Audit Template Research Articles

A prescription audit in the ear, nose and throat outpatient department, in a tertiary care hospital: a descriptive cross-sectional study

Background: Prescription audit is a quality improvement process aimed at enhancing patient care and outcomes by reviewing prescriptions. It provides feedback to healthcare providers, (HCPs) to identify areas for improvement and ensure the quality of prescriptions. This study aims to analyse the prescription patterns and prescribing behaviour of doctors using world health organization (WHO) recommended core prescribing indicators and prescription audit guidelines from national health mission (NHM), India and implement action plan accordingly. Methods: A descriptive observational cross-sectional study was conducted for one month in the ear, nose and throat outpatient department (ENT OPD) of KMC-RI, Hubballi. A total of 96 prescriptions were analysed using WHO-recommended core indicators and additional indicators from a prescription audit template. An action plan was created to enhance prescription quality. Results: All the prescriptions contained complete demographic details of the patients, OPD registration name and date of consultation. Handwriting was legible in all 96 prescriptions with a score of 100%. Two lowest performing attributes were identified using prescription audit tool namely, allergy status and generic name with a score of 7% and 37.9% respectively. The study revealed that average number of drugs encountered was 1.9, the percentage of drugs prescribed by generic name was 37.9%, percentage of encounters with an injection prescribed was 2.08% and percentage of drugs prescribed from NLEM was 37.9%. Conclusions: The prescription audit revealed that most prescriptions adhered to WHO standards. However, improvements are needed in documenting allergy status and prescribing by generic name. An action plan with a defined timeline has been prepared to provide feedback, aiming to enhance prescription quality and ensure better healthcare outcomes.

DO CONCEITO À PROPOSTA DE IMPLEMENTAÇÃO: AS LINHAS DE DEFESA À LUZ DA NOVA LEI DE LICITAÇÕES E CONTRATOS (LEI 14.133/2021)

In the face of Law 14.133/2021, although at risk of successive extensions, the required innovations are remarkable. After 30 years of coexistence with Law 8666/1993, the legislator brought a robust structure arising from themes targeted by judgments, regulations, normative instructions and even international standards. In this way, art. 169 which, aiming at a governance risk management practice, used the internal audit template “The Institute of Internal Auditors – IIA”, a standard recognized worldwide for the three lines of defense in organizations. Comparing the estimated assumptions to the realities of public entities, some inconsistencies are identified, remedied through forthcoming regulations. Using the deductive method and the bibliographic technique, this article aims to conceptualize and structure the demand for regulation of Art. 169 of Law 14.133/2021 based on the perspectives and realities of the interested public entity. It is therefore concluded that, even if it is necessary to previously establish the Risk Management Policy, Governance and Compliance Policy and the organizational structure of the Central Internal Control Body and, even if there are inconsistencies in the letter of the law on the subject, it is appropriate for regulation in the form of definitions of competences, as drafted in this work.

IMPROVING CORPORATE COACHING THROUGH STRUCTURED FEEDBACK AND POSITIVE REINFORCEMENT IN A TELEMARKETING SETTING

This study investigates the effects of structured feedback and positive reinforcement on coaching quality within a telemarketing company. A corporate audit template was developed, consisting of five competency levels, allowing superior managers to provide personalized feedback to intermediate managers on the quality of their action plans for enhancing agents' performance. Additionally, five custom-designed badges, resembling the order of colors on karate belts, were implemented to publicly recognize the coaching quality of intermediate managers. These badges served as positive reinforcement for adhering to the criteria outlined in the audit template. Results revealed a significant improvement in coaching quality, as measured by the audit template, from pre-treatment to post-treatment and during a three-month follow-up period. The study also emphasizes the importance of utilizing scientific psychology to enhance performance beyond traditional methods such as in-class learning.

Do not attempt cardiopulmonary resuscitation documentation: a quality improvement project

ObjectivesThis quality improvement project looked at enhancing do not attempt cardiopulmonary resuscitation (DNACPR) documentation in a Welsh National Health Service trust.MethodsA full clinical review cycle was carried out, evaluating 50...

