P30
ASSESSING THE EFFECTIVENESS AND ADHERENCE TO POST-OPERATIVE MONITORING PROTOCOLS FOR APNOEA DETECTION IN INFANTS UNDER 6 MONTHS: A FOCUS ON EDUCATION AND TRAINING
T. Ghodake, C. Watkinson, E. O’Connor
Royal Victoria Infirmary, Newcastle Upon Tyne, UK
Introduction and Aims:
Timely and effective post-operative monitoring of infants under 6 months is crucial to ensure patient safety after surgical procedures. This young age group is at particularly high risk of complications due to physiological immaturity and underdeveloped organ systems[1]. Current guidelines aim for a monitoring period of six hours post-operatively with intermittent regular observations, continuous oxygen and etCO2 monitoring as apnoeas are most common in the first 4-6hrs, but can occur 12 hours later.[2] Close monitoring allows for early detection of adverse events which are more likely to have serious consequences. This audit aims to evaluate the efficacy and adherence to postoperative monitoring protocols in infants under six months following day-case surgeries at the Great North Children’s Hospital [3]. The study aims to assess the existing practices, identify potential gaps, and propose recommendations and training for optimizing postoperative care in this vulnerable population. By identifying any deviations from national guidelines, we hope to standardize care pathways, and training for healthcare professionals, improve compliance and enhance patient outcomes and safety.
Methods:
A thorough retrospective review of 91 medical records from a specific cohort of infants below six months who underwent surgical procedures between January 1st, 2023, and June 30th, 2023, has been meticulously conducted. The data assesses adherence to established postoperative monitoring protocols, encompassing vital sign monitoring, apnoea detection, complications documentation, and instances of readmission. The data has been collected and analysed to discern prevalent trends, pinpoint deficiencies, and highlight areas necessitating improvement and further training.
Results:
Preliminary findings highlighted only 2.5% of patients are monitored with complete concordance with the guidelines and the average discharge time post-operatively was 3.75 hours. No patients were documented to have any readmissions regardless of discharge time, however, 10 patients had unplanned overnight admissions due to post-operative complications and had stayed for the minimum 6 hours emphasising the importance of vital sign monitoring frequency and adherence to the guidelines. Due to continuous O2 sats monitoring[2], 7 infants were detected as having apnoea and were kept for 12 hours for monitoring. Furthermore, the study identifies challenges in standardized documentation of complications and deviations from established postoperative care guidelines.
Discussion and conclusions:
Improved adherence to monitoring protocols is imperative for enhancing the quality of care for infants under six months following surgical procedures. Addressing the identified variations and implementing comprehensive guidelines for monitoring and discharge will likely improve outcomes by identifying potential complications earlier in this population who are more susceptible to postoperative apnoea. Recommendations to refine protocols by implementing manual alarm reminders for monitoring and e-record alerts aim to enhance patient safety. Training healthcare staff with these new protocols and repeating the audit will assess the impact on clinical outcomes and further improve safety.
References:
[1] Frawley G. Special considerations in the premature and ex-premature infant. Anaesthesia & Intensive Care Medicine. 2023;24(1):23–9. doi:10.1016/j.mpaic.2022.10.013
[2] 1. Villa A, Dodson G. Apnea of prematurity and postoperative apnea [Internet]. 2023 [cited 2024 Jan 19]. Available from: https://www.openanesthesia.org/keywords/apnea-of-prematurity-and-postoperative-apnea/
[3] Snell A, Watkinson C, Ahmed S. The Newcastle upon Tyne Hospitals NHS Foundation Trust. Day-case Surgery for Infants <6 months. Newcastle Upon Tyne: Great North Children’s Hospital; 2021.