Information Leaflets Research Articles

The development of an informative leaflet for children and adolescents suffering from Osgood-Schlatter disease.

The mainstay in the treatment of Osgood-Schlatter Disease (OSD) is guidance on activity modification alongside exercises. The purpose of this study was to create an informative leaflet for patients with OSD, based on evidence and stakeholders perspectives. A synthesis of the literature, including national reference work, clinical research, and systematic reviews informed the initial leaflet. Twelve children with OSD and four clinical experts provided feedback through semi-structured interviews. After incorporating stakeholder input, the leaflet 'Osgood-Schlatter-Information and guidance' was developed. This provides a resource to assist the provision of information and translation of the current evidence.

Development, implementation and evaluation of a dental hygienist supported daily toothbrushing programme in Irish pre-schools: A single-case experimental design.

Many pre-school children in Ireland experience dental caries in their primary dentition. The rate of dental caries varies, impacted by the levels of fluoride in the water and socio-economic status (18%-55%). This article reports on a novel initiative in which dental hygienists (DHs) supported pre-school teachers (PST) to implement a toothbrushing programme for children attending pre-schools in Ireland. It was hypothesised that such an initiative would create an environment in pre-schools that would improve the oral hygiene skills and habits of children and increase the oral health knowledge of parents and PST. A storybook (Brushing our teeth with Brush Bunny), a toothbrushing song and information leaflets were developed. DHs were provided with specific online training for the programme. The resources, including toothbrushes and toothpastes, were delivered to the pre-schools and training was provided by the DHs to the PST to prepare for and implement daily toothbrushing sessions. The standards for the toothbrushing programme followed the ChildSmile© programme. Before and after questionnaires gathered quantitative and qualitative data from the parents and PST. The toothbrushing programme was implemented by PST for 3 months. Sixteen DHs and PST from 19 classes in 17 schools successfully delivered the programme to 331 children, and 227 parents completed both pre- and post-questionnaires. Poor baseline knowledge in relation to the 'spit don't rinse' message increased from 29% to 48%. However, there was no improvement in awareness of the benefits of fluoride in toothpaste. Awareness of the best brushing routines in relation to frequency and length was good at baseline and remained so after the programme. Most parents (90%) felt the programme had impacted positively on their child's toothbrushing routine. This experimental study suggests that the logistics of implementing a daily toothbrushing routine to improve the oral hygiene skills and habits of pre-school children are possible in Irish pre-school settings when PST are supported by DHs. Parents' oral health knowledge may be improved, and it may impact positively on the children's daily toothbrushing routine. A larger study is required to confirm these findings.

331 Patient experience in a Falls and Syncope service in a large Irish teaching hospital

Abstract Background The measurement of patient satisfaction provides valuable information about patients’ perceptions of their received healthcare. It is an excellent measure of the quality of care delivered by a healthcare facility. This allows service providers to continue to move towards patient-centred care. A positive patient experience is an important aim that leads to better clinical outcomes. Methods A 20-question patient satisfaction survey was developed for an outpatient Falls and Syncope Unit in order to assess the patient’s perception of service delivery. All patients attending the service were invited to complete the survey over a 2-month period in 2022. Results 71 responses were received. 76% of respondents found their appointment beneficial, and 94% felt their appointment was necessary. Satisfaction with staff ranged between 97–99%. 98% of patients felt they were treated with respect and 88% felt free to express complaints, with 97% satisfactory telephone interaction with the service. 60% of patients received a patient information leaflet, with 97% of patients finding the information leaflets provided useful. Twenty-five respondents (31%) indicated further information on their care would have been beneficial. Conclusion This patient satisfaction survey provided positive feedback for all staff on care delivered in the Falls and Syncope service. Recommendations for changes in practice included increased use of patient information leaflets, in order to improve patients’ experience, since 97% of patients found information leaflets useful and 40% of patients did not receive a leaflet.

