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BackgroundSince the 2004 Ayling report (1), the offer of formal chaperone during intimate examinations has been mandated in health care settings and reflected in the GMC guidance (2). The use of Chaperone Policies across NHS Trusts has considerable variability (3 4) and in practice adherence with chaperone policies is often poor (5). Within paediatrics there may be confusion about whether the presence of caregivers negates the need to offer a formal chaperone, further compounded by the absence of clearly defined age limits.ObjectivesThe aim of the project was to evaluate compliance with the Trust formal chaperone policy within a tertiary paediatric hospital and to then develop strategies to improve performance.MethodsThe Trust chaperone policy applies to all children and young people (CYP) under 18 years of age. The audit was conducted within the children’s emergency department (CED) and children’s outpatient department (COPD). Criteria for offer of a formal chaperone included unaccompanied CYP, intimate examinations (including upper torso examinations of female patients) and CYP or parents/carers with a history of difficult or unpredictable behaviour.A prospective analysis of notes for CYP meeting the eligibility criteria was undertaken for paediatric CED attendances over a 7- day period and COPD attendances over a 2-day period in July 2019.Data collected included:type of examination;documentation of formal chaperone offer (even if declined);name and designation of formal chaperone;gender (or gender identity) of formal chaperone and patient.ResultsOf 567 attendances in paediatric ED and 118 COPD clinic attendances, 66 met eligibility criteria (9.6% of all attendances). Of these 6% were unaccompanied CYP and 94% underwent an intimate examination.Only 10% of eligible patients in the paediatric ED and 8% in paediatric outpatients respectively had documented a formal chaperone. When a formal chaperone was documented there was >80% compliance with documentation of their name and designation and with being of the same gender/gender identity as the CYP.Following the analysis, it was clear there were gaps in staff awareness of the policy and inconsistent documentation. A plan-do-study-act quality improvement method was used and the following interventions were implemented between November -December 2020:A chaperone poster was developed with staff and patient feedback and displayed in all clinical areas;A quick reference guide to the trust chaperone policy was created and disseminated to trainees at induction;An educational training video was created and presented to the consultant body and in the departmental trainee teaching;A chaperone sticker was introduced to be used in medical notes in paediatric ED and Outpatient departments to improve documentation.Post-intervention evaluation is ongoing.ConclusionsThe use of formal chaperone in the paediatric setting is increasingly important as a means to safeguard both young patients and the staff involved in their care. Compliance with Trust Chaperone policy in a busy Paediatric hospital was poor and highlighted gaps in staff awareness and inadequate documentation. A quality improvement approach may help to improve compliance in this challenging area of paediatrics.

Aims, Objectives and BackgroundAcute wheeze is one of the commonest reasons for childhood Emergency Department (ED) attendances. Ongoing recovery following discharge should be supported with robust safety-netting advice including advice for ongoing bronchodilator use. Evidence for recovery bronchodilator dosing is lacking, likely leading to variation in advice across the UK and Ireland.This study aimed to describe discharge practices, exami„ning consistency and quality of safety-netting advice „(including bronchodilator plans) when discharging children with wheeze or asthma, and identify opportunities for improvementsMethod and DesignThis two-phase study was conducted across PERUKI registered sites between June 2020 – September 2021. Phase 1 consisted of single site survey responses regarding departmental discharge practices for acute wheezy presentations. During phase 2, discharge instructions provided for caregivers underwent formal review. Data abstraction tools were developed based upon existing literature regarding written wheeze safety-netting information, BTS/SIGN 2019 asthma guidelines, NICE safety-netting recommendations and the BTS Asthma Discharge Bundle.Abstract 1804 Table 1Analysis of written safety-netting information (n=61) Type of leaflet 1. Discharge – Normal (expected) recovery path50 (81.9)2. Combined discharge and AAP33 (54.1) - Combined discharge (normal & abnormal) and AAP 17 (27.9)  - Combined discharge (normal recovery) and AAP16 (26.2)3. Discharge – with a Normal (expected) path AND abnormal (unexpected/deterioration) recovery path31 (50.8)4. PAAP/ plan for future episodes only11 (18.0) General Information provided to caregivers* Inhaler and Spacer technique 33 (54.1)Overview of information about wheeze23 (37.7)How inhalers work 19 (31.1)Expected time course for recovery 18 (29.5)Advice on what to do overnight:16 (26.2) - Do not wake to give inhalers overnight9 (56.3) - Continue to administer overnight including waking if sleeping6 (37.5) - Administer only if felt required1 (1.6)Signs of improvement7 (11.5)Inhaler side effects3 (4.9) Red Flags * Unable to speak52 (85.2)Respiratory distress51 (83.6)Inhalers not lasting 4 hours49 (80.3)Audible wheeze40 (65.6)Coughing37 (60.7)Fast breathing or short of breath36 (59.0)Poor feeding or drinking32 (52.5)Looks pale31 (50.8)Not improving after specified period26 (42.6)Drowsiness25 (40.9)Caregiver is worried8 (13.1) Escalation- how to seek help* Contact GP47 (77.1)Call 99945 (73.7)Call / reattend hospital25 (40.9)Call 11119 (31.1)No advice given7 (11.5) Where is red flag and escalation advice described Within PAAP/future episodes information only31 (52.5)Within discharge recovery information28 (47.5)None described2 (3.3) GP Follow-up recommended GP Follow-up (any)38 (62.3)Within 48hr28 (45.9)Within 1 week 4 (6.6)Within 72 hr3 (4.9)Other timeframe2 (3.3)Within 2 weeks1 (1.6) Other support* Smoking cessation support offered15 (24.6)Specialist Nurse 8 (13.1)Asthma Clinic 4 (6.6)Open access (OA)3 (4.9)Community Nursing Team (CNT)3 (4.9)General Paediatric Clinic1 (1.6)* Percentages may be greater than 100% as more than one could be selectedResults and ConclusionThis two-phase study was conducted across PERUKI registered sites between June 2020 – September 2021. Phase 1 consisted of single site survey responses regarding departmental discharge practices for acute wheezy presentations. During phase 2, discharge instructions provided for caregivers underwent formal review. Data abstraction tools were developed based upon existing literature regarding written wheeze safety-netting information, BTS/SIGN 2019 asthma guidelines, NICE safety-netting recommendations and the BTS Asthma Discharge Bundle.National comparison of discharge practices and written safety-netting information for wheezy children attending EDs showed wide variation. This highlights the need for evidence-based guidance to improve and standardise care, providing consistent discharge and safety-netting advice for carers.

ObjectiveRecovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing.DesignTwo-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers.SettingSecondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI).Main outcome measuresDescribe practice and variation in discharge advice, treatment recommendations and safety netting provision.ResultsOf 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) ‘nearly always’ assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were less frequent. In phase II, 61/66 (92.4%) submitted their discharge documents; 50/66 (81.9%) included bronchodilator plans. 11/66 (18.0%) provided Personalised Asthma Action Plans as sole discharge information. 45/50 (90%) provided ‘fixed’ bronchodilator dosing regimes; dose tapering was common (38/50; 76.0%). Median starting dose was 10 puffs 4 hourly (27/50, 54.0%); median duration was 4 days (29/50, 58.0%). 13/61 (21.3%) did not provide bronchodilator advice for acute deterioration; where provided, 42/48 (87.5%) recommended 10 puffs immediately. Subsequent dosages varied considerably. Common red flags included inability to speak (52/61, 85.2%), inhalers not lasting 4 hours (51/61, 83.6%) and respiratory distress (49/61, 80.3%).ConclusionsThere is variation in bronchodilator dosing and safety netting content for recovery following acute wheeze and asthma attacks. This reflects a lack of evidence, affirming need for further multicentre studies regarding bronchodilator recovery strategies and optimal safety netting advice.

IntroductionSlush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content.ObjectiveTo describe a series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMDs).MethodsA retrospective case review of 21 children who presented to centres across the UK and Ireland from 2009 through 2024 was carried out.ResultsAlmost all of the children (93%) became unwell within 60 min of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years – 6 years 9 months). Presenting features include acute decrease in consciousness (94%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), pseudohypertriglyceridaemia (89%) and hypokalaemia (75%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (95%) subsequently avoided slush ice drinks and did not have reoccurrence.ConclusionConsumption of slush ice drinks containing glycerol may cause a clinical syndrome of glycerol intoxication in young children, characterised by decreased consciousness, hypoglycaemia, lactic acidosis, pseudohypertriglyceridaemia and hypokalaemia. This mimics inherited disorders of gluconeogenesis and glycerol metabolism. Clinicians and parents should be alert to the phenomenon, and public health bodies should ensure clear messaging regarding the fact that younger children, especially those under 8 years of age, should avoid slush ice drinks containing glycerol.

Why did you do this work?Slush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content. Its use has increased since the introduction of the ‘sugar tax’. We describe a novel series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMD). This novel association between slush ice drinks and this acute presentation has not been published previously.What did you do?We carried out a retrospective review of 21 children who presented to 9 centres across the UK and Ireland between 2009 – 2024, in order to further characterise this novel presentation and raise awareness.What did you find?Almost all of the children (93%) became unwell within 60 mins of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years – 6 years 9 months). Presenting features include acute decrease in consciousness (93%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), and hypokalaemia (80%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (90%) subsequently avoided slush ice drinks and did not have reoccurrence.What does it mean?Young children can become seriously unwell due to glycerol intoxication, shortly after consuming slush ice drinks containing glycerol. This phenotype mimics specific IMDs. Based on cases included in this series, an alert about slush ice drinks and glycerol intoxication have been added to Toxbase. The Royal College of Emergency Medicine has issued a ‘Safety Flash’ for ED teams, and food safety authorities in the UK and Ireland have advised against slush ice drinks for young children.

Specific support requested by trainees to facilitate research involvement included supervisory and methodological support.Table 1 Results from thematic analysis of responses to motivators and barriers around research Motivators/benefits to research Example quotes Clinical care ‘I feel it can benefit so many more children than I am able to see clinically on an individual basis. The TRN recognises the positive impact of signposting all trainees to relevant support systems when developing research or quality improvement studies.3 Without appropriate exposure to high-quality research while in training, we risk compromising evidence-based care. Contributors Survey review, analysis of data, drafting and review of article—TR, HM, FM, LP, ELW, CWC, CJ and the RCPCH Trainee Research Network Working Group.