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.

Marketing Mix and Community Product Purchase Behavior During Covid-19 Pandemic in Surabaya

During stable times, firms will generally aim to create reliable B2B relationships that provide increased efficiency and profitability. However, tumultuous times, such as the time during a major pandemic, cause many significant disruptions in both internal and external environmental domains. Thus, we argue that it is critical during this time to reevaluate the company's business relationships as a whole. While long-term partnerships are great for handling incremental changes during stable times, disruptive environmental changes may require managers to consider disruptive changes to their businesses. A pandemic may also present opportunities for establishing new relationships as there may be other partners/suppliers who are better equipped to help the company address urgent short-term needs and to capitalize on significant long-term opportunities. In this paper, we design a new relationship audit template to help B2B firms weather the immediate crisis at hand and position themselves more strategically for the future. We explore this idea about the coronavirus outbreak, introduce the idea of a B2B crisis relationship audit, and offer potential steps forward for firms.

P132 An audit of quality of histopathology reporting of colorectal mucosal biopsies for the diagnosis and assessment of Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD) biopsies form a large part of the reporting workload of most histopathology departments. Published UK and European guidelines include recommendations on how best to report these biopsies for IBD diagnosis and assessment 1,2. The purpose of this audit is to assess whether biopsies reported at our institution adhere to these guidelines and to discuss potential improvements in IBD histology reporting. Methods An electronic search of histopathology records was conducted using diagnostic results coded for Inflammatory Bowel Disease. The search yielded 56 cases. Percentage compliance was measured for 24 criteria under the following headings: Clinical details and processing; Macroscopic description/processing; Microscopic report; and Summary/conclusion. Satisfactory compliance was set at 90%, using the recommendations from the UK Royal College of Pathologists3. Results Of the 24 criteria, 14 were accepted as adhering to the guidelines. Noteworthy results for non-compliance were: Duration of disease stated: 86% Endoscopy findings provided: 79% Actual copy of endoscopy report provided: 4% Endoscopist states probability of IBD: 63% Sampling is adequate and appropriate: 50% Distribution within sites is recorded: 68% Comment on presence or absence of basal plasmacytosis is made: 32% Preference for Ulcerative Colitis or Crohn’s disease is stated, or inability to subclassify is recorded: 71% Conclusion There is potential for improvement in IBD reporting at our site. Problems identified included lack of access to endoscopy reports, inappropriate sampling at endoscopy, and absence of endoscopy comments on the probability of IBD. Discussion of audit results with the endoscopists and creation of a regular IBD multidisciplinary team meeting (MDTM) could help to promote communication between departments and provide a route towards higher quality reporting. Areas of concern regarding microscopic reporting and interpretation included failure to describe distribution of inflammation within sites, absence of a record of basal plasmacytosis, and failure to state a preference for Ulcerative Colitis or Crohn’s disease. A lack of clarity in these areas has the potential to impact patient management negatively. Recommendations included consideration of a structured histology reporting system such as a template or the PAID approach available in the British Society of Gastroenterology guideline2.

Improving quality of preclinical academic research through auditing: A feasibility study.

How much can we rely on whether what was reported in a study was actually done? Systematic and independent examination of records, documents and processes through audits are a central element of quality management systems. In the context of current concerns about the robustness and reproducibility of experimental biomedical research audits have been suggested as a remedy a number of times. However, audits are resource intense and time consuming, and due to their very nature may be perceived as inquisition. Consequently, there is very little experience or literature on auditing and assessments in the complex preclinical biomedical research environment. To gain some insight into which audit approaches might best suit biomedical research in academia, in this study we have applied a number of them in a typical academic neuroscience environment consisting of twelve research groups with about 100 researchers, students and technicians, utilizing the full gamut of state-of-the-art methodology. Several types of assessments and internal as well as external audits (including the novel format of a peer audit) were systematically explored by a team of quality management specialists. An experimental design template was developed (and is provided here) that takes into account and mitigates difficulties, risks and systematic errors that may occur during the course of a study. All audits were performed according to a pre-defined workflow developed by us. Outcomes were assessed qualitatively. We asked for feedback from participating employees in every final discussion of an audit and documented this in the audit reports. Based on these reports follow-up audits were improved. We conclude that several realistic options for auditing exist which have the potential to improve preclinical biomedical research in academia, and have listed specific recommendations regarding their benefits and provided practical resources for their implementation (e.g. study design and audit templates, audit workflow).