267 Survey of knowledge and medications Management of Patients with Parkinson’s Disease among non- consultant hospital doctors

Abstract Background Parkinson’s Disease is a progressive neurodegenerative movement disorder. is the second most common neurodegenerative condition after Alzheimer Disease. The incidence is 1–2:1000 of the general population and 1:100 of the over 80’s, therefore estimating that there are approximately 12,000 people living with Parkinson’s in Ireland. Providing care services and best management for Parkinson’s disease patients needs to be ensured through training staff and continuously auditing the service to meet international standards and patient satisfaction. Methods This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties of Non-Consultant Hospital Doctors (NCHD) in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and how commonly NCHD manage patients with Parkinson’s Disease. The second section contained questions to assess general knowledge on medications. Results Of the 40 respondents of non-consultant hospital doctors (NCHD) 50% were SHOs, 30% Interns 20% Registrars. 38% reported to lack confidence in managing patients with Parkinson’s and 50% somewhat confident and only 12% were confident. 77% weren’t familiar with medication side effect and 90% weren’t aware about rescue medications. 82% weren’t familiar with conversion methods. 95% felt that they needed more training. Conclusion Parkinson’s disease patients are commonly admitted to hospitals under medical and surgical teams, and ensuring every patient gets the best management should be our goal. More training is required among hospital doctors, in addition to other continuous easily accessible supportive materials, such as information leaflets, links to be included into hospital’s mobile phone application, Parkinson’s nurse specialist as a point of contact, and regular education.

174 A silver lining: the identification of silver trauma at triage for older persons (>65) presenting to the emergency department

Abstract Background Trauma in patients over 65 (silver trauma), can result in serious injury from lower impact mechanisms. The NOCA Major Trauma report highlights that 58% of major trauma is a result of a fall from 2 metres or less and mortality increases with age and comorbidities. Failure to identify, rapidly assess and treat older persons who have suffered silver trauma results in prolonged emergency department stays with an increase in morbidity and mortality. We therefore, performed a completed audit cycle to assess the identification of Silver Trauma in our emergency department. Methods A focus group involving key stakeholders was established, including Emergency Physicians, nurses and members of the Gerontological Emergency Department Intervention team. An audit assessed patients triaged as ‘major trauma’ from October to December 2022. We established silver trauma guidelines for triage. Teaching sessions on the recognition of silver trauma were provided, daily briefings were given, and information leaflets were placed in all triage areas. A triage discriminator of ‘Silver Trauma’ was introduced to prompt recognition and review by clinicians. A full audit cycle was completed. Results Our initial audit (October to December 2022) revealed 25 patients triaged as ‘Major Trauma’ who were aged over 65. After the completion of the initial audit and implementation of measures, 122 patients were triaged as ‘Silver Trauma’ between January 20th and March 31st. We identified that 59% (N = 72) were due to falls from 2 meters or less. Other mechanisms of injury included unwitnessed fall (21% N = 25), syncope (7% N = 8), fall from height (11% N = 13) and Major Trauma (3% N = 4). Seventy-one (58.19%) were admitted and 51 (41.80%) were discharged home. Conclusion This audit demonstrates that departmental education and implementation of a triage discriminator has significantly improved the recognition of silver trauma within the ED setting.

