Queen Elizabeth University Hospital: case note review - overview report

This overview report examines the incidence and impact of qualifying episodes of infection in paediatric haemato-oncology patients cared for at the Queen Elizabeth University Hospital and the Royal Hospital for Children from 2015 to 2019 and the potential link to the hospital environment.

9. Evidence Of Good Practice

In the course of our Review we identified areas of Good Practice which we briefly summarise here.

9.1 Nursing Care Records

Nursing records were especially comprehensive and clearly written. There was almost universal completion of vital signs and central venous line and peripheral venous catheter documentation.

9.2 Medical Care Records

Notwithstanding our criticism of the organisation of the medical records, the medical care notes were generally comprehensive and frequently very detailed in their account of specific clinical issues. Reading these notes gave a picture of good communication between junior and senior medical staff and clear evidence of consultant led care.

9.3 Communication with families

Although we are aware of complaints from some families about standards of communication, we saw examples where communication with individual families about clinical care was particularly carefully recorded and, in respect of professional Duty of Candour, this included cases where an adverse event had occurred.

We also saw evidence of joint consultations with parents by Consultant Haematologists/Oncologists and Consultant Microbiologists to discuss specific aspects of the causes and treatment of difficult to treat infection.

9.4 CLABSI surveillance and incidence

Despite the fact this Review has been initiated because of concern about bacteraemia, we are also aware of the work done by the Quality Improvement group established in 2017 to reduce central line associated blood stream infection. We have seen data which illustrates the impact of their interventions, currently achieving rates at 0.77/1000 line days. We also recognise the openness with which the group acted to ensure comparison was made between NHS GGC and other institutions nationally and internationally to establish a benchmark for future care.

9.5 Infection Prevention Control Nursing practice

Where ICNet generated a case in response to a positive laboratory test result, there was evidence of good record keeping and a detailed information of the IPC nurse response and intervention.

During IMT investigations the IPC nursing response was seen to generate appropriate infection prevention and control support measures, often undertaking an enhanced review of basic IPC practice and actions.

9.6 Microbiology advice

The advice provided to the Haematology Oncology Team by the microbiologists was well documented in Telepath and shows that frequent and clear advice was provided about the identification of the infecting organism; antibiotic sensitivities; choice and duration of antibiotic treatment; and removal of the central venous line.



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