General Surgery Wards Research Articles

The effect of surgical inguinal hernia repair on testicular blood supply: A prospective superb microvascular imaging ultrasonography study.

In this study, we aimed to evaluate the differences in vascularity between the testis on the inguinal hernia (IH) side and the contralateral healthy testis by performing preoperative and postoperative (first month) examinations with superb microvascular imaging ultrasonography (SMI USG), and to compare results with power Doppler (PD) USG. In this prospective cohort study, 35 patients diagnosed with IH between April 2023 and July 2023 who were hospitalized in the general surgery ward of a tertiary hospital for IH surgery were evaluated. The postoperative vascular index (VI) values obtained by SMI were found to be significantly lower than preoperative VI values in both operated and non-operated testes (p < 0.001). The VI values obtained with PD in the postoperative period were significantly lower in the operated and nonoperated testes on both sides compared with the VI values obtained in the preoperative period (p < 0.001 and p = 0.029, respectively). There was a significant difference between preoperative and postoperative VI difference values obtained by SMI and PD on the operated side (p = 0.015). In our study examining patients who had undergone IH surgery, testicular vascularity was assessed more precisely with the SMI USG method compared with the PD method.

WP7.2 - The Role of a Frailty Team to improve Perioperative Care for ELLSA Patients

Abstract Aim Frailty assessment amongst emergency laparotomy patients is essential. The 8th NELA report highlighted that only 31.8% of patients who were frail and over 65 years received geriatrician input. Within our organisation, patients who undergo emergency laparotomy are included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). The consultant geriatrician led Surgical Acute Frailty Team (SAFT) works collaboratively with the emergency general surgery team and ELLSA specialist nurse to review ELLSA patients within our hospital. Our aim was to establish outcomes of ELLSA patients reviewed by SAFT. Methods Data collected routinely via Redcap as part of our organisation’s ELLSA was reviewed. All ELLSA patients aged ≥65 years admitted between November 2022 and November 2023 were included. Data included frailty assessment, discharge destination and 30 day mortality. Results 152 patients aged ≥ 65 years underwent operative intervention as defined by ELLSA. 100% of patients had a documented Clinical Frailty Scale (CFS) score. 72 patients (47.4%) had a pre-operative frailty review. 68.4% of patients had their initial frailty assessment by a consultant geriatrician. 19.7% of patients were reviewed by frailty ANPs or clinical fellow. Only 7.9% of patients required care support on discharge. 30 day mortality was 17.1%. Conclusions Embedding a dedicated frailty team within our general surgery wards has been incredibly successful; frailty assessment is significantly above that of the 8th NELA report. The majority of ELLSA patients aged ≥65 years are discharged home independently. Collaborative working and early identification of frailty in ELLSA patients is essential to improve patient outcomes.

Effect of Perioperative Blood Transfusion on Complications Following Emergency Non-trauma Laparotomy in Mulago Hospital: A Prospective Cohort Study.