Managing business relationships during a pandemic: Conducting a relationship audit and developing a path forward

During stable times, firms will generally aim to create reliable B2B relationships that provide increased efficiency and profitability. However, tumultuous times, such as the time during a major pandemic, cause many significant disruptions in both internal and external environmental domains. Thus, we argue that it is critical during this time to reevaluate the company's business relationships as a whole. While long-term partnerships are great for handling incremental changes during stable times, disruptive environmental changes may require managers to consider disruptive changes to their businesses. A pandemic may also present opportunities for establishing new relationships as there may be other partners/suppliers who are better equipped to help the company address urgent short-term needs and to capitalize on significant long-term opportunities. In this paper, we design a new relationship audit template to help B2B firms weather the immediate crisis at hand and position themselves more strategically for the future. We explore this idea in relation to the coronavirus outbreak, introduce the idea of a B2B crisis relationship audit, and offer potential steps forward for firms.

Identifying the nutritional profile of outpatient haemodialysis patients in Beaumont Hospital

AbstractBeaumont Hospital Kidney Centre, Dublin is currently the largest provider of haemodialysis in Ireland. There is a dedicated renal dietetic team to address the nutritional needs of these patients. In order to provide an optimal service, a thorough understanding and insight of the service demands is needed. Currently there is no nutritional profile of these patients. Similarly the Renal dietetic team have not been in a position to identify if they are meeting current best practice guidelines, as outline by the National Kidney Foundation. E-Med, an online renal electronic notes system, was used to provide all dietetic notes during 2018. Using an audit template, an audit of these notes for outpatient haemodialysis patients was carried out to identify a number of nutritional issues. 75% (123/163) of outpatient haemodialysis patients received direct dietetic intervention in 2018. 76% of these patients demonstrated more than one nutritional issue and 16% displayed more than five nutritional issues. The most prevalent nutritional issues arising were hyperkalemia (41%) and hyperphosphatemia (33%). Currently guidelines, which recommend a dietetic review, every 3–4 months are not being met. 53% of patients received either none or only one direct dietetic intervention in this time period. The recommended ratio of 1:100 (dietitian: haemodialysis patient) is also not being met. Currently the ratio stands at 1:243 as the dietitian responsible for haemodialysis patients is also responsible for peritoneal dialysis patients. The average length of time recorded for each direct intervention was 1 hour. Beaumont Hospital haemodialysis outpatient cohort is a nutritionally complex group of patients, which require ongoing and frequent dietetic input. Beaumont Hospital renal dietitians are successfully providing at least one episode of direct intervention to the majority (75%) of the outpatient haemodialysis patients, suggesting efficient and effective use of available resources. An increase in dietetic staffing for the renal service could offer the potential to provide direct dietetic input to all haemodialysis patients within the hospital and to also provide an increased number of reviews to patients, as per guidelines. It is possible that the amount of time spent on dietetic patient assessments is being under-reported and further work is needed to cross-reference these figures using an alternative statistical package.

Implementing participation-focused services: A study to develop the Method for using Audit and Feedback in Participation Implementation (MAPi).

It is widely agreed that children's services should use participation-focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence-based knowledge translation strategy, to support implementation of participation-focused practice in front-line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers. Best-practice guidelines for using audit and feedback were followed. For audit, participation-focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning. A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians' skills in participation-focused behaviours (median = 3.00-5.00, interquartile range [IQR] = 2.25-6.00), social processes (median = 4.00, IQR = 3.00-5.00), and behavioural regulation (median = 4.00-5.00, IQR = 3.00-6.00). MAPi provides a practical, off-the-shelf method for front-line services to investigate and support their implementation of participation-focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across-services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.

