Departmental Induction Research Articles

A77Translational simulation in practice: an enhanced orthopaedic induction for new trainees

The gap between imagined and realized healthcare practice is indisputable. For trainees who rotate between departments, the challenges of navigating complex healthcare systems are unmet by standard induction programmes [1,2]. Our simulation centre and orthopaedic department collaborated to create an enhanced departmental induction using immersive simulation. Following a thorough needs assessment for new trainees rotating to trauma and orthopaedics. We looked at previous trainee feedback, adverse event data from our safeguarding reporting system, and expert opinion from orthopaedic staff. It became clear that at times of transition, the process of accessing timely and appropriate support was challenging. Furthermore, there were a myriad of clinical duties and patient cohorts covered by the trauma team. Working within this dynamic and complex structure was difficult for new trainees. We used team-informed process mapping to define the escalation systems in place, and the distinct roles within the team. We identified key learning objectives for a simulation induction session. We used a case vignette of an unwell trauma patient and aligned the scenario design to the required learning objectives on clear escalation pathways and whole team working within a complex environment. Following a successful pilot run, this enhanced induction is routinely delivered four monthly for junior doctors rotating to the orthopaedic department. Current trainees, orthopaedic consultants, and senior managers also attend this trainee induction as an open forum for dialogue on service improvements. All participants have rated these sessions as good or excellent; they value the whole team approach and repeatedly ask for further simulation sessions. Feedback from other members of the trauma team following these sessions commented on increased connection within the team, which included junior trainees attending departmental meetings. The orthopaedic team also felt that, following the induction programme, new trainees had demonstrated improved handover skills when escalating unwell patients. This whole team simulation-enhanced approach to orthopaedic induction is novel, and in contrast to the majority of standardized induction programmes [3]. This work provides a template that can be applied to different healthcare systems. By delivering constructively aligned simulation sessions, we can improve team training and enable new trainees to flourish during periods of transition. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

332 Improving Preparedness of Junior Doctors in Surgery Through Development and Implementation of an Induction Booklet

Abstract Aim Disruption to undergraduate clinical training during the COVID-19 pandemic caused a perceived lack of preparedness amongst newly qualified junior doctors. We aimed to improve junior doctor preparedness in surgery, through development and implementation of an induction booklet. Method An electronic survey distributed in December 2021 assessed junior doctors’ perceived preparedness for their surgical job and identified inadequacies in the existing induction programme. Through feedback and suggestions, we designed a 30-page induction booklet containing information for each surgical sub-specialty, on-call commitments, the rota, practical tips, and important contact numbers. The booklet was distributed to the subsequent two junior doctor cohorts, six weeks prior to them joining, in April and August 2022. They completed an electronic survey within their first week to assess the impact of the induction booklet. Results Survey response rate was 60% (n = 29) from the pre-intervention cohort and 55% (n = 28) from the post-intervention cohort. Prior to intervention, most junior doctors felt unprepared for their day-to-day surgical job (79%) or their first on-call shift (69%). Following the implementation of the booklet, only 11% of respondents felt unprepared for their day-to-day surgical job, more than a seven-fold improvement (p<0.0001). The proportion of respondents who felt unprepared for their first on-call shift significantly decreased to 32% (p = 0.0081). 93% of respondents reported that the induction booklet was useful in preparing them for their surgical job. Conclusions Development and implementation of a departmental induction booklet is a useful tool to improve preparedness amongst junior doctors in surgery.

284 Quality improvement in venous thromboembolism (VTE) risk assessment

Abstract Aims To improve the rates of venous thromboembolism (VTE) risk assessment on the elective Upper GI surgery ward in a tertiary hospital. Methods A standard of 95% completion of VTE risk assessment within 24 hours of admission was set, in line with our trust policy and NICE guidance. Initial data collection for one month was followed by implementation of measures to improve rates of assessment: raising the issue in our departmental governance meeting, allocation of responsibility to ward based junior doctors for daily checking and completion of assessments and prescriptions, and fortnightly snap audits to check progress. Data was collected from electronic patient records to evaluate the impact of these measures in the subsequent two months. Results Initially, only 75% of VTE assessments were completed. Following the interventions, compliance increased to 89% and subsequently to 98.5%. Conclusion VTE assessment is a mandatory requirement for all admissions with the potential for serious harm if the risk is not assessed and managed appropriately. Compliance was initially poor, falling well below our standard. Following simple interventions and active engagement from junior doctors, this was greatly improved and sustained over two months. Moving forward, we anticipate the main issue to be longevity as junior doctors rotate through the department. We recommend highlighting the issue in departmental induction and allocation of responsibility for ongoing quality improvement to rotating juniors in the role of a ‘VTE champion’. In future work we aim to assess the correlation between improved compliance with risk assessment and incidence of VTE.

