M.Sc. (Med.) (Child Health Neurodevelopment Option), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Two public sector hospitals in Pietermaritzburg, KwaZulu-Natal, Edendale and Grey‟s have specialist clinics for children with epilepsy. Children with suspected epilepsy are referred to Edendale and Grey‟s hospital Paediatric Outpatient Department for their assessment from primary health care clinics, level 1 and level 2 hospitals. Health care workers managing children with suspected epilepsy do not adhere to childhood epilepsy guidelines and protocols and therefore find epilepsy a difficult condition to manage. The purpose of this clinical audit was to assess the quality of care of children referred to Edendale and Grey‟s hospital with suspected epilepsy. Information obtained from this audit will be used to improve the quality and consistency of patient care and therefore reduce childhood morbidity and mortality from the complications of epilepsy among children in Area 2, KwaZulu-Natal. Materials and Methods The Paediatric Outpatient Department registers at Edendale and Grey‟s hospital were used to identify children referred with suspected epilepsy, and their case notes were retrieved. Children who met the inclusion criteria for the study were: i) those referred to the Paediatric Outpatient Department, Neurodevelopment or Epilepsy clinics for their first assessment with a diagnosis of suspected epilepsy and ii) children aged 14 years at Grey‟s hospital and 10 years at Edendale hospital. Children excluded from the study were those i) with febrile convulsions; ii) who had repeat visits and iii) not referred with suspected epilepsy.
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Letters from referring hospitals and patient case notes were reviewed and this information was used to fill in the audit forms. A modified British Paediatric Neurology Association audit tool was used for the study. The study period covered was from January 1st 2004 to January 31st 2006. Results From the two-site audit, 232 folders were retrieved and of these 119 case notes met the inclusion criteria and were reviewed, 83 from Edendale and 36 from Grey‟s hospital. The median age of the patients at Edendale hospital was 4-years (age range 2-months to 10-years) at Grey‟s hospital the median age was 3-years (age range 8-months to 12-years). Sixty-six patients were male and fifty-three were female. At Edendale hospital, the majority of patients, 88% were seen within a week of referral, with only 2% seen more than a month later. Of these patients, 37% were assessed by interns and 16% by paediatricians. At Grey‟s hospital the majority of patients were seen more than a month after booking for their first assessment and were assessed by registrars (35%), paediatricians (28%) and senior medical officers (14%), none of the patients were assessed by interns. From reviewing the history, examination, diagnosis, treatment, communication and future care it was found that the overall care of children presenting with suspected epilepsy to both hospitals was poor. Conclusion This was a retrospective study that relied on the availability and review of patient case notes and adequate documentation by the assessing health care workers.
The findings from this audit suggest that the quality of care of children presenting with suspected epilepsy to Edendale and Grey‟s hospital is inadequate, with a lack of
adherence to guidelines as shown by the lack of adequate statements from history taking, diagnosis, inappropriate use of investigations and inadequate counselling on treatment and future patient care. To improve the management of children referred with suspected epilepsy there should be an improvement in health care worker training to ensure that epilepsy guidelines are adhered to. There should also be an improvement in caregiver and child counselling and education; and strengthening of systems - record keeping, research, and audit with a regular review of epilepsy guidelines.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/7374 |
| Date | 20 October 2009 |
| Creators | Madekurozwa, Matilda Ntombizonke |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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