Background Although blood transfusion may be required during emergency non-trauma laparotomy, several retrospective cohort studies have identified blood transfusion as a significant predictor of postoperative infections and mortality. However, no study has explored such an association in a resource-limited setting. This study aims to determine the effect of perioperative blood transfusion on the 30-day risk of surgical site infections (SSIs) and mortality among patients undergoing emergency non-trauma laparotomy in a large urban tertiary hospital in a resource-limited setting. Methodology In this prospective, single-center, cohort study, we recruited 160 consecutive adult patients admitted to the general surgery wards 48 hours after emergency non-trauma laparotomy. We grouped them based on transfusion exposure status. Transfusion exposure and possible confounders were recorded on entry, while the presence or absence of SSIs and mortality were obtained over 30 days of follow-up. The data were analyzed using Epi Info version 7 and Stata version 14. P-values <0.05 indicated statistical significance. Results All 160 participants recruited, 28 (17.5%) transfusion-exposed and 132 (82.5%) non-exposed, were included in the final analysis. Transfusion exposure (relative risk = 8.16; 95% confidence interval (CI) = 2.73-24.37; p < 0.001) was an independent risk factor for SSI after multivariate logistic regression analysis adjusted for confounders. Inverse probability weighting with regression adjustment (IPWRA) revealed that transfusion exposure significantly increased the incidence of SSI by 36.2% (95% CI = 14.2%-58.2%; p = 0.001). Furthermore, transfusion exposure (hazard ratio (HR) = 3.62; 95% CI = 1.28-10.27; p = 0.015) and age ≥60 years (HR = 5.97; 95% CI = 1.98-18.01; p = 0.002) were independent risk factors for 30-day mortality after multivariate Cox regression analysis adjusted for confounders. IPWRA revealed that transfusion exposure significantly increased the incidence of mortality by 17.6% (95% CI = 1.4%-33.8%; p = 0.033). Conclusions This study suggests an independent association between perioperative blood transfusion and the occurrence of SSIs and mortality among patients undergoing emergency non-trauma laparotomy. A larger multicenter prospective cohort study considering more confounders and the use of established restrictive transfusion protocols is recommended.

269 Quality Improvement: Implementing a General Surgery Ward Round Proforma at Stoke Mandeville Hospital

269 Quality Improvement: Implementing a General Surgery Ward Round Proforma at Stoke Mandeville Hospital

Optimization of appropriate antimicrobial prophylaxis in general surgery: a prospective cohort study

BackgroundSurgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to surgical antimicrobial prophylaxis (SAP) is paramount in mitigating the occurrence of SSIs. In this study, we aimed to evaluate the appropriateness of SAP use in patients undergoing surgical procedures in the field of general surgery according to the American Society of Health-System Pharmacists (ASHP) guideline and to determine the difference between the pre-training period (pre-TP) and the post-training period (post-TP) organized according to this guideline.MethodsIt is a single-center prospective study conducted in general surgery wards between January 2022 and May 2023, with 404 patients pre-TP and 406 patients post-TP.ResultsCefazolin emerged as the predominant agent for SAP, favored in 86.8% (703/810) of cases. Appropriate cefazolin dosage increased significantly from 41% (129 patients) in pre-TP to 92.6% (276 patients) in post-TP (p < 0.001), along with a rise in adherence to recommended timing of administration from 42.2% (133 patients) to 62.8% (187 patients) (p < 0.001). The proportion of patients receiving antibiotics during hospitalization in the ward postoperatively decreased post-TP (21–14.3%; p = 0.012), as did antibiotic prescription at discharge (16.8–10.3%; p = 0.008). The incidence of SSI showed a slight increase from 9.9% in pre-TP to 13.3% in post-TP (p = 0.131).ConclusionsRoutine training sessions for surgeons emerged as crucial strategies to optimize patient care and enhance SAP compliance rates, particularly given the burden of clinical responsibilities faced by surgical teams.

The Ottawa resident observation form for nurses (O-RON): evaluation of an assessment tool’s psychometric properties in different specialties

BackgroundWorkplace-based assessment (WBA) used in post-graduate medical education relies on physician supervisors’ feedback. However, in a training environment where supervisors are unavailable to assess certain aspects of a resident’s performance, nurses are well-positioned to do so. The Ottawa Resident Observation Form for Nurses (O-RON) was developed to capture nurses’ assessment of trainee performance and results have demonstrated strong evidence for validity in Orthopedic Surgery. However, different clinical settings may impact a tool’s performance. This project studied the use of the O-RON in three different specialties at the University of Ottawa.MethodsO-RON forms were distributed on Internal Medicine, General Surgery, and Obstetrical wards at the University of Ottawa over nine months. Validity evidence related to quantitative data was collected. Exit interviews with nurse managers were performed and content was thematically analyzed.Results179 O-RONs were completed on 30 residents. With four forms per resident, the ORON’s reliability was 0.82. Global judgement response and frequency of concerns was correlated (r = 0.627, P < 0.001).ConclusionsConsistent with the original study, the findings demonstrated strong evidence for validity. However, the number of forms collected was less than expected. Exit interviews identified factors impacting form completion, which included clinical workloads and interprofessional dynamics.