1215 IMPROVING THE QUALITY OF ANTICIPATORY CARE PLANNING FOR PATIENTS WITH RECURRENT ASPIRATION PNEUMONIA

Abstract Introduction Recurrent episodes of aspiration pneumonia (RAP) are a significant problem in frail patients leading to high re-hospitalization and mortality. Anticipatory care planning (ACP) enables improved quality of life and end of life care. We reviewed the assessment, ACP discussions and communication with Primary Care in these patients. Methods We used a PDSA methodology, reviewing 116 patients with RAP referred to Speech and Language Therapy (SLT) in Elderly Medicine wards over six months, including the winter. Educational interventions were implemented. An illustrative case and pre-intervention results were presented at an online hospital-wide seminar and subsequently at an online departmental medical staff teaching session. Post-intervention analysis of 10 patients with RAP admitted over two summer months was conducted. The second round of interventions included departmental induction teaching for newly rotated doctors and creating an electronic ACP document (RAP ACP) for inclusion within the medical record. Results Baseline data was collected from 116 patients (mean age 85, 47% female). After the educational interventions, data was collected from 10 patients (mean age 88, 70% female). Data is being collected from winter months after the second intervention. This will be available before the conference. Baseline data demonstrated the need for improvements in documentation of Mental Capacity Assessment (MCA) specific to feeding (21.5%), ACP completion (26.7%) and flagging patients suitable for the Gold Standards Framework (GSF) on discharge (15%). Following educational interventions, there was a substantial improvement in MCA documentation (80%). Furthermore, there was a marked improvement in the completion of ACP discussions (70%). Communication of patients eligible for GSF was similar (14.2%) post-intervention. Conclusions Educational interventions substantially improved the quality of individualised care provided to patients with RAP. Mortality was high in both groups, yet documentation of eligibility for GSF was low, prompting further interventions targeting discharge communication.

Improving obstetrics and gynaecology departmental induction using simulation

It is well established that trainee doctors struggle with the transition into a new department. There is evidence that simulation-based education (SBE) improves competence and confidence [1]. At our Trust, there is a one-day induction for Obstetrics and Gynaecology (O&G) introducing logistics of the Department and basic skills (e.g. rota and speculum examination). However, it had limited coverage of clinical knowledge, trust protocols, and management of common O&G presentations. The aim of this study was to improve the confidence of new doctors beginning their O&G clinical rotation by increasing their knowledge-base of common presentations, protocols, and procedures through designing and implementing a trainee-focused simulation-based training programme into their induction. We collected feedback from six trainees who had undergone the previous induction programme regarding its utility and how confident the trainees felt on starting their rotation. It was evident from this that the induction did not adequately prepare them for their role and all were in agreement to have simulation embedded into the induction programme. We designed six scenarios based on common O&G presentations and used Trust Protocols (consenting, postnatal ward round checks, bleeding in pregnancy) as a guide for best practice. The programme was delivered to two cohorts (total of 12 trainees) in December 2021 and April 2022. During the new simulation-based induction, trainees completed a pre- and post-programme questionnaire which measured self-reported changes in confidence levels, O&G knowledge, and departmental protocols via a 5-point Likert scale. The questionnaire also explored their expectations of the day, whether they were met, and if this programme should feature permanently in the O&G departmental induction. These responses were analysed using the framework analysis. Quantitative results revealed: increased confidence (+80%; p<0.001), decreased anxiety (-53.4%; p<0.001), increased knowledgebase (+50%; p=0.003), increased knowledge of Trust protocols (+82.6%: p=0.001), and all 12 participants were able to locate them when needed. Analysis of qualitative results revealed common themes of improved confidence, increased knowledgebase, clearer expectations of their job roles, and 100% of participants agreed that simulation should form a permanent part of their induction. Furthermore, their expectations of the programme were met was confirmed by the thematic analysis of participants’ expectations before and after the induction. We recommend the use of simulation in departmental inductions as it is essential in improving trainee confidence; increasing their knowledge of common O&G presentations and of Trust protocols and procedures, and of their roles within the department. 1. Lateef F. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock. 2010;3(4):348.

