G431(P) Audit on looked after children at risk of blood–borne infections

Abstract

Aims We aimed to assess whether Looked After Children (LAC) at risk of blood–borne infections (BBI) were identified, assessed, tested and referred as per the British Association for Adoption and Fostering (BAAF) guidance, in our specialist LAC service. Methods Retrospective 12–monthly audit (June13–June14) of all children attending our specialist LAC clinic in Community Paediatrics in our University Teaching Hospital. Data collected from patient health reports, blood investigation results (including maternal antenatal infection screening) and information from Social Care on parental lifestyle. Data analysed using Microsoft Excel. Results 212 children attended our specialist LAC clinic. 37 children (17%) were identified as needing BBI screen. Out of these, only 22 (60%) were screened. 8 out of 22 children (36%) had a complete screen (Hepatitis B/C and HIV) with the remaining having a partial screen. 12 children had Hepatitis C positive mothers. Worryingly, only 8 of these 12 children (66%) had BBI screen. There were no Hepatitis B or HIV positive mothers. Reasons for not having BBI screen were difficulties in obtaining consent, failure to identify those children at risk or to get the extended information about parental lifestyle and screening results. BBI screen revealed 2 children positive for Hepatitis C antibodies and appropriate follow–up was arranged. There were no children that had a BBI screen when that was not indicated. Conclusion Our audit revealed a wide variation in practice as to which children have a BBI screen. We subsequently developed a protocol in the form of two flowcharts. These will be included in the LAC health assessment paperwork and aim to promote clarity and good clinical practice. As failure to obtain consent played an important hindering factor in getting our vulnerable population screened for BBI, we suggested that, when possible, consent is taken at the time of consultation. Improved communication and information sharing between Health and Social Care is essential. Finally, team education is greatly important and will be reinforced by the integration of BBI risk assessment to induction of new community trainees. We plan to implement this in March 2015, and we aim to maintain and reinforce those changes, by continuous monitoring and service evaluation.