305 Assessing patient attire in a medical gerontology ward: impact of an ‘End PJ Paralysis’ audit

Abstract Background Richard Asher’s influential essay, ‘The Dangers of Going to Bed’, highlighted the risks of bed rest for inpatients, including deconditioning and pressure areas. This audit evaluates whether patients are sitting out of bed and wearing personal clothes during mealtimes. Methods Using the ‘End PJ Paralysis’ campaign as the audit standard, a single-day audit recorded patients’ positioning and attire at breakfast and lunch. All inpatients on our medical gerontology ward were included. Interventions involved staff education on pyjama (PJ) paralysis implications, promoting the day room’s use at lunchtime, facilitating communication with patients/relatives regarding personal clothes/footwear, and organising a clothing donation drive. A re-audit occurred after one month. Results The initial audit included 39 patients (mean age: 81.8 years). At breakfast, 38.5% sat out, with 25.6% in their own clothes, 69.2% in pyjamas, and 5.1% in hospital gowns. The lunchtime audit included 38 patients: 84.2% sat out, with 78.9% in their own clothes, 25% in pyjamas, and 2.6% in a hospital gown. In the re-audit with 44 patients, 56.8% sat out at breakfast, with 18.2% in their own clothes and 81.8% in pyjamas. For lunch, 81.8% sat out, with 75% in their own clothes and 25% in pyjamas. No patients wore hospital gowns in the reaudit. Conclusion The re-audit demonstrated an improvement with 18.3% more patients sitting out at breakfast. In both audits, most patients opted for pyjamas at breakfast (69.2% in the initial audit and 81.8% in the re-audit) and their own clothes at lunch (78.9% in the initial audit and 75% in the re-audit). Hospital gowns were eliminated in the re-audit. Overall, this suggests that the ‘End PJ Paralysis’ campaign has positively influenced patients sitting out and the use of hospital gowns. Future plans involve education sessions for the broader multidisciplinary team, displaying posters, developing patient information leaflets, and conducting a re-audit to assess sustained impact.

349 From the voice of experience: listening to older adults to co-design: a new frailty service in the emergency department

Abstract Background The Patient and Public Involvement (PPI) aspect of healthcare service evaluation is key to service development. Following the 12th month of operation, a ‘frailty at the front door’ team, in a model 3 hospital, sought feedback from the patients using the service with an emphasis on listening to their perspective on using the service and recommendations for improvement. The project aimed to collaborate with the patients to design and implement a service providing high quality care for the older person attending the ED. From this a service improvement initiative commenced. Methods The Model for Improvement was employed, which incorporates the plan, do, study, act methodology. A patient survey was issued to all patients who had attended the rapid access clinic on discharge from the ED. Questions included understanding the role of the team within ED, was the intervention received helpful, how was the overall experience and what could be done to improve the service. Results Of 12 respondents: 67% reported not understanding the role of the team as a specialised service for older persons in ED. 67% rated their experience in the follow up Rapid Access Clinic to be very good, 25% rated their experience as good and 8% reported they would prefer not to say. 100% reported that they felt the team input was helpful. A suggestion for improvement was to help patients understand the specialised role in ED. Conclusion A focus group was held to consult a group of over 65 patients on how to communicate the role of the team and improve visibility. As a result the team created a badge as part of their uniform and also created a patient information leaflet to issue at point of assessment. The survey will be implemented quarterly to measure the success of the new interventions or further improvements.

74 Making mobility falls prevention and management everyone’s business

Abstract Background Falls in hospital are detrimental to patient safety and the highest reported patient safety incident. The falls committee undertook a review. It identified a need for improved processes around the identification of falls risk. There was a need for a succinct multi-disciplinary approach to falls prevention following the identification of falls risk. Staying mobile and having clear visible mobility goals while in hospital was targeted as a strategy. This was appropriate as reduced mobility is a modifiable risk factor for in-patient falls. Methods PDSA quality improvement methodology was used. A mobility and falls policy was developed. The policy provides a framework of three algorithms for falls risk identification, prevention and management. Additionally, referrals to health and social care professionals were streamlined to reduce time from risk assessment to referral. Falls prevention information leaflets were developed to help make patients partners in the process. Whiteboards were used behind patients beds with magnets to clearly show falls risk. Mobility status and goals were written on the whiteboard. This ensured a succinct joint approach to patient mobility. Education and staff engagement enabled implementation. Excellence was awarded with a certificate for display on the wards quality boards. Clinical audit was used to measure results. Results Review of audit data between October 2022 and January 2023 recognised improved processes in the identification and management of falls. Outcome measurement showed up to 100% increase in communication between healthcare professionals in relation to patient mobility status and goals. Conclusion In conclusion, we learnt that identifying and communicating falls risk was not enough. A clear succinct multi-disciplinary plan of action was required. Patients must be partners in that plan.