479 Closed Loop Quality Improvement Project Improving Time to Peripherally Inserted Central Catheters (PICCs) and Intravenous (IV) Antibiotic Administration in Patients with Complex Orthopaedic Infections

Abstract Aim Bone, joint and soft tissue infections often require long term antibiotic therapy. Reliable IV access is essential for IV antibiotic administration and monitoring. PICCs provide consistent, long-term IV access. Aim: improve time to PICC request, insertion, and reduce issues with poor IV access in patients requiring long term IV antibiotics. Method Standard audit protocol. Data tool was developed and tested. Data was collected retrospectively from departmental database and online records for all patients admitted with suspected bone, joint or soft tissues infection from 01/11/19–29/2/20. Department policy and induction programme were updated. Cycle 2 included all patients from 1/8/20–30/11/21. Results Cycle 1 included 91 patients. 30 PICCs were requested with 26 inserted. Mean time to PICC request from diagnosis was 8.7 days(1–33). Mean time to PICC from request was 6.7 days(1–15). Mean time to PICC from diagnosis was 15.9 days(4–39). 10 of 30(33.3%) patients missed antibiotics due to lack of IV access. Cycle 2 included 156 patients. 36 PICCs were requested with 18 inserted. Mean time from diagnosis to request was 4.4 days(1–15). Mean time from request to insertion was 4.2(1–8) days. Mean time from diagnosis to insertion was 8.6 days(1–21). Missed IV antibiotics were reduced from 33.3% to 15.4%. Conclusions Time to PICC insertion was improved through education and introduction of new policy at departmental induction. This low-cost change can significantly improve both treatment and patient experience when admitted for complex orthopaedic infection through reliable antibiotic administration and reducing the number of IV access attempts.

EP-235 Improving working conditions of junior surgeons

Abstract Aims Significant exception reporting is reflective of difficult working conditions though well-recognised barriers exist to reporting which may reflect the culture within a unit. This study used exception reporting data to understand and improve the working conditions of juniors. Methods Junior surgeons were surveyed in December 2019 to evaluate additional hours worked, reasons for this work and whether exception reports were completed; where they were not, doctors were asked why. After data analysis, rota structures and surgical teams were changed and formal education about exception reporting given at departmental induction. The main changes involved greater opportunities to take leave and enhanced staffing on evenings and weekends. Surgical juniors were re-surveyed in September 2021. Results In December 2019, 49.2 additional hours were worked between 18 juniors. No exception reports were completed with the main reasons being a personal decision to stay late (for training opportunities), lack of understanding on how to report and cultural issues that made juniors unsure about how exception reports would be viewed. In September 2021, only 30 additional hours were worked between 17 respondents. Again, no exception reports were completed with over 95% of respondents citing a personal decision to stay late. Cultural issues within the department were no longer cited and knowledge of how to exception report was greatly increased. Conclusions A positive and open culture, where consultants and surgical leaders engage with juniors about rotas and working conditions can lead to a reduction in additional hours and improve the understanding of exception reporting.

321 Surgery Induction Guidebook – an Aid to a Successful Transition

Abstract Aim There is a 4–12% increase in mortality following the August change over in the National Health Service (NHS) UK. A well-structured induction programme is mandatory to improve both the competency and confidence of new junior doctors. This activity was designed to evaluate and improve the induction process in Pilgrim Hospital by introducing an induction guidebook. It aimed to provide a sustainable and reliable source of information to junior doctors. Method An initial survey in the department assessed the needs and identified the information required for the guidebook. An induction guidebook was designed and circulated during the changeover. A feedback survey was conducted after the six months of the initial Induction guidebook release, to know the usefulness of components of the induction guidebook and identify any gaps to improve the guidebook. Results A total of 15 participants completed the feedback survey. 47% (7) found the induction guidebook beneficial and 53.3 % (8) found it ‘slightly beneficial'. Similarly, only 1 participant (6.7%) rated the guidebook to be “of minor importance”, while 53% (8) rating it “very important” part of induction. The feedback for the contents of the book was also encouraging with suggestions. Conclusions The guidebook proved to be a valuable source in helping new doctors during times of transition to adjust to the local system and improve the induction process. It provided information about local guidelines, job overview, team structure, IT, useful contacts, and other relevant information. We recommend the departmental guidebook as a vital part of local departmental induction during the changeover.

