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004 Improving the consideration of non accidental injury in under 1s presenting to the emergency department with apparent trauma

Non-accidental injury (NAI) is recognised as a common cause for injuries in children, especially in the very young, immobile child. STAG data from the RHC in Glasgow showed that 8% of paediatric trauma cases were due to NAI. All were under 2 years of age. It is vital that any clinician working in the Emergency Department considers NAI as a differential for the injured child. At Hairmyres it was noted through previous audit work that documentation and understanding of NAI was poor, and the process for highlighting concerns both difficult and confusing. These conclusions showed that consideration of NAI needed to be improved among clinicians A QIP was undertaken to improve each of the areas identified. A proforma was created to allow a tick–sheet approach to documentation for NAI. A new referral process was introduced to facilitate sharing of information with social work with clear guidance for staff using the Notification of Concern (NOC) form. A multidisciplinary child protection meeting was set up to include staff from social work, paediatrics, child protection and emergency medicine. Over a 8 month period (November 2017 to June 2018): clear documentation of any child protection concerns rose from 0 to 70%. Documenting who accompanied a child rose from 20 to 100% checking for social work involvement rose from 0 to 70%. Documenting time of injury rose from 40 to 85%. Attendance at the child protection meeting improved to the extent that it will extend to be inclusive of two other sites in NHS Lanarkshire. Social work has received 46 NOCs (3 for under 1s), all deemed appropriate. Conclusion Documentation for consideration of NAI has improved.Communication between respective departments has improved since the meetings commenced allowing collaboration to ensure we are getting it right for every child.