104 Audit on Adherence to the BOAST Guidelines on the Safe Use of Intraoperative Tourniquets

Abstract

Abstract Aim Tourniquets can prevent blood loss and improve the surgical viewing field however incorrect use leads to local tissue damage and production of harmful metabolites, causing further damage. The aim of this audit was to investigate the usage of correct tourniquet techniques during intraoperative procedures, comparing them to updated BOA guidelines. Method Conducted a retrospective clinical audit documenting discrepancies between operation notes/data against BOA standard guidelines. All procedures, both elective and emergency, during the period of November 2021 to February 2022 which required the use of tourniquets were included. Results A total 291 procedures were carried out, 90% were limb and the remaining 10% were finger/toe tourniquets. In the former pressure was recorded in 230 (87.8%) procedures and the mean pressure in upper limbs was 248 (+-14)mmHg and 270 (+-27) in lower limbs. 95.2% of patients in the study were >16 years old and the mean tourniquet time was 61.5 (+-36.4) mins, exceeding 120 minutes in only 13 cases. The Tourniquet type was documented for only 8.2% of procedures and the method of exsanguination for 34.7%. There was no record of skin isolation methods and skin condition. Conclusions Adherence to guidelines was not sufficient for some components of the procedures, including site information, method of isolation and method of exsanguination. Possible interventions include educational tutorials for staff and setting up visual aids within the OT. Results were presented in a local meeting and a re-audit is planned for 3-4 months’ time.