498 Junior Doctor Checklist for the Management of Neck of Femur Fracture: A Quality Improvement Project

Abstract

Abstract Aim Patients admitted with Neck of Femur (NOF) fracture are often complex and frail. Junior doctors in our institution are first on call and have minimal orthopaedic experience. Anecdotal experience has shown that patients are often inadequately optimised. For example, fluids not prescribed, and anticoagulants not reversed which could lead to further complications and delay to surgery, affecting patient outcomes. Therefore, we developed a junior doctor checklist to improve the quality of care for patients with NOF fracture. Method A plan-do-study-act (PDSA) methodology was utilized in designing this project. Data was collected prospectively from 50 patients presented with NOF fracture pre and post intervention. Clerking proforma, drug chart and electronic systems were reviewed. Outcome measures were prescription of analgesia, fluids, anti-emetics and laxatives, completion of venous thromboembolism (VTE) prophylaxis, abbreviated mental test (AMT), group and save and reversal of anticoagulation, if available. Intervention included production of a checklist outlining the management plan which was distributed to junior doctors. Results Areas for improvement identified from pre intervention cycle were prescription of fluids, anti-emetics, laxatives, and anticoagulant reversal, with a compliance of 56%, 44%, 42% and 50%. Other parameters had a compliance of >90% pre and post intervention. Post intervention compliance was 90% for fluids, 66% for anti-emetics, 74% for laxatives and 80% for anticoagulant reversal. Conclusion Introduction of a checklist is effective in improving the quality of care for patients with neck of femur fracture. More interventions incorporating the PDSA methodology will be carried out to strive for further quality improvement.