6356 Improving vital signs monitoring and documentation in the neonatal intensive care unit at gulu regional referral hospital

Objectives In Gulu, Uganda, infants born prematurely or term but sick are admitted to the NICU for close observation and medical care. However, most infants do not have continuous or regular vital signs monitoring due to inadequate monitoring equipment, staff knowledge and heavy workload. This leads to poor identification of unwell patients. Delaying in recognition of deteriorating patients and escalation of care can contribute to the morbidity and mortality of newborns. This project aimed to improve the frequency of vital signs monitoring and documentation by nursing staff in the NICU. It also aimed to improve staff knowledge and engagement towards escalation of care. Methods Baseline data were collected retrospectively from patients who were admitted to NICU in February 2023. It was agreed with the local neonatal team that all patients should have a minimum of four observations per 24 hours. A new observation chart with a Neonatal Early Warning Score (NEWS) was developed and implemented in April 2023. Staff nurses received multiple teaching sessions on vital signs monitoring, documentation, and escalation pathways. Pre and post-tests were conducted to assess their knowledge. A poster with an annotated observation chart was devised as a visual prompt in the NICU. We also filmed a training video and used it as part of induction for new staff and nursing students to standardise vital signs monitoring. Data were collected in April and June 2023 to evaluate the frequency and completeness of vital signs documentation, and the escalation of care for sick patients. Results In February 2023, no patients had vital signs documented in the observation chart a minimum of four times per 24 hours. After the interventions were introduced, a steady increase of 11% and 29% of patients had at least four vital signs monitored and documented per 24 hours in April and June 2023 respectively. Of all the observation entries on the charts, 64% and 61% of the observations were completed in full. All the NICU staff nurses attended the teaching sessions. The number of correct answers improved from 87.5% in the knowledge pre-test to 91% post-test. 66% of patients in June 2023 who had abnormal observations had escalation of care documented in notes. Conclusion The new observation chart and teaching sessions had a positive and sustainable impact on staff knowledge and frequency of vital signs monitoring and documentation in the NICU. The NEWS was shown to be useful in identifying unwell patients early for escalation of care.