6162 Attracting trouble- An audit on rare earth magnet ingestion

Objectives Rare earth magnets (REM) are almost ten times stronger than ordinary magnets, easily available, cheap, and often brightly coloured. If ingested they can cause significant bowel injury including necrosis and perforation, especially when multiple magnets are ingested together.¹ Concerns were identified by the NHS England and Improvement's National Patient Safety Team and the Royal College of Emergency Medicine (RCEM)² who issued a joint safety alert which was followed up by the Department of Health NI³ directive for implementation of alert. Aim Review the clinical profile, presentation and outcome of children and young people aged 0–16 years presenting to Southern Health Social Care Trust (SHSCT) with REM ingestion. Compare management with standards outlined by RCEM's 'Best Practice Recommendations on ingestion of super strong magnets in children'⁴ Methods We retrospectively audited children and young people under 16 years who accidentally or intentionally ingested REMs presenting to all hospitals within the SHSCT during 2019–2022. From the data we ascertained: patient demographics, radiological investigations, management and clinical outcomes. We compared our data above to standards outlined in RCEM. Results Over the audit period 2019–2022 we identified 18 patients with magnet ingestion. There were 12 male and 8 female with an age range 1 year to 12 years (median of 4 years). Of the 18 patients identified presenting to ED: Imaging: Only 44% (8) had correct initial recommended imaging of abdominal and chest Xray Outcomes: 82% (14) were discharged from ED of which only 3 reattended for further imaging 2 admitted locally 2 transferred to tertiary surgical centre Safety advice No record of information leaflets given on discharge. Conclusion Conclusion: Over half of the patients did not meet standards for radiological investigations on initial presentation Over three quarter of the patients did not meet standards for repeat imaging None of the patients were offered a patient advice leaflet on discharge. Recommendations: Raise awareness of guideline through planned joint paediatric and Emergency Department simulation Create infographics for Health Care Professionals reminding them on pathway Providing accessible patient advice leaflets in emergency department Campaign for reintroduction of warnings on product at the point of manufacture. Limitations: The audit time frame included a period before the RCEM guideline was released therefore practice was variable. References Hussain SZ, Bousvaros A, Gilger M, Mamula P, Gupta S, Kramer R, Noel RA. Management of ingested magnets in children. JPGN 2012;55(3):239–242 https://www.england.nhs.uk/wp-content/uploads/2021/05/NaPSA-Alert-Magnets-FINAL-v5.pdf https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-hsc-sqsd-5-21_0.pdf Ingestion of Super Strong Magnets in Children-The Royal College of emergency medicine best practice guideline, 2021. https://rcem.ac.uk/wp- content/uploads/2021/10/RCEM_BPC_Ingestion_of_Super_Strong_Magnets_in_Children_170521.pdf