Molecular Analysis of Carbapenem and Aminoglycoside Resistance Genes in Carbapenem-Resistant Pseudomonas aeruginosa Clinical Strains: A Challenge for Tertiary Care Hospitals.

Carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) strains have become a global threat due to their remarkable capability to survive and disseminate successfully by the acquisition of resistance genes. As a result, the treatment strategies have been severely compromised. Due to the insufficient available data regarding P. aeruginosa resistance from Pakistan, we aimed to investigate the resistance mechanisms of 249 P. aeruginosa strains by antimicrobial susceptibility testing, polymerase chain reaction for the detection of carbapenemases, aminoglycoside resistance genes, extended-spectrum beta-lactamases (ESBLs), sequence typing and plasmid typing. Furthermore, we tested silver nanoparticles (AgNPs) to evaluate their in vitro sensitivity against antimicrobial-resistant P. aeruginosa strains. We observed higher resistance against antimicrobials in the general surgery ward, general medicine ward and wound samples. Phenotypic carbapenemase-producer strains comprised 80.7% (201/249) with 89.0% (179/201) demonstrating genes encoding carbapenemases: blaNDM-1 (32.96%), blaOXA48 (37.43%), blaIMP (7.26%), blaVIM (5.03%), blaKPC-2 (1.12%), blaNDM-1/blaOXA48 (13.97%), blaOXA-48/blaVIM (1.68%) and blaVIM/blaIMP (0.56%). Aminoglycoside-modifying enzyme genes and 16S rRNA methylase variants were detected in 43.8% (109/249) strains: aac(6')-lb (12.8%), aac(3)-lla (12.0%), rmtB (21.1%), rmtC (11.0%), armA (12.8%), rmtD (4.6%), rmtF (6.4%), rmtB/aac(3)-lla (8.2%), rmtB/aac(6')-lla (7.3%) and rmtB/armA (3.6%). In total, 43.0% (77/179) of the strains coharbored carbapenemases and aminoglycoside resistance genes with 83.1% resistant to at least 1 agent in 3 or more classes and 16.9% resistant to every class of antimicrobials tested. Thirteen sequence types (STs) were identified: ST235, ST277, ST234, ST170, ST381, ST175, ST1455, ST1963, ST313, ST207, ST664, ST357 and ST348. Plasmid replicon types IncFI, IncFII, IncA/C, IncL/M, IncN, IncX, IncR and IncFIIK and MOB types F11, F12, H121, P131 and P3 were detected. Meropenem/AgNPs and Amikacin/AgNPs showed enhanced antibacterial activity. We reported the coexistence of carbapenemases and aminoglycoside resistance genes among carbapenem-resistant P. aeruginosa with diverse clonal lineages from Pakistan. Furthermore, we highlighted AgNP's potential role in handling future antimicrobial resistance concerns.

Preoperatif Durumluk-Sürekli Anksiyete Düzeyi ve Uygulanan Anestezi Tekniğinin Postoperatif Bulantı ve Kusmaya Etkisi

Objective: It was aimed to determine the effect of preoperative anxiety levels and anesthesia of the patients on postoperative nausea and vomiting (PONV). Methods: This study was a cross sectional research. It was conducted with 323 patients at a state hospital between April-June 2022. Data were collected with Sociodemographic and Clinical Characteristics Form, State-Trait Anxiety Inventory (STAI), and Rhodes Index of Nausea, Vomiting, and Retching. Descriptive statistics were applied to analyze the data. Results: The mean age of the patients were 50.5 ± 17.3 years, and 18.9% of them were treated in the general surgery ward. There was a significant difference in the development of PONV in the Trait Anxiety Inventory (STAI-T) severe anxiety group compared to the mild anxiety group (p=0.031) and in the State Anxiety Inventory (STAI-S) moderate anxiety group compared to the mild anxiety group (p=0.012). When anesthetic type was included in the model, there was a significant difference in the development of PONV between the STAI-S moderate and mild anxiety groups (p=0.006). State Anxiety Inventory scores were found to be effective in the group that received general and spinal anesthesia (p=0.013). Postoperative nausea and vomiting development was 41.2% in the moderate anxiety group and 21.7% in the mild anxiety group in the general and spinal anesthesia group. Conclusion: It was determined that undergoing general or spinal anesthesia increases the risk of developing PONV as the STAI-S score increases. Keywords: Surgery, anxiety, nausea, vomiting

