5980 Shining a light on prolonged jaundice: a clinical audit to improve workup performance

Objectives The audit aimed to evaluate the management of prolonged jaundice in infants at the healthcare trust, focusing on adherence to defined criteria and identifying areas for improvement. Prior to the audit, there were concerns about complaints and misinterpretation of results in the management of prolonged jaundice. Prolonged jaundice, defined as lasting over two weeks in full-term infants or three weeks in premature infants, can indicate underlying health issues, making its effective management crucial.¹ Methods The audit was initially conducted in October 2022 and a re-audit occurred in June 2023. Data were collected from Unity, including blood test results and medical notes, and analysed using Microsoft Excel. Results Several corrective actions were initiated following the initial audit, such as removing outdated guidelines, condensing guidelines into a concise one-page PDF for SHOs, placing informative posters in the unit, implementing a unique blood request system for prolonged jaundice workup, and conducting educational sessions for SHOs and nursing staff. The audit covered 27 patients in October and 22 in June. Notably, the average age of presentation decreased from 3.6 to 3.3 weeks, with a reduction in the number of patients receiving investigations after four weeks old, declining from 13 to 6. Moreover, the rate of appropriate actions taken following abnormal results showed significant improvements. Conjugated bilirubin management increased from 14.3% to 50%, TSH management improved from 0% to 100%, T4 management rose from 44% to 100%, and haemoglobin management went from 0% to 100% (table 1.1). However, the audit revealed that unnecessary tests, including LFT and reticulocyte counts, were still commonly performed (table 1.2). Conclusion In conclusion, the audit findings suggested that SHOs could effectively carry out prolonged jaundice workup with appropriate induction, education, and information. To maintain best practices, it was recommended that resources in shared folders be updated regularly. Additionally, the audit identified discrepancies in managing abnormal conjugated bilirubin ratios, leading to contact with the liver team at tertiary level for an updated management plan. Overall, this audit demonstrated significant improvements in the management of prolonged jaundice in infants, ensuring that investigations were conducted in a timely and appropriate manner, and providing valuable guidance for healthcare professionals involved in this process. The changes implemented as a result of the audit aimed to enhance patient care and align practices with updated trust standards. Reference McKiernan PJ. Neonatal Cholestasis, 2002.