data in full ACIR 2008 - 2015

Australasian Clinical Indicator Report 2008–2015 © ACHS. This work is copyright. Requests and inquiries concerning reproduction and rights should be addressed to [email protected]

Contents

Paediatrics, version 5 1

Appropriateness ................................................................................................................................. 1

1.1 Registered nurses with paediatric basic life support qualifications (H) 1 1.2 Medical practitioners with paediatric basic life support qualifications (H) 2 1.3 Paediatric patients admitted to a paediatric ward/area (H) 3

Adverse events ................................................................................................................................... 4

2.1 Medication errors (L) 4 2.2 Adverse events when not in a paediatric ward/area (L) 6 2.3 Adverse events in a paediatric ward/area (L) 7

Documentation ................................................................................................................................... 8

3.1 Completed asthma action plan – paediatrics (H) 8 3.2 Paediatric surgery post-procedural report (H) 9 3.3 Physical assessment completed by medical practitioner and documented (H) 10 3.4 Physical assessment completed by registered nurse and documented (H) 11 3.5 Medical discharge summary completed – paediatrics (H) 12

Paediatric ICU ................................................................................................................................... 13

4.1 Unplanned return to PICU (L) 13 4.2 Adverse events - PICU clinical handover between registered nurses (L) 14 4.3 Adverse events - PICU clinical handover between medical practitioners (L) 15 4.4 Adverse events - PICU clinical handover to another area (L) 15

Paediatric anaesthesia..................................................................................................................... 16

5.1 Paediatric patients who fast 6 hours prior to anaesthesia (H) 16 5.2 Adverse event due to non-adherence to paediatric fasting guidelines (L) 17 5.3 Parent/guardian present at induction of anaesthesia (N) 18

Characteristics of contributing HCOs ............................................................................................ 19

Summary of Results 21

Appropriateness 21 Adverse events 21 Documentation 21 Paediatric ICU 22 Paediatric anaesthesia 22

Expert Commentary 23

Paediatrics and Child Health Division of The Royal Australasian

College of Physicians (RACP) ......................................................................................................... 23

Introductory comments 23 Appropriateness 23 Adverse events 23 Documentation 23 Paediatric ICU 23 Paediatric anaesthesia 23 General/closing comments 23

Australian College of Children and Young People’s Nurses (ACCYPN) ..................................... 24

Appropriateness 24 Adverse events 24 Documentation 24 Paediatric ICU 24 Paediatric anaesthesia 24 General/closing comments 24

Australasian Clinical Indicator Report 2008–2015 Page 1

© ACHS. This work is copyright. Requests and inquiries concerning reproduction and rights should be addressed to [email protected]

Paediatrics, version 5

Appropriateness

1.1 Registered nurses with paediatric basic life support qualifications (H)

Rationale

The appropriate care of paediatric patients is an important measure of quality in acute care settings.

To effectively care and provide better patient outcomes for this specific population, medical

practitioners and registered nurses should have up-to-date paediatric CPR qualifications and

paediatric patients should be located in paediatric wards / areas.

Numerator Number of registered nurses caring for paediatric patients that have up-to-date paediatric

basic life support qualifications.

Denominator Number of registered nurses caring for paediatric patients.

Desirable level: Low High Not specified

Type of Indicator: Process Outcome Structure

Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 6 301 320 94.1 86.1 97.8 12

2015 12 373 402 92.8 88.3 98.0 21 5

# per 100 registered nurses

In 2015, there were 21 records from 12 HCOs. The annual rate was 92.8 per 100 registered nurses.

Variation between strata

There were no significant stratum differences in 2015.

Variation between HCOs

In 2015, the potential gains totalled 21 more registered nurses with current paediatric life support

qualifications.

Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was five fewer

registered nurses with current paediatric life support qualifications. The outlier HCO rate was 70.4 per

100 registered nurses.




1.2 Medical practitioners with paediatric basic life support qualifications (H)

Numerator Number of medical practitioners caring for paediatric patients that have up-to-date paediatric

basic life support qualifications.