Evidenced-based radiology? A single-institution review of imaging referral appropriateness including monetary and dose estimates for inappropriate scans.

There has been a year on year increase in imaging requests at our academic institution. The iRefer guidelines are produced by the Royal College of Radiologists in the UK and are designed to prevent inappropriate imaging and radiation exposure. They have been available to general practitioners and hospital physicians in Ireland since March 2015. Our aims were to determine the proportion of inappropriate imaging referrals pre- and post-guideline introduction and to calculate the cost and dose estimates for inappropriate scans. A retrospective review of 1124 radiographs was performed with reference to a validated audit template. Emergency department, in-patient, and general practitioner referrals were reviewed. Cost and cumulative dose estimates were calculated for inappropriate referrals taking into account salaries, average time spent performing/reporting radiographs, and median effective dose values. The introduction of the iRefer guidelines has not significantly affected the proportion of inappropriate radiograph referrals at our institution, 42% pre-introduction and 43% post-introduction. We identified 784 inappropriate referrals across 6 radiograph subtypes, imparting a total median effective dose of 65.1mSv to patients. The time spent performing inappropriate abdominal and spinal radiographs in 2017 yielded an estimated cost of €8036.40. A significant amount of inappropriate radiographs continue to be requested and performed, exposing patients to needless ionizing radiation and wasting staff members time at a financial cost. Interventions are needed to decrease inappropriate referrals.

Evaluation of Interstate Work Zone Mobility using Probe Vehicle Data and Machine Learning Techniques

According to the Federal Highway Administration (FHWA), US work zones on freeways account for nearly 24% of nonrecurring freeway delays and 10% of overall congestion. Historically, there have been limited scalable datasets to investigate the specific causes of congestion due to work zones or to improve work zone planning processes to characterize the impact of work zone congestion. In recent years, third-party data vendors have provided scalable speed data from Global Positioning System (GPS) devices and cell phones which can be used to characterize mobility on all roadways. Each work zone has unique characteristics and varying mobility impacts which are predicted during the planning and design phases, but can realistically be quite different from what is ultimately experienced by the traveling public. This paper uses these datasets to introduce a scalable Work Zone Mobility Audit (WZMA) template. Additionally, the paper uses metrics developed for individual work zones to characterize the impact of more than 250 work zones varying in length and duration from Southeast Michigan. The authors make recommendations to work zone engineers on useful data to collect for improving the WZMA. As more systematic work zone data are collected, improved analytical assessment techniques, such as machine learning processes, can be used to identify the factors that will predict future work zone impacts. The paper concludes by demonstrating two machine learning algorithms, Random Forest and XGBoost, which show historical speed variation is a critical component when predicting the mobility impact of work zones.

The ESR Audit Tool (Esperanto): genesis, contents and pilot

Clinical audit is a powerful tool to improve patient care, experience and outcome. It consists of measuring a clinical outcome or procedure against predefined standards, identifying differences between current practice and the standards, and changing practice where necessary to facilitate meeting the standards, followed by re-audit (the audit cycle). The recently implemented European Council Basic Safety & Standards (BSS) Directive (2013/59/Euratom) emphasises that carrying out clinical audit is compulsory in the EU “in accordance with national requirements”. In 2017, the ESR published a Clinical Audit Tool booklet (Esperanto), consisting of an explanation of clinical audit, guidance on how to start a program in a radiology department, and 17 sample audit templates which could guide departments through the process of performing audits. A sample of key audits from these templates was performed by participating EuroSafe Imaging Star departments as a pilot project, with participants providing feedback on the audit process, and their experience of using the templates. Responses showed that the chosen topics were relevant, the audit process and templates were straightforward and easy to use, and that the audit process was time-efficient. Following this successful pilot, the Audit Tool has been made available for all potential users through the ESR website.Key Points• Clinical audit is the process of assessing one’s practice against defined standards, altering practice if necessary to meet standards, and re-assessing following changes to confirm improvement• Clinical audit should be part of practice in all radiology departments• Under European Council Directive 2013/59/Euratom, clinical audit is compulsory in the EU “in accordance with national requirements”• The ESR has developed a Clinical Audit Tool (Esperanto) to explain the process and guide departments through sample audit templates• This Clinical Audit Tool was successfully piloted in 2017, and is now available to all users on the ESR website

