G91(P) Auditing the use of medical photography (MP) in suspected non-accidental injury (NAI) cases in a community paediatric setting

Abstract

Aims Safeguarding advice from the RCPCH states that ‘It is good practice to photograph any visible finding in suspected child abuse’. In this audit we aimed to review: Our referral pathway for MP in NAI cases Whether consent was adequately documented How MP is recorded in Child Protection (CP) reports CP reports are distributed to multi-disciplinary safeguarding teams and it is therefore important to document whether MP has been performed and whether the captured images are in keeping with what was seen on examination (e.g. lighting making bruises appear less prominent). Methods A closed loop audit was performed of the use of MP for paediatric NAI cases from January 2017 to June 2018. Data was collected retrospectively and prospectively from all CP reports and electronic records. This included how MP was requested, how consent was recorded and if images were described in CP reports. Results In 2017 there were 136 NAI cases, of which 4.4% were referred for MP From January to June 2018 there have been 55 NAI cases, of which 21.8% were referred for MP. Review of Request Forms: 23% had the correct hospital ID 84% had legible body maps. Review of CP reports: 100% documentation of consent 100% confirmed if MP requested 0% confirmed MP performed 0% described/interpreted the images obtained Conclusion More children are being sent for MP in suspected NAI cases. However, we are inadequately completing referral forms and have not commented on MP in CP reports. This will impact on the wider safeguarding team, e.g. social services and police, who may be unaware if/when MP is performed. These findings were presented at a clinical governance meeting and a new MP protocol produced. Paper forms were updated to electronic requests and all reports must now include clinicians’ comments about the images captured. This will optimise medical documentation in CP cases and provide superior, objective evidence if cases are taken through CP/legal proceedings.