6446 Quality improvement project for documentation of NNAP data entry in the badgernet system

Objectives The National Neonatal Audit Programme (NNAP) uses a range of measures to monitor high quality neonatal care. A recurrent them e at Royal Preston Neonatal Unit with regards to NNAP data was missing Badgernet data entry especially around preterm perinatal optimisation and parental partnership which affected the performance outcomes. The prime reasons for deficient entry were clinical workload and no effective system of handover of Badgernet entry. The objective was to improve the percentage of data entry all the NNAP data quality indicators ensuring documentation of high-quality care. Methods Baseline data entry was collected for two months and following which two Plan-Do-Study-Act (PDSA) cycles were implemented. The 1st PDSA cycle implemented a checklist in the medical notes containing all the 2023 NNAP measures. Awareness to the medical staff regarding the checklist and to check Badgernet entry in ward rounds was done during weekly Grand round and Team communication meetings. Performance data was presented on bi-weekly basis for 5 weeks. The 2nd PDSA cycle was implemented with emphasis on indicators of preterm perinatal optimisation measures including antenatal steroid, Magnesium sulphate, delayed cord clamping, thermoregulation, early colostrum and parental consultation within 24 hours. Data was presented on monthly basis for 11 weeks to establish and evaluate consistent improvement. Results Baseline NNAP data entry completion for 17 admissions and 21 discharges were compared and presented in chart 1. Both PDSA cycles showed an improvement in the completion of Badgernet entry for admission measures. The total number of admissions and discharges analysed in the 1st PDSA cycle were 33 and 44 respectively and during 2nd PDSA cycle were 84 and 61 respectively. Preterm perinatal optimisation data entry was strictly monitored and the performance of the unit is depicted in chart 2. Documentation of culture results for blood stream infection are done by consultants with final reports, preterm birth injury during weekly cranial ultrasound meetings, and NEC as a part of NEC care bundle. Conclusion Use of checklist as a prompt and projection of statistics resulted in consistent awareness of documentation by medical staff and conscious handover of data entry. The reduction in the performance especially with discharge quality indicators in 2nd PDSA cycle may be as a result of reduced frequency of reminders from biweekly to monthly and the QIP also coincided with the two changes of doctors in August and September. Any deviation from the optimal perinatal management is being actively monitored and efficient documentation is the key step in improving quality of care.