Monitoring and Improving Quality Care through the development of an automated audit tool

Introduction (comprising context and problem statement) The Health Information and Quality Authority (2016) specify that designated centres for older people must monitor, review and improve the quality of care and experience of residents on an ongoing basis. Although the Kerry Community Hospitals/ Nursing Units undertake regular audits, the paper based process is time consuming and fails to provide real time data with trend analysis consistently throughout the year. Short description of change implement : Viclarity provide compliance monitoring solutions to healthcare organisations in Ireland, the United Kingdom and America. Total quality management initiatives develop customer focused processes and procedures to meet internal and external clients, real data and constant monitoring are essential to measure the improvement progress (Trofino 2000). Viclaritys innovative platform would facilitate the Kerry Community Hospitals/ Nursing Units to track and manage all of their audits and paper based processes in one system using a colour coded dashboard. Aim and theory of change : The aim of this project is to customise Viclaritys pre-built audit templates to create an automated audit tool that monitors each of the Kerry Community Hospitals/ Nursing Units in accordance with evidence based practice and the regulatory standards for designated centres for older people in Ireland (Health Information and Quality Authority 2016) Targeted population and stakeholders : Residents, Health Care Assistants, Registered Nurses, Clinical Nurse Managers, Clinical Development Co-ordinator, Directors of Nursing, Area Manager Timeline : A timeline of 12 months has been assigned to this quality improvement initiative. Designing the customised audits Trialling the system to ensure it is meeting service need and user friendly Resolving any technical issues Installation / implementing across all sites Highlights (innovation, impact and outcomes) The colour coded dashboard will provide live information on all audits conducted Instant visual identification of non-compliance, action plan required by the system to specify how non-compliance will be addressed thus promoting quality of the service The system has a fully integrated CA/PA feature built in and delivers detailed informative reports with one click, promoting a more efficient and effective service Exception reports with action plans that specify how the issue will be resolved and who is responsible for same, thus monitoring and improving the quality, effectiveness and efficiency of the service. Comments and sustainability : Regular consultation and collaboration between Viclarity and Clinical Development Co-ordinator to ensure the customised audits are updated in accordance with any evidence based changes in hospital policy or regulatory standards. Comments and transferability : Implementation throughout the 6 Community Hospitals/ Nursing Units Transferable to all designated centres for older people Easily modified to transfer into any healthcare organisation/ service References : 1- Health Information and Quality Authority. National Standards for Residential Care Settings for Older People in Ireland. Health Information and Quality Authority. 2016. 2- Trofino A.J. Transformational Leadership: moving total quality management to world class organisations. International Nursing Review. 2000;47: 232-242.

P037: The Ontario Emergency Department Return Visit Quality Program: a provincial initiative to promote continuous quality improvement

Introduction: Analyzing the charts of patients who have a return visit to an emergency department (ED) requiring hospital admission (termed ‘RV’) is an efficient way to identify adverse events (AEs). Investigating these AEs can inform efforts to improve the quality of care provided. The ED RV Quality Program (RVQP) is a new initiative supported by Ontario’s Ministry of Health and Long-Term Care and managed by Health Quality Ontario. It aims to promote a culture of continuous quality improvement through routine audit/investigation of RVs. Methods: The provincial program is mandatory for high-volume EDs and requires auditing of some 72-hour RVs and all 7-day RVs involving ‘sentinel diagnoses’ (subarachnoid hemorrhage [SAH], acute myocardial infarction [AMI], or pediatric sepsis [PS]). A standardized audit template is followed that includes assessment of the type/severity and underlying causes of AEs, and potential actions for improvement. Results: 73 high-volume EDs and 16 smaller EDs (collectively receiving 90% of all ED visits in Ontario) are participating in the program. Nine months’ data have been released to date, comprising 33,956 RVs (1.05% of 3,235,751 ED visits). Of these, 233 RVs (0.69%) were for a sentinel diagnosis (SAH=11, AMI=191, PS=31). The most common presenting complaint on the index visit was abdominal pain (18%). The most common discharge diagnosis following RV admission was acute appendicitis (3.8%). Conclusion: The ED RVQP aims to improve the quality of care provided in Ontario’s EDs by requiring hospitals to conduct audits of RVs and plan actions for improvement when quality gaps are identified. Participating hospitals have completed hundreds of audits to date.