217 Attitudes towards Physician-Assisted Dying among medical students in an Irish medical school

Abstract Background Physician-Assisted Dying (PAD) is a controversial topic, particularly among medical practitioners, While PAD is currently illegal in Ireland, it has been legalised in several European countries. It is likely PAD will become an increasingly contentious issue as current medical students progress through their training and over the course of their future careers. Methods This project comprised of a fully anonymised survey (using the platform Qualtrics), exploring Trinity College Dublin (TCD) medical students’ attitudes towards PAD. All TCD medical students, aged 18 and above, were invited to take part in the online survey. The survey included thirteen questions, addressing student: sex, age, stage of medical training, exposure to geriatric medicine rotations, opinions on training in relation to PAD, and overall attitude to PAD. A participation information leaflet containing a link & QR code to the survey was distributed to students at lectures. An email inviting students to take part in the study was also circulated. Consent was implied by completion of the survey. Results 200 students completed the survey. 119/200 (59.5%) of students were in favour of PAD, 53/200 (26.5%) were unsure, and 28/200 (14%) were opposed to PAD. Only 42/200 (21.%) students felt that their medical training adequately prepared them for potential discussions with patients about PAD The majority of students (31/37) who had completed rotations in Gerontology also felt that they were not adequately prepared for such discussions. 173/200 students feel that additional medical training related to PAD is warranted. Conclusion The majority of TCD medical students, across all genders, year of training and age groups, were in favour of PAD. Most students feel that their medical training does not prepare them for potential discussions about PAD in the future. Those who had clinical rotations in Gerontology did not feel more prepared for future discussions regarding PAD, suggesting the need for more formal teaching on the subject.

SWAT 137: A 2x2 randomised factorial SWAT of the use of a pen and brief information leaflet to improve recruitment in a randomised controlled trial of a community-based clinic for patients with persistent physical symptoms

Background Many strategies are used by trialists to improve recruitment, but few have been tested. We aimed to evaluate two interventions: 1) a study branded pen and 2) brief participant information leaflet, included within invitation packs for the Multiple Symptoms Study 3 (MSS3) trial. Methods A 2x2 factorial ‘study within a trial’ (SWAT) embedded into MSS3 – a randomised trial of a community-based clinic for patients with persistent, medically unexplained, physical symptoms. Potential MSS3 participants received postal invitations sent via GP practices, along with a MSS3 branded pen and/or brief participant information leaflet (PIL) or neither. The primary outcome was randomisation rate. Secondary outcomes were return rate, time to return, reasons for non-randomised returns and cost-effectiveness. Results 108 GP practices posted 6946 invitations, from which 318 participants (4.6%) were randomised to the host trial. Between those sent a brief PIL (n=3467) and not sent a brief PIL (n=3479) there was no significant difference in randomisation rates (166 (4.8%) vs 152 (4.4%); OR 1.10, 95% CI 0.88-1.38). Response rates were significantly higher in those sent the brief PIL (573 (16.5%) vs 513 (14.7%); OR 1.14, 95% CI 1.01-1.30). Between those sent the pen (n=3464) and not sent the pen (n=3482) there was no evidence of increased randomisation (145 (4.2%) vs 173 (5.0%); OR 0.84, 95% CI 0.67-1.05) and the difference in response rates was not statistically significant (563 (16.3%) vs 523 (15.0%); OR 1.10, 95% CI 0.96-1.25). For both SWAT interventions, time to response was comparable between groups. Conclusion There was no significant evidence of effectiveness of the brief PIL intervention or the pen intervention on recruitment to the host study. There was evidence of increased response rates to the initial invitation in the brief PIL group, compared to those not receiving a brief PIL in their invitation pack.

Procedural Sedation in a UAE Emergency Department: Encouraging Informed Decision-Making Through a Patient Information Leaflet.

