Neonatal Chronic Lung Disease: Are we following the Guidance? Service Evaluation of Infants Discharged on Home Oxygen in a Level 2 Neonatal Unit in the UK

Background: Chronic neonatal lung disease (CNLD) is the commonest cause of discharging infants on home oxygen (60%). Discharging patients on home oxygen reduces the costs of hospital stay while allowing infants to develop in their own environment and minimises family disturbance. Because it’s a high-risk group, precautions and measures have to be in place to ensure their safety and also empower carers to deliver care in conjunction with community team.

Aim: To measure the current practice against the BTS guidance for home oxygen in children as a standard.

Method: In level 2 neonatal unit on two sites (same trust). Included infants born before 32 weeks gestation with a discharge diagnosis of CNLD discharged home on oxygen between 2015-2018. Excluded babies with structural lung and airway anomalies and PPHN. Data was collected from Badger net, case notes and laboratory results system.

Results: 39 patients’ data was collected. We were able to highlight good practice documenting oxygen supply requests, routine and special immunisations given, training parents on resuscitation, giving open access and requesting clinic follow up.

However, there were significant areas for improvement. There was more than one version discharge checklist being used and not been updated for a while. Also, we were able to pick variable practices regarding follow up and home oximetry timeframe requests. Moreover, significant lack of documentation was seen in areas of smoking cessation advice, echocardiography reports and badger net discharge summaries.

Conclusion/recommendations:

- Adopt a local guidance that covers the main standards according to the BTS guidelines.

-We have also drafted a standard discharge checklist to be used.

-A new proforma for reporting echocardiography was created to ease the process of documentation.

- Improve the quality of discharge summaries and make sure it is reviewed by a consultant.

- Re-enforce the suggested changes to staff for implementation.