39 Using Simulation to Improve Surgical Departmental Induction for Junior Doctors

Departmental induction is essential for trainee well-being and patient safety, particularly for doctors in the early stages of their careers. Studies have shown that junior doctors often feel underprepared and without sufficient knowledge for safe and efficient practice in surgical rotations This pilot project aimed to create an immersive simulation-based course for junior doctors, focussing on the technical and non-technical skills required to deal with common post-operative and post-procedural emergencies, to improve the departmental induction process.Junior doctors completed a questionnaire to identify their learning needs. On the basis of this, six high-fidelity immersive simulation scenarios were designed: post-operative bleeding, post-ERCP pancreatitis, post-NG tube insertion aspiration pneumonia, anastomotic leak, post-operative wound dehiscence and post-operative cardiac arrest. The scenarios were constructively aligned to both technical and non-technical learning objectives. Scenario participation was followed by a facilitated debrief. Participants completed a pre- and post-course questionnaire exploring their experience on surgical wards, confidence managing surgical ward emergencies and evaluation of the course.Two pilot sessions have been facilitated, involving seven junior doctors. Highlighted challenges of surgical ward work include the need for independent decision-making, obtaining senior support and ensuring review of post-operative patients. Pre-course, confidence was particularly low in identifying and managing post-operative emergencies, identifying patients who need to return to theatre and making escalation decisions for surgical patients. Confidence was higher in escalating to surgical seniors and recognizing own limitations. Post-course, confidence had improved in all technical and non-technical skill domains. Participants found the scenarios and subsequent debriefs relevant and educationally valuable. The main suggestion for improvement was to include the course earlier in the rotation. Data collection is ongoing.Our results show that junior doctors find specific simulation-based training in surgical ward and post-operative emergencies extremely valuable, with improved confidence in technical and non-technical skills. We hope to embed this training as part of the departmental induction within our health board and suggest that simulation training for junior doctors on post-procedural emergencies would be of widespread benefit.

105 A Simulation-Based Departmental Induction Using Virtual Reality 360

One of the challenges faced during the COVID-19 pandemic was the need for quick departmental inductions to allow rotating and redeployed junior doctors to familiarize themselves with rapidly changing departmental environments. We were unable to continue traditional inductions due to various challenges including lack of senior staff to provide the induction due to increased workload; lack of administrative staff to support inductions due to sickness and self-isolation; and lack of physical space under the constraints of social distancing. Thus, an alternative was needed incorporating all aspects of a traditional induction. Video Reality 360 (VR360) technology and video simulation have been on the rise during the last few years in medicine The aim of the study was to produce a simulation-based departmental induction programme that would be equally effective to the traditional model.We started with identifying the components of a departmental induction and then held a multi-disciplinary team meeting to encourage the addition of topics felt to be important and often overlooked. Stakeholders were involved in a needs analysis on the induction material; previous and current departmental junior doctors, the lead pharmacist, medical registrars, emergency physicians, acute physicians, the clinical lead, the medical director and the director of medical education were all contacted with specific questions on content and junior doctors’ needs. Components of the recent General Medical Council surveys were taken into account to allow for a more junior doctor-centred induction. Subsequently, scenarios were designed with input from the directors of simulation and approved by the acute medical unit (AMU) lead. With the help of our colleagues at Hull Institute of Learning & Simulation (HILS) the scenarios were filmed, edited, and filed to produce an educational tool.The end-product of our VR360 induction has been checked by the educational lead of AMU against specific variables and standards and was characterized as ‘much more flexible and a potentially more effective educational tool for junior doctors’ medical induction’. Initial feedback from junior doctors has been very positive; however, further feedback comparing traditional and VR360 induction is needed. Work is ongoing to produce an interactive VR360 induction video with the hope that this could replace face-to-face departmental induction within our hospital.