Denominator Number of medical practitioners caring for paediatric patients.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2015 3 89 89 100 100 100

# per 100 medical practitioners

In 2015, there were five records from three HCOs. The annual rate was 100 per 100 medical

practitioners.




There were no potential gains in 2015.

Outliers

There were no outlier HCOs in 2015.




1.3 Paediatric patients admitted to a paediatric ward/area (H)

Numerator Number of paediatric patients admitted to a dedicated paediatric ward/area.

Denominator Number of paediatric patient admissions.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 5 13,273 16,512 80.4 61.4 93.8 2,219 1,384

2015 14 19,392 21,831 88.8 77.2 100 2,430 1,085

# per 100 paediatric admissions

In 2015, there were 19 records from 14 HCOs. The annual rate was 88.8 per 100 paediatric

admissions.




In 2015, the potential gains totalled 2,430 more paediatric patients admitted to a dedicated paediatric

ward/area.

Outliers

In 2015, there were four outlier records from three outlier HCOs whose combined excess was 1,085

fewer paediatric patients admitted to a dedicated paediatric ward/area. The outlier HCO rate was 68.8

per 100 paediatric admissions.

Funnel plot of excess events




Adverse events

2.1 Medication errors (L)

Rationale

Medication errors are prevalent in paediatric patients due to their variations in physical size and

physiological capacities, which causes difficulties in determining paediatric dosages. These

medication errors can result in adverse events depending on the magnitude of the medication error

and the timeliness of the response of the ward staff.

Numerator Number of adverse medication incidents involving paediatric patients where the incorrect

dose of medication was administered.




Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 4 7 3,396 0.21 0.076 0.20 4

2015 12 55 19,088 0.29 0.11 0.47 34 33 4


In 2015, there were 21 records from 12 HCOs. The annual rate was 0.29 per 100 paediatric

admissions.


Rates by Public / Private

Year Stratum

No.

HCOs

Total

numerator

Total

denominator

Stratum

rate#

Standard

error

Stratum

gains

2015 Private 5 2 4,427 0.13 0.084

Public 7 53 14,661 0.35 0.047 33


Boxplot of Rates by Public / Private


In 2015, the potential gains totalled 34 fewer paediatric adverse medication incidents due to incorrect

dose, corresponding to a reduction by approximately one-half.




Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was four more

paediatric adverse medication incidents due to incorrect dose. The outlier HCO rate was 1.0 per 100

paediatric admissions.




2.2 Adverse events when not in a paediatric ward/area (L)

Numerator Number of adverse events involving paediatric patients that occur in a ward/area that is not

specifically dedicated to paediatric patients.




Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2015 4 139 7,402 1.88 0.037 2.30 136 26


In 2015, there were seven records from four HCOs. The annual rate was 1.88 per 100 paediatric

admissions.




In 2015, the potential gains totalled 136 fewer adverse events involving paediatric patients,

corresponding to a reduction by approximately four-fifths.

Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was 26 more

adverse events involving paediatric patients. The outlier HCO rate was 2.9 per 100 paediatric

admissions.




2.3 Adverse events in a paediatric ward/area (L)

Numerator Number of adverse events involving paediatric patients that occur in a ward/area that is

specifically dedicated to paediatric patients.




Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2015 5 420 13,858 3.03 0.070 5.89 410 211


In 2015, there were 10 records from five HCOs. The annual rate was 3.03 per 100 paediatric

admissions.




In 2015, the potential gains totalled 410 fewer adverse events involving paediatric patients,

corresponding to a reduction by approximately four-fifths.

Outliers

In 2015, there were two outlier records from one outlier HCO whose combined excess was 211 more

adverse events involving paediatric patients. The outlier HCO rate was 7.0 per 100 paediatric

admissions.





Documentation

3.1 Completed asthma action plan – paediatrics (H)

Rationale

Effective communication through completed documentation is essential for physicians to provide the

most safe and effective care for their patients. This process may reduce the incidence of adverse

outcomes resulting in fewer visits to the emergency department and further hospitalisation.

