A clinical audit of the pre-hospital paediatric respiratory assessment in London

Assessing a child with difficulty in breathing is a challenge in a pre-hospital setting, especially children under 3 years old. Nevertheless, hypoxia must be treated early, and a respiratory assessment is essential to ensuring the well being of these patients. The aim of this audit was to update the research, as there have been changes in equipment and training since this was last addressed. A criterion-based clinical audit was undertaken of 253 patient report forms collected from the London Ambulance Service over a one-month period. The pre-hospital clinician must have coded dyspnoea (difficulty in breathing) and the patient's age must be under three years. The observations audited were: respiratory rate, auscultation attempt and oxygen saturations, any exceptions were noted. The results showed that 85% (n=220) had two respiratory rates recorded, 70% (n = 178) recorded an auscultation attempt, whilst two oxygen saturation recordings were documented for 52% (n=131). The main reason for no oxygen saturations was ‘no kit’, accounting for 38% (n= 45) of the non-compliance. Overall, 39% (n=99) recorded all three observations in this audit. It was concluded that there has been progress since the last review; however, there is still potential for better compliance. Recording oxygen saturations especially needs improving and the availability of equipment requires addressing.

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