Chapter 7.7 Monitoring the quality of care

Chapter 7.7.1 Mortality audit

A register of admissions, discharges and deaths should be kept. This should contain information about the children (such as weight, age and sex), day of admission, date of discharge or date and time of death.

To identify factors that can be changed to improve care, determine whether most of the deaths occurred:

  • within 24 h: consider untreated or delayed treatment of hypoglycaemia, hypothermia, septicaemia or severe anaemia, incorrect rehydration fluid or volume of fluid or overuse of IV fluids
  • within 72 h: check whether the volume of feed given during re-feeding was too high or the formulation was wrong. Were potassium and antibiotics given?
  • over 72 h: consider nosocomial infection, re-feeding syndrome, heart failure and HIV infection.
  • at night: consider hypothermia due to insufficient covering of the child or no night feeds.
  • when beginning F-100 or RUTF: consider too rapid a transition from starter to catch-up feeds.