Numerator Number of paediatric patient separations with a primary diagnosis of asthma who are

discharged with a completed asthma action plan.

Denominator Number of paediatric patient separations with a primary diagnosis of asthma.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 3 217 247 87.9 80.3 99.5 29

2015 3 388 415 93.5 80.4 100 27 22

# per 100 separations

In 2015, there were five records from three HCOs. The annual rate was 93.5 per 100 separations.




In 2015, the potential gains totalled 27 more paediatrics discharged with asthma action plans.

Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was 22 fewer

paediatrics discharged with asthma action plans. The outlier HCO rate was 60.9 per 100 separations.




3.2 Paediatric surgery post-procedural report (H)

Numerator Number of paediatric patients where the post-procedural instructions are documented on the

Surgeon's/Operation Report.

Denominator Number of paediatric patient surgical separations.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 1 343 343 100 100 100

2015 1 170 170 100 100 100


In 2015, there were two records from one HCO. The annual rate was 100 per 100 separations.





Outliers





3.3 Physical assessment completed by medical practitioner and documented (H)

Numerator Number of paediatric patients with a completed documented physical assessment conducted

by a medical practitioner within 4 hours of admission, over a consecutive 7-day period in May

or November.

Denominator Number of paediatric patient admissions, over a consecutive 7-day period in May or

November.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2015 2 116 123 94.3 85.0 98.1 5


In 2015, there were four records from two HCOs. The annual rate was 94.3 per 100 paediatric

admissions.




There was relatively little variation between HCOs and so the potential gains were small in 2015.

Outliers





3.4 Physical assessment completed by registered nurse and documented (H)

Numerator Number of paediatric patients with a completed documented physical assessment conducted

by a registered nurse within 4 hours of admission, over a consecutive 7-day period in May or

November.

Denominator Number of paediatric patient admissions, over a consecutive 7-day period in May or

November.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2015 2 87 123 70.7 57.1 98.1 34



admissions.




In 2015, the potential gains totalled 34 more paediatrics given a physical assessment.

Outliers





3.5 Medical discharge summary completed – paediatrics (H)

Numerator Number of paediatric patients with a completed medical discharge summary in their medical

record, within the time specified in your healthcare organisation’s guidelines.

Denominator Number of paediatric patient separations.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2015 1 846 846 100 100 100


In 2015, there were two records from one HCO. The annual rate was 100 per 100 separations.





Outliers





Paediatric ICU

4.1 Unplanned return to PICU (L)

Rationale

Unplanned returns to a paediatric intensive care unit (PICU) may reflect less than optimal

management of the paediatric patient. This can be attributed to premature discharge as a

consequence of inadequate resources or miscommunication between healthcare professionals during

clinical handover.

Numerator Number of unplanned returns to the paediatric intensive care unit (PICU) during the same

admission.

Denominator Number of paediatric admissions to the paediatric intensive care unit (PICU).



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 1 1 185 0.54 0.54 0.54

2015 2 17 639 2.66 1.06 45.1 10 2



admissions.




In 2015, the potential gains totalled 10 fewer unplanned returns to the PICU, corresponding to a

reduction by approximately one-half.

Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was two more

unplanned returns to the PICU.




4.2 Adverse events - PICU clinical handover between registered nurses (L)

Numerator Number of paediatric intensive care unit (PICU) patients that had an adverse event relating to

clinical handover from registered nurse to registered nurse.

Denominator Number of paediatric intensive care unit (PICU) patients that underwent clinical handover.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 1 0 185 0 0 0

2015 1 0 10 0 0 0

# per 100 paediatric patients

In 2015, there were two records from one HCO. The annual rate was 0 per 100 paediatric patients.





Outliers





4.3 Adverse events - PICU clinical handover between medical practitioners (L)


clinical handover from medical practitioner to medical practitioner.




Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 1 0 185 0 0 0


No data was submitted in 2015.

4.4 Adverse events - PICU clinical handover to another area (L)


clinical handover to another area.




Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 1 0 185 0 0 0






Paediatric anaesthesia

5.1 Paediatric patients who fast 6 hours prior to anaesthesia (H)

Rationale

Fasting prior to the induction of anaesthesia is recommended to minimise the occurrence of residual

gastric volume and acidity prior to surgery. Non-adherence to the fasting guidelines has been found to

result in perioperative respiratory adverse events. Therefore, parents/guardians should ensure that

they comply with the recommended guidelines and report if they have not adhered to them. They may

also wish to be present to reassure the child during the induction of anaesthesia.

Numerator Number of paediatric patients who fast for more than 6 hours prior to induction of

anaesthesia.

Denominator Number of paediatric patients undergoing surgery who were administered general

anaesthesia.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2015 4 1,413 1,553 91.0 69.6 100 140 105


In 2015, there were seven records from four HCOs. The annual rate was 91.0 per 100 paediatric

patients.




In 2015, the potential gains totalled 140 more paediatrics fasting for more than six hours prior to

anaesthesia.

Outliers

In 2015, there were two outlier records from one outlier HCO whose combined excess was 105 fewer

paediatrics fasting for more than six hours prior to anaesthesia. The outlier HCO rate was 63.6 per

100 paediatric patients.





5.2 Adverse event due to non-adherence to paediatric fasting guidelines (L)

Numerator Number of adverse events involving paediatric patients due to non-adherence to fasting

guidelines.


anaesthesia.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

Centile

Gains

Stratum

Gains

Outlier

Gains

2014 1 0 988 0 0 0

2015 3 0 1,168 0 0 0


In 2015, there were five records from three HCOs. The annual rate was 0 per 100 paediatric patients.





Outliers





5.3 Parent/guardian present at induction of anaesthesia (N)

Numerator Number of paediatric patients where their parent/s or guardian was present at the time of

induction of anaesthesia.


anaesthesia.



Year

No.

HCOs

Total

numerator

Total

denominator Rate#

Rate#

(20)

Rate#

(80)

*Centile

Gains

*Stratum

Gains

*Outlier

Gains

2015 2 162 163 99.4 99.4 99.4

# per 100 paediatric patients *Gains are not calculated when the desirable level is not specified.

In 2015, there were three records from two HCOs. The annual rate was 99.4 per 100 paediatric

patients.




Outliers

Since it has not been specified whether high or low rates are desirable, outlier HCOs are not reported.




Characteristics of contributing HCOs

Public/ Private and Metropolitan/ Non-metro total denominators and number of HCOs by clinical indicator

