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Febrile Convulsions CPI
Clinical scenario
Febrile convulsions are a very frightening and life threatening condition occuring in children under 5 years of age. However, less than 1% of children go on to develop full blown epilepsy. prolonged fits lasting over 15 minutes can have an adverse prognostic significance. Therefore timely management and investigation of underlying causes is paramount.
Audit question
Are febrile convulsions managed appropriately according to best practice guidelines?
Method
Retrospective audit
Sample: 30-50 Emergency Department patient records
Criteria
Inclusions: All patients aged 6 months to 5 years (inclusive) with a primary diagnosis of febrile convulsion
Exclusions: All patients aged under 6 months or over 5 years, or presenting with another medical condition
Audits
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1st August 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st August 2008 | Patients aged 6 months to 5 years attending the ED with febrile convulsions | Management of patients according to the criteria | Documented examination for signs of meningitis | 100 % | 52.3 % |
| Patient information given and documented if discharged from the ED | 100 % | 33.55 % | |||
| Antipyretic given within 10 mins unless already given | 100 % | 55.525 % | |||
| BM measured within 5 mins of arrival | 100 % | 46.475 % | |||
| Temp measured within 5 mins of arrival | 100 % | 80.775 % | |||
| All children admitted after first episode of convulsions | 100 % | 89.625 % | |||
| Triaged as Orange if temp >38.5 deg C. | 100 % | 81.175 % |
Comments
Overall a mixed set of results. Documentation of observations has partially improved, as have documentation of examination for signs of meningitis, appropriate admission rates, and appropriate triage scoring. However, there is a decline in the use of antipyretic and documentataion of distributuion of patient information leaflets. None of the criteria are achieving target, scoring maily red, therefore there is still a significant amount of work to be done.
Audit Bottom Line
Some improvements made, however scope for improvement across the board, patricularly with documentation, BM measurements on arrival and use of antipyretic according to the guidelines.