Results of thyroidectomies according to general surgeons and otolaryngologist and cervico faciale surgeons at the general Hospital of Reference of Niamey, what differences in the protocols of management?

ObjectiveTo evaluate the surgical management of thyroid pathologies at the Reference General Hospital.MethodsThis was a retro-prospective study over 4 years 6 months carried out in the departments of General and Digestive Surgery (GDS) and Otorhinolaryngology and Cervico Facial Surgery (ORL/FCS). It involved 182 patients who underwent thyroid surgery.ResultsA frequency of thyroidectomy of 9.46% was found. Females predominated with a sex ratio of 0.1. The average age of patients was 42.85 years, a standard deviation 12.80. 84.06% of patients had consulted for anterior cervical mass. EU-TIRADS score 3 represented 7,14% of cases. Heteromultinodular goiter was the main indication for thyroid surgery (59.34%). Total thyroidectomy was the most commonly performed gesture in general surgery in 88,23% (n = 105), in Otorhinolaryngology, it was in the same proportion as lobo-isthmectomy at 47.61% (n = 30). The first route was video-assisted thyroidectomy 2.2% (n = 4). The recurrent laryngeal nerve was dissected and seen in 159 cases (87.36%) and parathyroid glands were also seen and preserved in 58.24% of cases (n = 106). In immediate postoperative surgery, the main complications were unilateral recurrent paralysis with dysphonia in 3.3% (n = 6) and compressive hematoma in 2.2% (n = 4). No deaths had been recorded.ConclusionTotal thyroidectomy was the most performed procedure in department of General and Digestive Surgery. Routine oral calcium and vitamin D supplementation in the general surgery ward, reduces the occurrence of hypocalcemia after total thyroidectomy and allows a safe and early exit. Standardizing protocols will further reduce complications.

Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group)

BackgroundColon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH).MethodsCoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago.ResultsA total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%).ConclusionsThis analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized.Trial registration (ClinicalTrials.gov) ID: NCT05943951.

Impact of wearable wireless continuous vital sign monitoring in abdominal surgical patients: before-after study.

Technological advances have enabled continuous monitoring of vital signs (CMVS) by wearable, wireless devices on general hospital wards to facilitate early detection of clinical deterioration, which could potentially improve clinical outcomes. However, evidence on the impact of these CMVS systems on patient outcomes is limited. This research aimed to explore the effect of CMVS on the clinical outcomes in major abdominal surgery patients in a general surgery ward. A single-centre before-after study was conducted from October 2019 to June 2022. Patients in the intervention group received CMVS in addition to conventional intermittent vital sign monitoring (standard care for control group). With CMVS, heart rate and respiratory rate were measured every 5 min by a patch sensor. Proactive vital signs trends assessments and, when necessary, subsequent nursing activities were performed every nursing shift. The primary outcome of interest was the length of hospital stay (LOS); also, 12 patient-related outcomes were analysed. In the CMVS group, follow-up nursing activities of deviating vital signs trends were described and patient acceptability was measured. Post-hoc subgroup analysis was performed for colorectal and hepatopancreatobiliary surgery. A total of 908 patients were included (colorectal: n = 650; hepatopancreatobiliary: n = 257). Overall, median LOS was lower in the CMVS group (5.0 versus 5.5 days; P = 0.012), respectively. Post-hoc subgroup analysis showed this reduction in LOS was mostly observed in the colorectal group and not in the hepatopancreatobiliary group. Apart from a decrease in nurse-to-house-officer calls (from 15.3% to 7.7%; P = 0.007), all secondary clinical outcomes were similar in CMVS and control groups. However, a non-significant trend towards less-severe complications and reduced ICU LOS was observed in the CMVS group. In CMVS patients, 109 additional nursing activities were performed and 83% of patients indicated CMVS was acceptable. CMVS was associated with a significant reduction in LOS, while other clinical outcomes were unchanged. CMVS triggered additional nursing activities such as extra patient assessments and therapeutic interventions.

