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EP13.25
Hyperemesis Day Centre Audit

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Hyperemesis Day Centre Audit

Background

Audit was performed originally analysing admissions to Hyperemesis Day Centre (HDC) December 2010-January 2012.
Re-audit performed March 2012- April 2013
171 admissions during complete analysis period
HDC referral pathway aims to reduce inpatient admissions and facilitate referrals
Retrospective analysis of  171 case notes was performed
 

Aims:

Assess if HDC protocol is being followed and analyse audit recommendations implemented
Assess impact of HDC on inpatient hospital admissions
 

HDC protocol

<17 weeks gestation
Drug regime and fluid regime prescribed
Scan to be performed after assessment
New HDC form to be used on each admission
 

Identified causes of recurrent admissions

Non-compliance with HDC protocol
Incorrect early discharge
Lack of senior involvement
Lack of further investigation on re-admission
Incomplete discharge with limited anti-emetics supplied
Lack of patient education on managing symptoms on discharge out of
 hours
 

Recommendations

Re-educate all staff involved with HDC on protocol and discharge
Drug regime proforma to be freely available out of hours on the ward
HDC Proforma  needs to be amended to ensure trigger for senior involvement
Educate medical staff about HDC at points of change over during the year
A new proforma document for each admission to ensure full assessment of patient
Factors such as nutritional status and VTE prophylaxis need to be highlighted in  patients with multiple re-admissions
Re-audit in 6 months required to assess efficacy of above changes
 

Conclusion

HDC has been successful since introduction with 74% of patients on re-audit being discharged home after HDC protocol
70% of patients on re-audit  compared to 50%  are discharged home on the same day
HDC is successful in cutting financial expenses of hyperemesis in reducing length of inpatient stay and number of re-admissions
HDC is also successful in educating patients how to use anti-emetics provided on discharge to manage symptoms  and further reduce re-admissions
HDC staff are still not fully compliant with HDC proforma, however a new electronic admission system is being introduced to tackle this.
Evident that inappropriate discharges are associated with further admissions

There are still some cases with multiple re-admissions likely to be associated with individual patient factors

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