Dementia and the use of the access audit: Identifying reasonable adjustment to buildings across all disabilities

This paper is part of the author's investigation of disabled access to goods and services, to assess whether current legislation, policing of that legislation and the processes adopted to facilitate the terms of the legislation are delivering as intended. Signs of dementia are often hidden, but they meet Equality Act definitions for the term ‘disability’. Dementia creates conditions that can make the use of buildings difficult. Having established the statutory position for providing equal access to goods and services, this paper looks at the building block of any access strategy — the access audit. Access audit templates are often used to undertake the survey part of an access strategy. These often refer directly to guide documents and standards. The paper investigates whether these templates, guides and standards contain the specific checklist items required to provide equal access for those living with dementia. It then measures some of the most commonly used guide documents and templates against a specific checklist for dementia, to see how the required adjustments are included. The research concludes by access auditing two case study buildings against the dementia checklist. The buildings have been significantly adjusted to offer enhanced disability access and the audit will establish if core adjustments for dementia are included among those measures. Unfortunately, the paper concludes by noting that in these case studies, they mostly have not.

Comparison of 14G, 16G and 18G core biopsies of lymph nodes in patients with suspected lymphoma

Purpose Fine needle aspiration cytology of lymph nodes has poor sensitivity for diagnosis of lymphoproliferative disorders. Core biopsy is preferred when lymphoma is suspected. It has been suggested that enlarged ovoid nodes with central echogenic hila (lymphoma morphology) are lymphomatous or reactive. The purpose of our study was to: – Determine the histological diagnosis in patients with this nodal appearance – Determine the adequacy of core biopsies (RCR audit template, target 95%). – Compare outcomes of differing core biopsy sizes for nodes with lymphoma morphology. Methods and materials Fifty eight consecutive patients who underwent ultrasound guided core biopsy of nodes with lymphoma morphology or a final diagnosis of lymphoma between January 2011 and May 2014 were retrospectively evaluated. Selection of biopsy gauge is related to changing departmental policy rather than node size. Results Needle gauge adequacy lymphoma diagnosed and typed. 18 gauge (G) (n = 21) 95% 69% 16G (n = 29) 96% 88% 14G (n = 8) 100% 87% 90% of nodes with lymphoma morphology were diagnosed as reactive or lymphoma on final histology. Conclusion Our figures suggest that larger biopsies are better for diagnosing and typing lymphoma. Nodes with lymphoma morphology are likely to be lymphomatous or reactive and a core biopsy should be performed rather than an FNA. Ultrasound guided core biopsy has a high yield in lymphoma and may obviate unnecessary excision biopsy. Fine needle aspiration cytology of lymph nodes has poor sensitivity for diagnosis of lymphoproliferative disorders. Core biopsy is preferred when lymphoma is suspected. It has been suggested that enlarged ovoid nodes with central echogenic hila (lymphoma morphology) are lymphomatous or reactive. The purpose of our study was to: – Determine the histological diagnosis in patients with this nodal appearance – Determine the adequacy of core biopsies (RCR audit template, target 95%). – Compare outcomes of differing core biopsy sizes for nodes with lymphoma morphology. Fifty eight consecutive patients who underwent ultrasound guided core biopsy of nodes with lymphoma morphology or a final diagnosis of lymphoma between January 2011 and May 2014 were retrospectively evaluated. Selection of biopsy gauge is related to changing departmental policy rather than node size. Needle gauge adequacy lymphoma diagnosed and typed. 18 gauge (G) (n = 21) 95% 69% 16G (n = 29) 96% 88% 14G (n = 8) 100% 87% 90% of nodes with lymphoma morphology were diagnosed as reactive or lymphoma on final histology. Our figures suggest that larger biopsies are better for diagnosing and typing lymphoma.