Drug Therapy Problems Identified by Clinical Pharmacists at a General Surgery Ward of an Academic Referral Hospital in Jordan.

Drug therapy problems (DTPs) continuously occur in hospitalized patients. This study aims to emphasize the role of clinical pharmacists in evaluating the DTP's frequencies, causes, severity ratings, and contributing factors at a general surgery ward in Jordan. This prospective observational study was conducted at one of the major teaching and referral hospitals in Jordan. Data were collected through clinical pharmacist reviews of paper and electronic medical records as well as patient interviews. DTPs were identified using Cipolle's classification system and rated for severity on a scale of 10. Multiple linear regression was performed to identify factors contributing to DTPs. Drug classesprimarily associated with DTPs were specified. During enrollment, a total of 80 patients were recruited in this study. The mean age of the enrolled patients was 52.35 ± 14.82 years, and 49 (61.25%) of them were males. Within the study period, 192 DTPs were identified by clinical pharmacists in 87.5%of the total recruited patients. The mean number of DTPs per patient was 2.40 ± 1.83. The most common categories of DTPs were "needs additional therapy" 46 (23.96%), "unnecessary drug therapy" 45 (23.44%), and "dosage too low" 39 (20.31%). Of the total DTPs, 127 (66.15%) were rated as severe. Multiple linear regression revealed that patients' length of hospital stay and the number of current medications had a statistically significant effect on the number of DTPs identified during hospitalization. Endocrine and metabolic drugs 51 (26.56%) and cardiovascular drugs 36 (18.75%) were the most frequent classes of drugs contributing to DTPs. DTPs are common in the general surgery ward. Clinical pharmacists can provide medication reviews for surgical patients to identify DTPs and rate their severities. Detecting risk factors for DTPs and the most common drug classes associated with them can assist in decision-making relevant to reducing DTPs in the surgical ward.

Assessing the Process of Written Informed Consent for Surgical Procedures among Inpatients: A Cross-sectional Study from a Tertiary Care Teaching Hospital in Southern India

Introduction: Informed Consent (IC) is a decision-making process wherein patients are provided with all necessary information regarding treatment to make an uncoerced, educated choice. There are gaps in the implementation of the IC process that need to be identified and addressed. Aim: To estimate the proportion of patients/surrogates who read, understood, and signed the IC form before undergoing surgical procedures; to identify the different healthcare team members involved in explaining the IC form; to evaluate the extent to which different components of the IC form were explained to patients/surrogates; and to determine the influence of the IC form on surgical decision-making, and the overall satisfaction with the IC process. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in the Dakshina Kannada District of Southern India from April 2020 to March 2021. It included 100 adult patients admitted to the postsurgical wards of general surgery, orthopaedics, obstetrics and gynaecology, otorhinolaryngology, and ophthalmology. Ethical clearance was obtained from the Institutional Ethics Committee. The parameters studied included socio-demographic variables, administration of the IC form, details on the person explaining the IC form along with its content, and the influence of the IC form on decisionmaking, as well as overall satisfaction with the IC process. Data were collected using a predesigned questionnaire and analysed using descriptive statistics in Statistical Package for the Social Sciences (SPSS) version 27.0. Categorical variables were presented as frequencies and proportions, whereas continuous variables were presented as means and standard deviations. Results: All participants received the IC form; however, only 21% read, understood, and signed it. The explanation of the IC form was given to 59% of the patients, with only 15% of these explanations provided by the treating surgeon. The components of the IC form, such as the surgical procedure and its benefits, were explained to the majority of the patients; however, the risks of the surgical procedure and alternative options were explained to only 53% and 7% of patients, respectively. The IC form had a minor influence on surgical decision-making for 61% of patients, and 43% expressed satisfaction with the IC process. Conclusion: The study revealed that the implementation of IC was inadequate. Surgeons should provide and explain the IC form well in advance, allowing time for patients to read, understand, and clarify their doubts. Hospital Ethics Committees need to enforce strict adherence to IC guidelines to ensure informed decision-making