All indicators Combined

Public % Private % Metropolitan % Non-metro % Total

Paediatrics Indicators Combined HCOs 19 66% 10 34% 20 69% 9 31% 29

Indicators by Topic

Appropriateness

Clinical Indicator Public % Private % Metropolitan % Non-metro % Total


HCOs 7 58% 5 42% 9 75% 3 25% 12

Denominator 220 55% 182 45% 333 83% 69 17% 402


HCOs 3 100% - 0% 2 67% 1 33% 3

Denominator 89 100% - 0% 78 88% 11 12% 89


HCOs 14 100% - 0% 10 71% 4 29% 14

Denominator 21,831 100% - 0% 19,241 88% 2,590 12% 21,831

Adverse events


2.1 Medication errors (L) HCOs 7 58% 5 42% 9 75% 3 25% 12

Denominator 14,661 77% 4,427 23% 12,852 67% 6,236 33% 19,088

2.2 Adverse events when not in a paediatric ward/area (L) HCOs 4 100% - 0% 1 25% 3 75% 4

Denominator 7,402 100% - 0% 1,145 15% 6,257 85% 7,402

2.3 Adverse events in a paediatric ward/area (L) HCOs 5 100% - 0% 3 60% 2 40% 5

Denominator 13,858 100% - 0% 7,651 55% 6,207 45% 13,858




cumentation


3.1 Completed asthma action plan - paediatrics (H) HCOs 3 100% - 0% 2 67% 1 33% 3

Denominator 415 100% - 0% 378 91% 37 9% 415

3.2 Paediatric surgery post-procedural report (H) HCOs 1 100% - 0% - 0% 1 100% 1

Denominator 170 100% - 0% - 0% 170 100% 170


HCOs 2 100% - 0% 1 50% 1 50% 2

Denominator 123 100% - 0% 88 72% 35 28% 123


HCOs 2 100% - 0% 1 50% 1 50% 2

Denominator 123 100% - 0% 88 72% 35 28% 123

3.5 Medical discharge summary completed - paediatrics (H) HCOs 1 100% - 0% - 0% 1 100% 1

Denominator 846 100% - 0% - 0% 846 100% 846

Paediatric ICU


4.1 Unplanned return to PICU (L) HCOs 2 100% - 0% - 0% 2 100% 2

Denominator 639 100% - 0% - 0% 639 100% 639


HCOs 1 100% - 0% - 0% 1 100% 1

Denominator 10 100% - 0% - 0% 10 100% 10




HCOs 2 50% 2 50% 1 25% 3 75% 4

Denominator 163 10% 1,390 90% 1,005 65% 548 35% 1,553


HCOs 2 67% 1 33% 1 33% 2 67% 3

Denominator 163 14% 1,005 86% 1,005 86% 163 14% 1,168

5.3 Parent/guardian present at induction of anaesthesia (N) HCOs 2 100% - 0% - 0% 2 100% 2

Denominator 163 100% - 0% - 0% 163 100% 163




Summary of Results

Appropriateness


In 2015, there were 402 registered nurses reported from 12 HCOs. The annual rate was 92.8 per 100 registered nurses. In 2015, the potential gains totalled 21 more registered nurses with current paediatric life support qualifications. There was one outlier record from one outlier HCO whose combined excess was five fewer registered nurses with current paediatric life support qualifications. The outlier HCO rate was 70.4 per 100 registered nurses.


In 2015, there were 89 medical practitioners reported from three HCOs. The annual rate was 100 per 100 medical practitioners. There were no potential gains in 2015.


In 2015, there were 21,831 paediatric admissions reported from 14 HCOs. The annual rate was 88.8 per 100 paediatric admissions. In 2015, the potential gains totalled 2,430 more paediatric patients admitted to a dedicated paediatric ward/area. There were four outlier records from three outlier HCOs whose combined excess was 1,085 fewer paediatric patients admitted to a dedicated paediatric ward/area. The outlier HCO rate was 68.8 per 100 paediatric admissions.

Adverse events

2.1 Medication errors (L)

In 2015, there were 19,088 paediatric admissions reported from 12 HCOs. The annual rate was 0.29 per 100 paediatric admissions. In 2015, the potential gains totalled 34 fewer paediatric adverse medication incidents due to incorrect dose, corresponding to a reduction by approximately one-half. There was one outlier record from one HCO whose combined excess was four more paediatric adverse medication incidents due to incorrect dose. The outlier HCO rate was 1.0 per 100 paediatric admissions.

2.2 Adverse events when not in a paediatric ward/area (L)

In 2015, there were 7,402 paediatric admissions reported from four HCOs. The annual rate was 1.88 per 100 paediatric admissions. In 2015, the potential gains totalled 136 fewer adverse events involving paediatric patients, corresponding to a reduction by approximately four-fifths. There was one outlier record from one outlier HCO whose combined excess was 26 more adverse events involving paediatric patients. The outlier HCO rate was 2.9 per 100 paediatric admissions.

2.3 Adverse events in a paediatric ward/area (L)

In 2015, there were 13,858 paediatric admissions reported from five HCOs. The annual rate was 3.03 per 100 paediatric admissions. In 2015, the potential gains totalled 410 fewer adverse events involving paediatric patients, corresponding to a reduction by approximately four-fifths. There were two outlier records from one outlier HCO whose combined excess was 211 more adverse events involving paediatric patients. The outlier HCO rate was 7.0 per 100 paediatric admissions.