106 How the COVID-19 Pandemic has Changed Departmental Teaching in a Tertiary Hospital

Pressure from the COVID-19 pandemic on healthcare has had a detrimental effect on the delivery of teaching to junior doctors. During a time when teaching is needed more than ever the constraints of a pandemic have made this challenging. Parallel to this patient safety remains a cause for concern in healthcare systems worldwide The aim of the study was to create an educational programme for the acute medical unit to allow flexibility of learning whilst incorporating key lessons from significant incidents.Our initial approach was to gain an understanding of the problem by consulting the multi-disciplinary team. We spoke with a range of healthcare professionals working on the acute medical unit to identify concerns relating to SIs: in particular, the governance lead was key in this. Following this, we consulted junior doctors using questionnaires to explore the challenges they faced working on AMU. The design of the scenarios is based around two SIs per scenario for a total of five scenarios and all scenarios were based around the management of common conditions seen on AMU. We opted for an interactive ward round style teaching with a particular focus on key skills such as prescribing and taking bloods. With the help of our colleagues at Hull Institute of Learning & Simulation (HILS) the scenarios were filmed in 1 day and later edited to produce a short video.We have designed and created a VR360 teaching programme that combines with departmental induction allowing junior doctors to access learning from anywhere in the world and immerse themselves on AMU. Feedback has been positive so far and we hope to expand this simulation-based learning to allow to include additional topics.

EP.TU.740Implementing a departmental handbook to improve induction for FY1s during COVID-19 pandemic

Abstract Aims The 2020 cohort of FY1s qualified during the COVID-19 pandemic; most prequalification placements were cancelled. Induction provides crucial information for new FY1s. We assessed the impact of redesigning the General Surgery induction handbook at Hereford County Hospital. Methods A 40-question survey, designed against standards in ’Recommendations for safe trainee changeover’ published by the Academy of Medical Royal Colleges, was sent to all FY1s commencing General Surgery in August 2020 two weeks following induction. The survey contained 5 sections: introduction; testing your knowledge parts A and B; team atmosphere; and demographics. Answer modalities included: binary answer; multiple choice; Net Promoter Scores (NPS); and free text. Submissions were made electronically via Microsoft Forms. Feedback guided redesign of the induction handbook which was sent to FY1s rotating December 2020. Information included: how to contact seniors; requesting investigations; referring to specialties and expected duties. A repeat survey was sent to FY1s 4 weeks following induction. Results 10/11 FY1s responded during the first rotation; 9/11 during the second. FY1s felt more confident requesting bloods (NPS +50 to + 90), requesting imaging (NPS –20 to + 70), completing discharge summaries (NPS +30 to + 80) and referring to specialties (NPS –40 to + 60). There was a better understanding of different shift types (NPS –40 to + 30). More FY1s correctly recalled on call bleeps for the medical registrar (from 56% to 75%) and the anaesthetic registrar (from 50% to 78%). Most (78%, NPS +78) felt they had enough support from other FY1s which remained the same (NPS +78) through the second rotation. As a result of the COVID-19 pandemic, prequalification experience varied greatly between individual FY1s. Conclusion Overall, FY1s were more confident requesting investigations, referring to other specialties and completing discharge summaries after redesign of the induction handbook. Considering disruptions in pre-qualification training as a result of the COVID-19 pandemic, a thorough departmental induction handbook can be an invaluable resource tool to aid rotation into a new specialty.

1231 A Full-Cycle Audit Of ‘Safe’ Surgical Handovers in A Tertiary Centre

Abstract Aim 1. Assess performance in surgical handovers at Southampton General Hospital (SGH) against RCS ‘Safe Handover’ guidelines Identify any areas for improvement to ensure safe and effective handover of surgical patients Method 10 evening surgical handovers were anonymously audited In October 2019 against RCS ‘safe handover’ guidelines. The results were subsequently analysed and circulated amongst the surgical department. Handovers were then led consistently by surgical registrars and advanced nurse practitioners (ANPs). A prompt including the RCS handover guidelines was made and distributed to all members of the surgical team and included in departmental inductions. Following this, a further 10 evening handovers were anonymously audited between July and August 2020. Results Many aspects of handover performance descriptors described by the RCS in the re-audit improved following the circulation of our prompt including RCS handover guidelines and examples of minimum or good standards of practice for handover. Specifically, handover timeliness, the briefings provided (100% from 70%), the audibility of a single speaker (70% from 30%), the number of educational discussions held during handovers (100% from 50%) and awareness of the on-call overnight consultant (100% from 80%) all vastly improved. Conclusions Emphasis on undertaking effective handovers needs to continue as ‘safe' handovers between shifts can protect both patient and doctor safety. This is especially true following the implementation of the European Working Time Directive (EWTD) and a move to full shift working. Handovers are also proposed as opportunities for training which may be helpful especially in an era of reduced hours of surgical training.