Surgical Diathermy versus Scalpel Incision in Elective Surgery: A Comparative Study

Background: Ancient scalpels were found in a Bronze age settlement older than 2100 BC in Turkey. Since that time it has been used in surgery. Surgical diathermy was introduced at the beginning of the 20th century. Since inception in 1929 it has been used in surgical practice (Lawrenson and Stephens, 1970). Surgical diathermy is used for tissue dissection, cutting and hemostasis. Aim of the study: The aim of the study was to observe the outcome between cutting diathermy and scalpel incision. Methodology: It was a comparative study carried out in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), from February 2017 to January 2018. A total of 64 patients age &gt;18yrs both sex of male and female meet the inclusion criteria undergoing elective surgery at general surgery ward of BSMMU were enrolled as study population. A purposive sampling methods were followed for respondent’s selection. Total patients were divided in to two groups, Group I was diathermy and Group II was scalpel. Results: The mean age in Group I was 48.78±14.54, compared to the mean age in Group II which was 44.28±15.29. Most of the patients were 46-55 age groups. Minimum age of patient was 19 and maximum age was 70 in Group I, minimum age of patient was 22 in and maximum age was 76 in Group II. Male patients were 17(53.1%) and females were 15(46.9%) in Group I, in Group II males were 19(59.4%) and females were 13(40.6%). Mean BMI, in Group I was 21.03±2.45, compared to 20.42±2.90 in group II, statistically was not significant and thereby the two groups remain comparable. Minimum BMI was 16.94 kg/m2 and maximum BMI was 27.59 kg/m2 in Group I. Minimum BMI was 15.23 kg/m2 and maximum BMI was 25.83 kg/m2 in Group II. Mean Hb (gm/dl) was 11.46± 1.00 in group I and 11.51±0.98 in group II. The mean values of pain score of each day that is from day one to day five for Group I were 5.41, 4.78, 3.91, 3.00, 1.94 in comparison to 7.69, 6.88, 6.06, 5.19, 4.09 for Group II. .........

347 General Surgery Ward Round Documentation: A Quality Improvement Project

Abstract Aim To improve the rate of inclusion, and quality, of important clinical details in the ward round documentation of General Surgery inpatients at a district general hospital. Method A 15-point ward round checklist was created, containing clinical details which were considered appropriate to be included in all wards round entries. An initial audit of 71 ward round entries was performed, assessing their compliance to this checklist. Following this, a ward round proforma was created and put into use. One month later, 106 wards round entries were sampled for a repeat audit, 85 of them having used the ward round proforma (80.2% compliance). These 85 entries were then analysed for compliance against the checklist, and results compared to the first cycle. Results Use of the proforma demonstrated improvement in 11 out of 15 checklist components, with one component (a documented management plan) remaining at 100% compliance. The proforma achieved an 100% compliance of 3-point patient identification (+43.7%), with dramatic improvements in the documentation of NEWS score/observations (+22.5%), medication review (+26.7%), thromboprophylaxis review (+53.4%), examination findings (+45.3%) and escalation/DNACPR status (+37.7%). The 3 components where performance declined were the name of the ward round lead (-8.5%), date (-2.4%) and time (-10.6%), most likely due to design of the proforma which has been rectified and will be reaudited to ensure improvement. Conclusions Using a ward round proforma greatly improves consideration and documentation of important clinical details on ward rounds. This has positive implications for patient safety and facilitates the subsequent ongoing care of the patient.