Documentation

3.1 Completed asthma action plan - paediatrics (H)

In 2015, there were 415 separations reported from three HCOs. The annual rate was 93.5 per 100 separations. In 2015, the potential gains totalled 27 more paediatrics discharged with asthma action plans. There was one outlier record from one outlier HCO whose combined excess was 22 fewer paediatrics discharged with asthma action plans. The outlier HCO rate was 60.9 per 100 separations.

3.2 Paediatric surgery post-procedural report (H)

In 2015, there were 170 separations reported from one HCO. The annual rate was 100 per 100 separations. There was no significant trend in the fitted rate. There were no potential gains in 2015.


In 2015, there were 123 paediatric admissions reported from two HCOs. The annual rate was 94.3 per 100 paediatric admissions. There was relatively little variation between HCOs and so the potential gains were small in 2015.


In 2015, there were 123 paediatric admissions reported from two HCOs. The annual rate was 70.7 per 100 paediatric admissions. In 2015, the potential gains totalled 34 more paediatrics given a physical assessment.




3.5 Medical discharge summary completed - paediatrics (H)

In 2015, there were 846 separations reported from one HCO. The annual rate was 100 per 100 separations. There were no potential gains in 2015.

Paediatric ICU

4.1 Unplanned return to PICU (L)

In 2015, there were 639 paediatric admissions reported from two HCOs. The annual rate was 2.66 per 100 paediatric admissions. In 2015, the potential gains totalled 10 fewer unplanned returns to the PICU, corresponding to a reduction by approximately one-half. There was one outlier record from one outlier HCO whose combined excess was two more unplanned returns to the PICU.


In 2015, there were 10 paediatric patients reported from one HCO. The annual rate was 0 per 100 paediatric patients. There was no significant trend in the fitted rate. There were no potential gains in 2015.

4.3 Adverse events - PICU clinical handover between medical practitioners (L)


4.4 Adverse events - PICU clinical handover to another area (L)




In 2015, there were 1,553 paediatric patients reported from four HCOs. The annual rate was 91.0 per 100 paediatric patients. In 2015, the potential gains totalled 140 more paediatrics fasting for more than six hours prior to anaesthesia. There were two outlier records from one outlier HCO whose combined excess was 105 fewer paediatrics fasting for more than six hours prior to anaesthesia. The outlier HCO rate was 63.6 per 100 paediatric patients.


In 2015, there were 1,168 paediatric patients reported from three HCOs. The annual rate was 0 per 100 paediatric patients. There were no potential gains in 2015.

5.3 Parent/guardian present at induction of anaesthesia (N)

In 2015, there were 163 paediatric patients reported from two HCOs. The annual rate was 99.4 per 100 paediatric patients.




Expert Commentary

Paediatrics and Child Health Division of The Royal Australasian College of Physicians

(RACP)

Introductory comments

Once again the minimal number of healthcare organisations (HCOs) responding makes this data

interesting, but difficult to interpret.

Appropriateness

The clinical indicators (CIs) chosen are valid but not comprehensive and this may be why the

engagement of HCOs is low.

Adverse events

It is interesting to note that adverse events in children admitted to paediatric units (CI 2.3) were higher

than those admitted to non-paediatric units (CI 2.2), although numbers are too low for statistically

valid conclusions to be drawn.

Documentation

Of note is that not all children are comprehensively admitted or examined by either medical or nursing

staff. Although there appears to be no progress in having one set of admission documentation by

healthcare professionals.

Paediatric ICU

Paediatric ICU unplanned returns (CI 4.1) appear to have trended down and there were no data

submitted for adverse events.


It appears that adherence to six hours fasting (CI 5.1) has improved, but it would be interesting to

know how many children have fasted for too long, which is a distressing and at times clinically

disadvantageous situation.

General/closing comments

Few HCOs are now submitting data, which may be because of the more comprehensive data

collection now undertaken by the Children’s Healthcare Australasia (CHA). Perhaps the ACHS should

consider working with the CHA to share and improve on data collection and therefore validity.