1636 Improving Plastics SHO Induction: A Three-Cycle QI Project and National Survey

Abstract Aim Burns and Plastic Surgery is a wide-ranging exciting field that is rarely taught well in undergraduate medical curriculums. As such, it is imperative that we design and deliver a safe and effective induction programme for Foundation doctors and core trainees who are new to this specialty. Method Plastics SHOs rotating to our unit from December 2019 to December 2021 completed quantitative and qualitative questionnaires on the departmental induction they received. Statistical analysis and thematic analysis of their quantitative and qualitative responses were performed respectively. We aimed to describe the process of modifying our induction programme to the modern learner's learning needs. In addition, we surveyed Plastics SHOs in all Plastics units in the UK to compare and assimilate best practice. Results A combination of didactic and practical workshops resulted in significantly improved learner satisfaction, SHO preparedness for oncalls and knowledge of departmental policies in our unit. SHO shadowing was the most preferred and effective method of SHO induction nationally but rarely used. SHO handbooks were useful but employed by less than 40% of Plastics units nationally. Conclusions Through a multi-cycle QI project and national survey, we look forward to presenting the ideal design of an SHO induction programme for a specialty that requires structured clinical assessment and procedural skills. In summary, the ideal SHO induction programme consists of a combination of didactic tutorials, practical workshops, and peer shadowing. This is crucial in maintaining patient safety and junior doctor well-being when tackling the often-busy plastic surgery oncalls.

804 Using Simulation as A Platform to Prepare for ENT Emergencies in The COVID-19 Era

IntroductionAt the onset of COVID-19 crisis, our ENT department was allocated five interim foundation (FiY1) doctors to help support the clinical team at a time of extreme pressure within the NHS. An ENT emergency simulation programme was-established in order to improve the skills, knowledge and confidence of the new doctors, with the course being subsequently incorporated into departmental induction for the new first-on-call-ENT-doctors.MethodFive FiY1 doctors attended a simulation study day, comprised of a “skills and drills” workshop followed by two interactive scenarios. An interactive SimMan3G-mannequin, technician utilizing a Mask-Ed™, trained confederate nurse and a video flexible laryngoscope trainer were used to provide high-fidelity simulation. Participants rated how prepared-they felt in managing the relevant condition before and after on a Likert scale (1–strongly disagree, 5–strongly agree). The session was repeated for the new nine first-on-call ENT doctors.ResultsParticipants in the pilot session felt more prepared in managing both tracheostomy emergencies (1.2vs4.2)-and-epistaxis (2.0vs5.8). Participants in the subsequent session also felt-more-prepared in managing stridor (2.1vs4.6) -and-epistaxis-(3.1vs4.7). All-14-attendants stated that they would recommend the session to others.ConclusionsDespite-the-simulation-course-being-originally-established-to help support newly qualified-FiY1 doctors during COVID-19, the success of the programme has resulted in its formal incorporation-into departmental ENT induction.

139 Efficacy of Implementation of a Junior Doctors' Teaching Program on The Secondary Prevention of Peripheral Arterial Disease in Vascular Patients

Abstract Introduction According to NICE Guidelines, the Best medical therapy (BMT) for secondary prevention of peripheral arterial disease includes antiplatelet and statin therapy unless contraindicated. Junior Doctors are usually allocated the job of prescribing patients’ medications. Due to discrepancies in their exposure to vascular surgery in earlier training, we implemented an introductory teaching session for them regarding this BMT and audited the efficacy of this intervention. Method A retrospective review of admission and discharge medications of all vascular ward patients from August 12th to 30th September 2019 was done, and the data was analysed via Excel. Results Out of 127 patients (median age 70), 67% and 64% had antiplatelet and statin medications respectively,while on admission. 1 in each patient cohort was found discharged without either medication. The GP of the patient discharged without antiplatelets was contacted to ensure this was rectified. The other patient had refused statin therapy and thus a discharge note to their GP was conducted to reflect this. Conclusions A teaching session as part of a vascular departmental induction emphasising the evidence base for antiplatelet and statin therapy can contribute to improving prescription practices of junior doctors starting in the department.