257 Postoperative Pain, Analgesic Choices, and Ileus: A Snapshot From a Teaching Hospital in a Developing Country

Abstract Aim In this study, we looked at the severity of postoperative pain, the type of analgesics used to control the pain, and the incidence of POI at Baghdad Teaching Hospital. We hypothesized that we would find an association between the type of analgesia used and POI. Method This observational study was conducted among 100 patients who were residents at the general surgery wards of Baghdad Teaching Hospital. A structured questionnaire was employed focusing on types of analgesics, degree of pain control, and the presence of ileus. Results Sixty-nine percent of patients received a combination of opioids and non-opioids. Moderate-to-severe pain was the most commonly reported category on pain scales. More than half of the patients (57%) were found to have POI during their hospital stay and there was a statistically significant association between the type of analgesia and POI development ( p = 0.001). Conclusions A mix of analgesics (opioids and non-opioids) was the most common regimen at our centre. The majority of the surgical inpatients reported having moderate-to-severe pain on both pain scales used in this study. Ileus incidence following abdominal surgeries (61%) was significantly higher than the reported incidence worldwide (10-30%). Postoperative ileus has multifactorial causes, one of which is the use of opioids for pain control. Considering the high incidence of ileus in our center and the association we found between the use of opioids and ileus, further studies should look at the doses of opioids used and whether alternative analgesic methods might result in less ileus.

Drug utilization pattern of analgesics after a surgical procedure in a tertiary care hospital: a prospective observational single centre cohort study

Background: the study aimed to understand the prescription pattern of analgesics used in the post-operative period after a general surgical procedure in a tertiary care hospital in India and estimate the severity of post-operative pain up to 48 hours. Such a study was not done in this institute of recent hence it was carried out. Methods: 266 adults of either gender were recruited and prescription pattern analyzed over a period of 1 year beginning January 2021 to December 2021 from the post-operative general surgery wards of a tertiary care hospital in India. Patient interview and records were used to collect data. Follow ups at 4, 24 and 48 hours were undertaken to assess pain according to the visual analogue scale (VAS) that was analyzed using the Friedman’s test followed by the post hoc Dunn’s test. Results: an average of 1.52±0.58 analgesics were prescribed per patient. Paracetamol was most commonly used followed by tramadol and diclofenac. All analgesics prescribed were a part of the national list of essential medicines. Effective pain management is feasible as seen by the significant (p&lt;0.0001) reduction in average pain score from 4.75±1.35 to 3.05±1.18 at 24 hours and further to 2.16±1.04 at 48 hours. Conclusions: Use of analgesics prescribed from a standardized list is effective in majority of patients.

ThTP3.2 Introducing a ward round template to improve the quality of documentation on the general surgery ward round

Abstract Aims We aimed to improve documentation on general surgical ward rounds, through the introduction of a ward round template at a single UK surgical unit. Methods The structure of the template was adapted from the ‘Surgical Assessment for Emergencies Ward Round Tool’ produced by the RCSEd, with modifications based on local requirements. A retrospective audit was performed of 4 weeks of electronic ward round notes prior to, and 4 weeks after the introduction of the template. Ward round notes on 2 chosen days (Wednesdays and Saturdays) during the 4 week study periods were included for analysis. We observed how frequently specific important clinical information was documented. Results 378 electronic ward round notes were analysed (176 before, and 202 after the introduction of the template). The ward round template was used, either in part or in full, in 72% of ward round notes following it’s introduction. An pre-existing structured electronic ward round note had previously been used in only 1% of cases. How frequently each of the following components was documented when using the template was: important admission events (86%), VTE prophylaxis (93%), nutritional status (76%), review of prescribed antibiotics (91%) and ceiling of care (65%). We demonstrated statistically significant improvements for each of these components (p&amp;lt;0.05) from pre-template rates (73%, 16%, 63%, 51% and 2% respectively). Conclusion The introduction of a ward round template vastly improved the frequency with which a structured approach to ward round was taken. In doing so, significantly improving the documentation of important clinical information.

