Compliance with BSG/BASL decompensated cirrhosis care bundle

Abstract

Background: This audit focuses on Compliance with the British Societyof Gastroenterology (BSG) and British Association for the Study of theLiver (BASL) Decompensated Cirrhosis Care Bundle as decompensatedliver cirrhosis is becoming a burden on the current NHS.Objectives: The study aims to ensure that future admissions with decompensatedcirrhosis adhere to the care bundle, identify areas of poor compliance,and pinpoint areas for improvement.Methodology: Over the course of 6 months, a sample of 29 patients, rangingin age from 29 to 77, were evaluated at Hinchingbrooke Hospital.Presentations and compliance were examined using manual medical takeclerking searches.Findings: Common presentations included jaundice, ascites, and varicealbleeding. In-hospital mortality stood at 31%. While basic investigationswere generally compliant, there were significant non-compliance rates forseptic screen (38%), ascitic tap (37%), and USS abdomen (24%). Partialcompliance was noted in recording alcohol intake (87%) and prescribingIV Pabrinex (89%), with non-compliance for CIWA (74%). Varicealbleeding management showed non-compliance in prophylactic antibiotics(60%), terlipressin (70%), and vitamin K (43%), while adequate lactulosedosing in encephalopathy was non-compliant in 71% of cases. VTEprophylaxis prescribing showed high compliance at 92% in appropriatecases.Conclusion: The audit highlights the need to adhere to the use of decompensatedcirrhosis care bundle. It shows gaps in compliance which can beareas for improvement and education.