Improving weekend handover in trauma and orthopaedics: A four cycle audit

Abstract

s / International Journal of Surgery 23 (2015) S15eS134 S86 Aim: The surgical wound is routinely infiltrated with local anaesthetic in minor and major orthopaedic procedures. Increasingly, all-comers are treated with volar locking plates. Local anaesthetic (LA) can be infiltrated as a single dose or via a wound catheter at the end of the procedure with low or negligible side effects. We audited the use of LA in patients who underwent open reduction and internal fixation for distal forearm fractures over a six month period in our designated orthopaedic theatre and performed a cost analysis. Methods: Data was collected on patients who underwent insertion of a volar locking plate for a distal forearm fracture in the preceding 6 months. Prior to closure, incisions were subcutaneously infiltrated with 10mls of 0.5% bupivacaine using a 10 ml syringe. Results: n 1⁄4 89 patients (61 women& 28 men) who met the audit criteria. Age ranged from 14 -71, with average age at the time of injury 57. Total cost was calculated for the use of needle, syringe & 0.5% bupivacaine. Conclusion: Total cost of local anaesthesia was V138.84. There were no needle stick injuries. Future studies based from this audit will evaluate LA lavage of surgical incision and compare cost, opiate consumption and pain scores. 0609: IMPROVING WEEKEND HANDOVER IN TRAUMA AND ORTHOPAEDICS: A FOUR CYCLE AUDIT A. Lunt, S. Yan, J. Stones. Worcester Royal Hospital, UK Aim: Handover between teams has been highlighted as a point of vulnerability in a patient's pathway. The Royal College of Surgeons (RCS) has published guidance on recommended handover practices. We aimed to assess the quality of weekend handover practices in our department, implement changes and re-assess for improvement. Methods: Data for 14 domains, based on RCS guidelines, were retrospectively collected from weekend handovers. The four cycles took place in June, July, August and November 2014 respectively (n 1⁄4 50, 58, 61, 55). Following the first cycle an electronic proforma for weekend handover was developed. Results: Overall compliance in each cycle was 73, 94, 72 and 95% respectively. Median handover scores were 9, 13, 10 and 13 in each cycle with a maximum possible score of 14. Improvement was demonstrated after implementation of electronic proforma, however this reversed in the third audit following the change over of doctors. Following education of the team, further improvement was demonstrated in the fourth audit cycle. Conclusion: Development and implementation of a simple proforma can improve the quality and effectiveness of patient handovers, however education of incoming doctors is essential in maintaining these standards. 0622: AN INTERNAL AUDIT ON EXOGEN USE IN THE EAST MIDLANDS N. Ibrahim , J. Mangwani , R. Natarajan , D. Mahadevan , I. Chauhan , W. Groom, J. Rudd . 1 Leicester Royal Infirmary, UK; Northampton General Hospital, UK Aim: EXOGEN is a portable medical device which utilises ultrasound to stimulate bone remodelling in cases of fracture non-union. Published healing rates are as high as 86%. We evaluated the outcomes of all EXOGEN use at two East Midlands centres e Northampton (NGH) and Leicester (LRI). Methods: Indications for EXOGEN initiation were analysed and compared against published gold standards using clinical notes and imaging. Results: 27 Patients were analysed at the LRI and 20 patients at NGH. 33% of LRI patients initiated on EXOGEN showed bone consolidation at 6 months and 25% at NGH. 26% of LRI patients underwent subsequent definitive surgery after trial and failure of EXOGEN, similarly 25% at NGH. Overall 26% of LRI patients did not meet the criteria for use. Conclusion: The published success of EXOGEN was not reproducible at either centre. The relative success of EXOGEN is heavily dependent on patient selection/adherence. The cost per unit is £2562.50 with an estimated spend of £74,123.50 at the LRI between Jul 2011 and Jan 2014. This Audit demonstrates the importance of establishing a protocol for EXOGEN use and monitoring adherence using a database. This is vital as the cost of the device can reimbursed in certain cases of clinical failure. 0630: RADIOGRAPHIC AND FUNCTIONAL OUTCOMES FOLLOWING KNEE ARTHRODESIS USING THE WICHITA FUSION NAIL IN IRELAND P. McQuail, J. Baker, P. Keogh, P. Kenny. James Connolly Memorial Hospital,