Australian College of Children and Young People’s Nurses (ACCYPN)

Appropriateness

The rate of qualification of 92.8% for registered nurses (CI 1.1) and 100% for medical practitioners is

a positive result (CI 1.2), yet some HCOs need to improve the nurses’ compliance rate. There is also

a need to follow the Australian Resuscitation Council (ARC) guidelines and provide further categories

to differentiate cardiopulmonary resuscitation (CPR) competency levels according to the child’s age

(e.g. infants versus children or adolescents). The annual rate of 88.8 per 100 paediatric admissions to

a paediatric ward/area (CI 1.3) is acceptable compared to previous years. However HCOs need to be

aiming for 100% in order to reduce adverse events i.e. medication errors as well as to ensure a well-

established family centred care environment for the child and their family.

Adverse events

It is unclear where and how the medication errors (CI 2.1) were reported. There is a need for further

clarification regarding whether the medication errors were mainly related to errors in prescription of

doses by medical practitioners or by nurses during the preparation and administration stages. In

addition the location of where medication errors were reported is also significant for interpretation of

the results (e.g. Emergency Department, PICU, NICU or general paediatric ward). The significant

differences in medication errors reported by the private and public hospital sector is also worthy of

further investigation; in particular accuracy of reporting.

It is noted that the rate of adverse events involving paediatric patients in a paediatric ward (CI 2.3) is

higher than those that occurred in a ward/area that was not specifically dedicated to paediatric

patients (CI 2.2). It would be helpful to obtain data that details the nature of these adverse events.

One HCO had 26 more adverse events involving paediatric patients when not in a dedicated

paediatric ward/area, which supports the aim of CI 1.3 to have all children cared for in a dedicated

paediatric ward/area.

Documentation

The reporting rate for asthma management plans (CI 3.1) is positive, and demonstrates an

improvement when compared to previous years. The reporting rate for post-surgical documentation

(CI 3.2) is positive and well-maintained for the periods indicated. The reporting rate for physical

assessment completed by registered nurses (CI 3.4) is low (70.7%) compared to the 94.3% reporting

rate by medical practitioners (CI 3.3). HCOs need to be aiming for an improvement in nurses’

documentation. The reporting rate for medical discharge summary (CI 3.5) is exceptional and reflects

good documentation; however, this rate is based on one HCO.

Paediatric ICU

There is a distinct lack of reporting of adverse events at the paediatric intensive care unit (PICU). It is

noted that there is a reduction by half for returns to the PICU (CI 4.1).


The reporting rate for parent/guardian present at induction of anaesthesia (CI 5.3) is positive, but

could be improved, as could the figures for children fasting for more than six hours (CI 5.1). However

the rate of reporting of adverse events due to non-adherence to fasting guidelines (CI 5.2)

demonstrated no potential gains in 2015 and should be carefully monitored.

General/closing comments

The majority of reporting rates of CIs are positive, yet it cannot be extrapolated to the general

child/young person population as there are a limited number of records from participating HCOs.




References

1. The Australian Resuscitation Council. ANZCOR Guideline 12.1 - Introduction to Paediatric Advanced Life Support.

Accessed from http://resus.org.au/guidelines/ on 4/05/2016.

2. Hill MK, Pawsey M, Cutler A et al. Consensus standards for the care of children and adolescents in Australian health

services. The Medical Journal of Australia 2011; 194(2): 78-82.

3. The Royal Australasian College of Physicians (RACP). Policy on the co-location of adults with children and adolescents in

healthcare settings. Sydney NSW; Paediatrics & Child Health Division, RACP. Accessed from

https://www.racp.edu.au/index.cfm?objectid=74ABBD76-CF93-A9A6-C9EFADC99AD1690 on 10/05/2015.

http://resus.org.au/guidelines/

https://www.racp.edu.au/index.cfm?objectid=74ABBD76-CF93-A9A6-C9EFADC99AD1690

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