Attitudes towards the mixing of COVID-19 vaccinated and unvaccinated patients in multi-bed hospital rooms.

To explore patient and staff views about the mixing of COVID-19 vaccinated and unvaccinated patients in multi-bed hospital rooms. We conducted a mixed methods study with paper surveys and structured interviews. Self-administered surveys were undertaken with inpatients on the general medicine, general surgery, orthopaedic and respiratory wards in Dunedin Public Hospital. Face-to-face interviews were conducted with ward staff including consultants, registrars, charge nurses, registered nurses and nurse managers. The study was undertaken in February 2022, at the start of the first New Zealand wave of the Omicron variant. Of 118 eligible patients, 63 agreed to participate. Sixty (95%) of these patients were vaccinated for COVID-19. Most patients (59%) thought that vaccinated and unvaccinated people should be accommodated in separate hospital rooms. Vaccinated patients felt more comfortable sharing a multi-bed room with others of the same COVID-19 vaccination status as themselves than with unvaccinated patients. Participants who thought that they were at higher risk of severe illness from COVID-19 were more likely to support separation of patients based on vaccination status. Fifteen ward staff were interviewed: most would prefer the hospital to separate patients by vaccination status but were aware this would present practical and ethical problems and thought that current arrangements were adequate. While most vaccinated patients and staff wanted patients to be separated according to their COVID-19 vaccination status, the current precautionary measures for COVID-19 were viewed by most staff members as adequate.

A Study to Assess the Level of quality of sleep among post-Operative Patients Admitted in Jubilee Mission Medical College and Research Institute Thrissur

The study was conducted to assess the level of quality of sleep among postoperative patients admitted in JMMC and RI, Thrissur. Objectives: Objectives were to assess the level of quality of sleep among post-operative patients admitted in JMMC and RI, Thrissur and to associate socio-demographic and clinical data variables with level of quality of sleep among post-operative patients admitted in JMMC and RI, Thrissur. Methodology: A non experimental approach with descriptive design was used. The study was conducted by purposive sampling technique with 91 samples having age above 18 years from the general surgery ward of JMMC and RI. The data collection tool used in the study are demographic and clinical data variables and self developed questionnaire. Questionnaire score &lt;45 is considered as adequate sleep and &gt;45 is considered as inadequate sleep. Both descriptive (frequency, percentage) and inferential statistics were used to analyze the data. Results: Socio-demographic data shows that majority of people 22 (24.2%) belong to the age group greater than 58 years and 39-48 years and 47 (51.6%) are males, 51 (56%) are Hindus. Clinical data variables shows that majority of people 74 (81.3%) were given general anesthesia, 38 (41.8%) of people is on 2 nd post operative day, 39 (42.8%) slept for 2-4 hours, 79 (86.8%) use general ward, 57 (62.6%) does not have any comorbid conditions, 75 (82.4%) have sleep disturbances, 39 (42.8%) have moderate pain and 83 (91.2%) have no history of past use of sleep medications. Inference from the Self developed Questionnaire shows that majority scored &gt;45, 63 (69.23%) post-operative patients had inadequate sleep and only 28 (30.6%) patients scored &lt;45 and had adequate sleep.1 There is significant association (p=0.001) between quality of sleep and sleeping hours. There is significant association (p=0.001) between quality of sleep and post-operative pain. Also there is significant association (p=0.001) between sleep quality and sleep. It is also evident that there is no association between quality of sleep and other socio-demographic and clinical data variables among post-operative patients thus adequacy of sleep identified here.2 Conclusion: The present study was to assess the level of quality of sleep among postoperative patients admitted in JMMC and RI,Thrissur. At the end of the study the investigators team found that majority 63 (69.23%) of post-operative patients have sleep disturbances only 28 (30.6%) had adequate sleep. This reflects that specific nursing care protocols for quality sleep in post-operative patients need to be developed and implemented.3