| Popis: |
Background Infants presenting with injuries are a high-risk group for potential safeguarding issues. The importance of appropriate assessment, recognition and response to concerns is highlighted in national guidance from both the emergency and child protection communities. Aim We aimed to evaluate and improve compliance with: ‘Facing The Future: Standards of Care in Emergency Settings’ Standard 38: ‘Infants, children and young people (ICYP) at high–risk of potential safeguarding presentations [eg. non–mobile infants with injuries] are reviewed by a senior (ST4+) paediatrician or PEM doctor’ RCPCH Child Protection Companion, Section 5.4: Findings are consistent with history and development Method We retrospectively audited notes of all infants Cases were included if triage presentation suggested injury (eg. ‘head injury’, ‘bruise’, ‘bite’); if presentation was unclear notes were reviewed to determine inclusion. Results 359 attendances of under–1s (16% of all attendances) 28 presented with an injury (8% of all under–1 attendances) Mean age was 5.6m (10d-10m) 57% male Babies 76% presented with head injury Standards Standard 38–85% compliance Consideration of history– 39% Consideration of development– 19% Documentation of: Time of injury–76% Social history– 23% Clinical plan– 100% Conclusion Though compliance with Standard 38 was good, other inadequacies in our current approach to infants with injuries were highlighted. Injury in infants, particularly head injury, is a common presentation to the CED. Our head injury proforma was felt to be unsuitable for use in infants; no ‘infant injury proforma’ exists. To address this, we delivered departmental training and adapted our induction information. Furthermore, we developed and introduced a new ‘Injuries in Under-1s’ proforma. This includes additional space for documentation of reported injury mechanism and specifically addresses: Assessment of development/mobility Safeguarding screening questions Need for ST4+ review Feedback from frontline staff suggests this aids both clinical and safeguarding decision-making. In order to complete the Plan-Do-Study-Act cycle we are currently in the process of re-audit. |