PWE-401 Nurse-led audit of post-operative morbidity following colorectal resection: making the most of existing resources

Introduction: Colorectal and stoma care nurses have been auditing their specialist services for years, but have contributed less frequently to colorectal surgical service-wide audit measuring clinical outcomes relating to surgical as well as nursing care. Nurse-led follow-up provides the ideal platform to measure key indicators of quality care and identify areas for both service improvement and future research activity. Method: A nurse-led follow-up clinic at 30 days following patient discharge was used to audit 142 consecutive patients undergoing elective (n= 98) or emergency (n=44) colorectal resection over a three month period. Audit data were recorded at two time-points, discharge from hospital and at clinic, with audit templates developed using validated tools designed to measure general post-operative morbidity (Grocott et al, 2007; Dindo et al, 2004) and modified to include a focus on colorectal surgery-specific complications. Audit templates were tested during two clinics prior to full data collection to ensure they included all required variables. Results: A wide range of anticipated and unanticipated findings were identified relating to both inpatient and early post- discharge morbidity. Findings were presented to the whole colorectal team, including upper GI and colorectal surgeons and their teams, specialist nurses, theatre-based and ward-based nursing staff. Areas of clinical practice identified by the audit as requiring improvement were identified and discussed, with immediate changes to surgical practice agreed by the whole team. Nurse-led follow-up for all colorectal patients was established as a potential goal for future service improvement. Conclusion: This nurse-led audit enabled the whole colorectal team to scrutinise their clinical practice by comprehensively examining patient outcomes at two time-points following colorectal resection. Nurse-led follow-up using an auditable documentation template facilitates the recognition and reporting of a wide range of post-operative complications and provides valuable support for patients, particularly those who do not have routine access to specialist nursing services.

PTU-271 Hidden morbidity following colorectal resection: postoperative evaluation

Introduction The implementation and evaluation of Enhanced Recovery after Surgery programmes over the past 15 years has ensured the accurate reporting of inpatient morbidity post colorectal resection. However, there is a paucity of audit or research examining post-operative morbidity in the early discharge period. Method 142 consecutive patients undergoing elective (n = 98) or emergency (n = 44) colorectal resection over a three-month period were invited to attend a nurse-led outpatient clinic at 30 days post-discharge. Audit data were collected at two time-points, discharge from hospital and at clinic. Audit templates were developed using the Postoperative Morbidity Survey, 1 Clavien-Dindo classification criteria 2 and modified to include additional colorectal surgery-specific outcomes. Results were recorded and analysed using SPSS. Results Unanticipated findings relating to post-discharge morbidity identified through the audit included: 35% (n = 32) of infection-free inpatients developed surgical site infections following discharge. 34% (n = 47) of all patients had significant urinary symptoms when seen in clinic. Dietary implications at 30 days post-discharge included an appetite of half or less than usual intake in 27% of patients (n = 37) and moderate to major changes in dietary intake compared to their pre-operative diet in 30% (n = 42). 27% (n = 38) of patients had an ileostomy; of those without an ileostomy, 20% (n = 21) had four or more daily bowel movements, with 22% (n = 23) describing their stool consistency as watery, loose or unsettled. 45% (n = 46) of those without an ileostomy reported one or more problematic bowel symptom related to their surgical experience at 30 days post-discharge. Conclusion These audit findings suggest that individuals undergoing colorectal resection experience significant levels of post-discharge morbidity, extending the burden on them and the services required to support them for longer than may have been previously anticipated. Nurse-led follow-up using auditable documentation templates facilitates the recognition and reporting of complications following discharge and provides valuable support for patients. Disclosure of interest None Declared. References Grocott MPW, et al . The Postoperative Morbidity Survey was validated and used to describe morbidity after pelvic surgery. J Clin Epidemiol 2007;60:919–928 Dindo D, et al . Classification of Surgical Complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213