Objectives The Junior MARSIPAN guidelines were created to improve the medical care of paediatric patients with severe anorexia nervosa. This audit aims to evaluate the care provided by a general paediatric ward compared to the recommendations outlined in the MARSIPAN guidelines and the completion of risk assessments.
Methods Retrospective analysis of patient notes was conducted on the most recent admission to the general paediatric ward of 10 patients with anorexia nervosa within the last 24 months. The documentation of their care was audited against a pre-made proforma based on the MARSIPAN guidelines and the MARSIPAN risk assessment. Medical notes and a nursing care pathway document were reviewed. The initial blood tests, refeeding blood and nursing care was also assessed. The inclusion criteria for this audit was any patient under the age of 18-years-old admitted in the last 24 months to the general paediatric ward. Any patients currently admitted or without a complete set of admission and inpatient medical notes were excluded.
Results 10 patients were included and a total of 434 bed days were assessed. Our results show variability in compliance with the MARSIPAN guidelines, in terms of the initial admission and the care received. On admission, 70% of the patients were reviewed by a consultant, 30% had a full MARSIPAN risk assessment and 40% had a percentage median BMI calculated. Important investigations were inconsistently completed, such as an ECG with a recorded QTc length (70%), sitting and standing blood pressure (20%), dehydration assessment (30%), and SUSS stand-squat and sit-up test (20%). Common initial blood tests such as Full Blood Count, Bone Profile and Liver Function Tests were completed for all patients, however many of the other important investigations were incomplete; for example Folate and B12 (40%), amylase (20%) and creatinine kinase (0%). 80% of the patients received daily biochemical blood tests to screen for refeeding syndrome in their first week in hospital; 100% of the refeeding blood tests included U&Es, magnesium, and phosphate levels. During their stay, 80% of patients had input from a dietitian and 100% had input from either CAMHS or a specialist eating disorder service. 20% of patients had daily consultant reviews and 30% of patients had a MARSIPAN risk assessment done during their admission, with only 10% having regular risk assessments. All patients received thiamine and vitamin supplementation. Nursing care was adherent to guidelines with 4-hourly vitals, enforced bed-rest, and supervised mealtimes for 100% of patients. 70% of patients had 4-hourly blood glucose measurements.
Conclusions The medical care documentation assessed in this audit was not compliant with MARSIPAN guidelines but nursing care was. The findings in this audit, along with national audits, suggest sub-optimal care for inpatient admissions with anorexia nervosa. The excellent nursing results demonstrates the introduction of the nursing pathway document makes a significant difference. We recommend a joint medical and nursing pathway document for admission including weekly medical reviews should be implemented and re-audited to reassess the documentation and adherence to guidelines, especially in light of the new MEED (Medical emergencies in eating disorders –CR233) guidelines.
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