European Journal of Nutrition & Food Safety

Background: The aim of this reaudit was to understand the nature of the client group in terms of diagnosis, to identify how clinical treatments were being used from the departmental clinical guideline [1,2] and to identify if the aims of treatment are being met in managing faltering growth. This audit followed on from a pilot audit in 2011, which raised several concerns and actions to be taken. In 2011, aims of treatment were shown to be vague and goal setting was found to be too optimistic for the child’s condition and social circumstances. Secondly, anthropometric measurements were missing in some cases, specifically length/height measurements. Results of the pilot audit were fed back to the team, with the aim of improving dietetic input and outcomes for children with faltering growth. 
Method: An audit tool was designed and used in both 2011 and 2013 to collect information relating the child’s diagnosis and treatment. The dietetic team agreed on a ranking scale used to define growth (good = increase one centile in weight, adequate=maintain current weight centile position, poor = decrease centile position). For the reaudit, data recorded on Patient Administration System (PAS) was used to identify patients who had been seen by the Community Paediatric Dietitian team between the dates 1^st December 2012 and 31^st January 2013. The dietitian then reviewed the case notes for each child and completed the audit of each set of case notes, according to age. The first 8 children identified in three age categories (0-5 years, 5-11 years, 12-16 years) were chosen for inclusion by the PAS referral code ‘failure to thrive’. 
Results: In addition to the above results, a vast improvement in record keeping was noted – length/height measurements were available for all children during this audit, which was not the case in 2011. 
Discussion: Re-auditing dietetic practice for children who experience faltering growth has produced significant improvements in their clinical outcomes in terms of growth. This was mainly as a result of improved record keeping and realistic goal setting. There was an improvement in identifying the aim of treatment for each child, taking into account their diagnosis, age and social circumstances. This has led to better goal setting and achievement of growth. There were no children who did not achieve anything as a result of their dietetic intervention. Further actions have been agreed within the team in order to continue to improve outcomes. 
Conclusion: Re-audit has helped to identify that improvements have been made, and reiterated the use of the clinical guideline. It has also allowed the identification of a clinical outcome related to growth to be agreed within a departmental contract. It would be useful to benchmark these outcomes with a similar service/population.