Improving Paediatric Safeguarding in the Emergency Department

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Background & Problem:

In the past year, 22,581 children have been seen in the Emergency Department (ED). Accurate history taking and completion of the safeguarding screening questions helps to identify children who may be at risk of abuse or neglect. If any risks are identified, appropriate referrals can then be made to children’s social care or public health nurses. Audits of the completion of the screening questions have indicated poor compliance from clinicians prior to the QI project. This may have resulted in missed opportunities to safeguard children, which in some cases may have meant they returned home and experienced harm, or the appropriate professionals were not notified of their attendance. Weekly audits of randomly selected notes were performed to establish baseline data and monitor completion levels.

Aim:

To correctly identify and appropriately action safeguarding concerns in paediatric patients presenting to the ED in >90% cases within 1 year. Outcome Measure: Increase the rate of completion of safeguarding screening questions to >90% from a baseline median clinician completion rate of 38%.

Method:

Strategies included:

1. Increased data collected by reception staff to include who is accompanying the child and school details.
2. Adjustments made to the paediatric elements of the ED induction package.
3. Regular meetings with stakeholders including health visitors, managers, ED and paediatric teams.
4. New ED paperwork.
5. Departmental teaching sessions.
6. Personalised emails to staff members feeding back compliance/non-compliance.
7. Increased access to Level 3 Safeguarding training.

Results:

The completion rate of the safeguarding questions has increased from 38% to over 90% Indicating an increased understanding of safeguarding children, which ultimately helps to keep children safe.

Lessons Learnt:

• Personalised emails, whilst time consuming, proved to be the most beneficial immediate change.
• Further work is needed on paperwork and IT systems to ensure sustainable compliance.
• Ideas can be spread out of the department to the Paediatric Assessment Unit.

Next steps:

• Further PSDA cycles to test new ED paperwork.
• Push for improvements to IT systems to ensure sustainability.