245 Multidisciplinary Learning in the Elective Orthopaedic Setting: Can Junior Doctors and Nursing Staff Learn Together?

Abstract Introduction Feedback from junior doctors highlighted dissatisfaction with the educational value of their orthopaedic job. Surveys showed that none had had a formal departmental induction, only 33% felt their confidence had improved during the placement and only 50% reported having adequate opportunities to complete workplace-based assessments. Nurses, overall, were dissatisfied with the relationship with ward-based doctors. Method We developed an educational programme for doctors and nurses which sought to cover induction to the specialty and common orthopaedic and allied specialty topics. The biweekly teaching programme utilised a variety of teaching methods including group learning, simulation, and seminars to facilitate interdisciplinary learning and team bonding with the emphasis on mirroring the way care is delivered. Doctors and nurses were re-surveyed at the end of the placement. Results 75% of doctors had now received an induction and confidence in managing orthopaedic conditions improved from 33% to 75%. Adequate opportunities to complete assessments improved from 50% to 75%. 100% of nurses agreed that multidisciplinary learning was both possible and beneficial compared to only 54% beforehand. Conclusions Multidisciplinary education can improve confidence and teamwork among doctors and nursing staff. A service that boasts a robust teaching programme makes orthopaedics a more attractive speciality for nurses and doctors alike.

Four-monthly Foundation doctor rotations affect compliance with colorectal cancer surgery-related extended VTE prophylaxis prescriptions at discharge: a closed-loop audit

Introduction: Colorectal cancer and major abdominopelvic surgery are venous thromboembolism (VTE) risk factors. Prophylaxis at discharge mitigates VTE events. Four-monthly Foundation doctor (FY) rotations rely on departmental induction and/or handing down of knowledge to prescribe extended VTE prophylaxis upon discharge. This audit aimed to assess departmental compliance with VTE prophylaxis prescribing after elective and emergency colorectal cancer surgery. Standard: NICE Guideline NG89 to identify, address and rectify variations with compliance.

Improving prescribing of extended prophylaxis for venous thromboembolism at discharge in patients who underwent surgery for colorectal cancer.

Prophylaxis at discharge is important in mitigating venous thromboembolism events from colorectal cancer and major abdominopelvic surgery, both of which are risk factors for venous thromboembolism. Foundation doctors frequently rotate between departments, and so rely on departmental induction and/or handing down of knowledge to prescribe extended venous thromboembolism prophylaxis upon discharge. A retrospective audit of all patients who underwent surgery for colorectal cancer at The County Hospital, Hereford, between 1 August 2018 and 31 August 2019, was undertaken to assess departmental compliance with guidance from the National Institute for Health and Care Excellence. A total of 181 patients underwent elective surgery and 29 patients had emergency surgery. The initial audit revealed a cyclical 4-monthly decline that coincided with foundation doctors' rotations. Six multidisciplinary interventions were implemented. Reaudit demonstrated 100% compliance with prescribing of extended venous thromboembolism prophylaxis at discharge. No venous thromboembolism events 30 days post operation were noted. A multidisciplinary approach involving educating health professionals about the importance of extended venous thromboembolis prophylaxis in patients who have undergone surgery for colorectal cancer can be effective in improving compliance with prescribing practices at discharge.

A novel method to teach and assess the sterility of donning sterile gloves.

Sterility is of utmost importance during surgery, particularly orthopaedic surgery. The literature suggests sterility, when compromised, is frequently contaminated at the point of donning sterile gowns and gloves. We describe a novel method to assess the compliance of sterility whilst applying surgical gloves using an ultraviolet lightbox and an ultraviolet-sensitive 'Germ paint'. We carried out an audit of 'sterility' using this method with our surgical trainees. A subsequent educational programme described methods of glove-donning. Repeat assessment yielded significantly improved results. Educating staff using this method may improve sterility in theatre. We believe this is a novel method to teach and assess sterility during glove-donning. The equipment is readily accessible within each NHS hospital. Medical and theatre staff should use this as part of training and departmental induction programmes.