Shields M D, Adams D, Beresford P, Dodge J A
Royal Belfast Hospital for Sick Children, Northern Ireland.
Qual Health Care. 1995 Dec;4(4):269-72. doi: 10.1136/qshc.4.4.269.
Important aspects of the management of meningitis in children include notification to local officers for control of communicable diseases; chemoprophylaxis for index cases and close contacts in cases of meningococcal or Haemophilus influenzae meningitis; and a formal hearing assessment for all survivors. A retrospective audit of these aspects of management was carried out for children admitted with meningitis in 12 months from 1 September 1990 to 31 August 1991 at the Royal Belfast Hospital for Sick Children. Only 20 of 36(56%) cases were notified by medical staff. Chemoprophylaxis was arranged for all close family contacts but to only five of the 23(22%) index cases for whom it was indicated. Appointments for audiological testing were arranged for only 19 of the 32(59%) survivors. Subsequently all doctors, including each intake of junior doctors, were given written information on the importance of notification and locally agreed guidelines for chemoprophylaxis and hearing assessments for survivors before discharge. Guidelines were also displayed prominently in each ward. A repeat audit from January 1992 to December 1992 showed significant improvement in these aspects of care. Twenty eight of 32 cases (88%) were notified, chemoprophylaxis was given to 20 of 22(91%) index cases for whom it was indicated, and 25 of 29(86%) survivors had hearing assessments arranged before discharge. Correct management of some aspects of care cannot be assumed, even if statutory (notification), nationally agreed (chemoprophylaxis), or generally agreed good practice (hearing assessments). These aspects of care improved after the first audit but the authors conclude that the notification rate remains below 100% and a repeat audit is necessary.
儿童脑膜炎管理的重要方面包括向当地传染病控制官员通报；对脑膜炎球菌性或流感嗜血杆菌性脑膜炎的索引病例及密切接触者进行化学预防；以及对所有幸存者进行正式听力评估。1990年9月1日至1991年8月31日的12个月期间，对皇家贝尔法斯特儿童医院收治的患脑膜炎儿童的这些管理方面进行了回顾性审计。36例病例中只有20例（56%）由医务人员通报。对所有密切家庭接触者都安排了化学预防，但在23例有指征的索引病例中，仅对5例（22%）进行了化学预防。在32例幸存者中，只有19例（59%）安排了听力测试预约。随后，向所有医生，包括每一批新入职的初级医生，提供了关于通报的重要性以及当地商定的幸存者化学预防和听力评估指南的书面信息。指南也在每个病房显著展示。1992年1月至1992年12月的重复审计显示，这些护理方面有了显著改善。32例病例中有28例（88%）得到通报，22例有指征的索引病例中有20例（91%）接受了化学预防，29例幸存者中有25例（86%）在出院前安排了听力评估。即使是法定的（通报）、全国商定的（化学预防）或普遍认可的良好做法（听力评估），也不能假定护理的某些方面得到了正确管理。第一次审计后这些护理方面有所改善，但作者得出结论，通报率仍低于100%，有必要进行重复审计。
