s / International Journal of Surgery 12 (2014) S13eS117 S104 0328: MITOMYCIN C GUIDELINES: AN IMPROVEMENT IN DEPARTMENT ADHERENCE THROUGH THE PROCESS OF AUDIT, LED BY JUNIOR DOCTORS Gerard Walls , David Curry, Hugh O'Kane. Regional Urology Unit, Belfast City Hospital, Northern Ireland, UK. Introduction: The authors intended to establish adherence to guidelines regarding time to administration of intravesical chemotherapy postTURBT, in the Regional Urology Unit. EORTC recommends Mitomycin C (MMC) instillation within 6 hours in eligible patients this reduces recurrence rates by 39%. Methods: Prospective audit of time to administration in all eligible patients during a 3 month period. Results were discussed at departmental level with a three tiered approach to improvement. Primarily, initiation of in-theatre instillation (Mostafid et al). Second, a training programme for ward staff in handling cytotoxic agents. Finally, awareness of the problem was raised to trainee urologists at the Regional Audit Meeting. A repeat three month audit series was performed six months later. The latter two processes had been implemented with plans for in-theatre administration on-going. Results: Initially, in 19 patients (40 eligible) the mean time to MMC administration was 18.3hrs (2.3-28.2hrs). 15.7% patients received MMC 3mm, first time. Unanimous, unequivocal histopathological diagnoses were achieved. Conclusions: Few biopsy devices provide satisfactory, representative and consistent samples for diagnosis. We experienced an unpredictable outcome with a 25% re-biopsy rate with various devices, however with BIGopsy forceps accurate histopathological diagnoses were achieved with a significant impact on the timely treatment for urothelial malignancies. 0401: HOW CLINICAL AUDIT HAS LED TO REDUCED RATES OF POST TRUS BIOPSY SEPSIS IN OUR TRUST Nicholas Gill , Michael Onyema, Anne Dyas, Vincent Koo, Paul Rajjayabun. Alexandra Hospital, Redditch, UK. Introduction: We recently reported the findings of a regional audit which identified rates of sepsis increasing to 1.8% following transrectal ultrasound guided prostate biopsies (TRUS). Following this audit I.V. Gentamicin 160mg was introduced as additional prophylaxis for patients undergoing TRUS biopsy. Our aim was to assess the impact of adding Gentamicin to the TRUS antibiotic prophylaxis bundle since implementation in August 2013. Methods: Analysis of all patients who underwent TRUS biopsy across our Trust between August-December 2013 with minimum 1-month follow up. Our findings were compared against our previous audit data and published literature. Results: Therewere 246 TRUS biopsy procedures carried out across the Trust following the introduction of our new antibiotic prophylaxis regime. Median age of the population examined was 67 years (range 42-84). Only 1 patient was admitted to Secondary care with significant sepsis (0.4%), 3 patients had positive urine cultures performed inPrimarycare but didnot require hospital admission (1.2%). There were no ITU admissions or mortalities. Conclusion: We conclude that the addition of I.V. Gentamicin has dramatically reduced the incidence of significant sepsis post-TRUS biopsy. This is an example of howwe have utilised audit tomodify clinical practice for the benefit of our patients. 0403: PROGNOSIS FOLLOWING PERCUTANEOUS NEPHROSTOMY INSERTION FOR MALIGNANT OBSTRUCTIVE UROPATHY: ONE CENTRE'S EXPERIENCE Nicholas Gill , Kevin Williams, Phil Holland, Chris Phillips, Fabio Conti, K. Wong, L. Delaney, L. Moore, Paul Rajjayabun. Alexandra Hospital,