Introduction Procedural sedation is a common procedure conducted in emergency departments (ED) across the world, which requires patients to receive anesthesia/sedation medication in a controlled environment in order to alleviate pain, anxiety, and suffering, thereby allowing multiple procedures to be completed in a safe and timely manner. We deploy this technique for joint reductions, burns dressings, wound repairs, etc. in our ED. As a large tertiary referral hospital ED, we aimed to benchmark our practice for this high-acuity procedure against international standards. The main objectiveof our audit was to benchmark our current practice of procedural sedation against international standards from the Royal College of Emergency Medicine (RCEM), United Kingdom, and American College of Emergency Physicians (ACEP) guidelines. As a secondary objective, we aimed to design and implement a multi-lingualprocedural sedation leaflet for our patients and their carers. Methods A retrospective electronic healthcare records review was conducted from January 2019 to August 2022 following which a convenience sample of 100 patients was selected.Records audited were obtained from the Hospital Quality and Pharmacy departments. We selected patients from the data provided by selecting sedation medication used (ketamine, midazolam, propofol) and frequency documented as 'pre-procedure' (Pre-Proc). We included patients of all age groupswho received procedural sedation in the emergency departmentand excluded inpatient encounters. After reviewing RCEM and ACEP guidance, we studied 14 criteria and standards. A team comprisingphysicians and hospital interpreters was set up to draft a procedural sedation leaflet. After hospital marketing team approval, these were published in Arabic, English, Urdu, Hindi, Bengali, and Malayalam. Results Compliance percentages of the 14 criteria were calculated.A "traffic light" color scheme was used toinform the reader of areas of good practice and areas for improvement.Percentages of 90-100% (green) were considered compliant, 80-89% (amber) were partially compliant, and 79% or less (red) were non-compliant. Of the 14 criteria, 10 were fully compliant. One criterion was partially compliantand three criteria were non-compliant. Conclusion Overall, we performed well in in this audit with 100% compliance rates in many areas. We identified that we had no written discharge information leaflet for our patients and carers. We drafted a multi-lingual procedural sedation leaflet and stocked this in the department. Through face-to-face education, we re-trained physicians on the importance of documentation when adhering tosafe practices aroundprocedural sedation.

Effects of blended learning training for oncology physicians to advise their patients about complementary and integrative therapies: results from the multicenter cluster-randomized KOKON-KTO trial

BackgroundMany oncology physicians are confronted with the topic of complementary and integrative medicine (CIM) by cancer patients. This study examined whether a blended learning (e-learning and a workshop) to train oncology physicians in providing advice on CIM therapies to their cancer patients, in addition to distributing an information leaflet about reputable CIM websites, had different effects on physician-reported outcomes in regard to consultations compared with only distributing the leaflet.MethodsIn a multicenter, cluster-randomized trial, 48 oncology physicians were randomly allocated to an intervention group (CIM consultation and an information leaflet) or a control group (information leaflet only). After the training, the oncology physicians conducted 297 consultations with their cancer patients. Measurements were assessed at oncology physician, physician–patient-interaction (measured by external reviewers), and patient levels. This analysis focused on the physician outcomes of stress reaction and perceived consultation skill competency. In addition, qualitative interviews were conducted with a subsample of oncology physicians who experienced both, the intervention and control condition.ResultsThe oncology physicians in the intervention group showed a lower stress reaction in all measured dimensions after CIM consultations than those in the control group. There was no significant difference between oncology physicians in the intervention and control groups regarding the perceived consultation skill competency (overburden: intervention 1.4 [95% CI: 0.7;2.1]; control 2.1 [95% CI: 1.4;2.7], tension: 1.3 [95% CI: 0.7;2.0] vs. 1.9 [95% CI: 1.3;2.5], and discomfort with consultation situations: 1.0 [95% CI: 0.4;1.7]; vs. 1.7 [95% CI: 1.2;2.3]). The qualitative data showed that only providing the leaflet seemed impersonal to oncology physicians, while the training made them feel well prepared to conduct a full conversation about CIM and provide the information leaflet.ConclusionsIn our exploratory study providing structured CIM consultations showed positive effects on the perceived stress of oncology physicians, and the training was subjectively experienced as an approach that improved physician preparation for advising cancer patients about CIM, however no effects regarding perceived consultation skill competency were found.Trial registrationThe trial registration number of the KOKON-KTO study is DRKS00012704 in the German Clinical Trials Register (Date of registration: 28.08.2017).

Patient information leaflet in the era of digitalisation: a cross-sectional study on patients' attitudes and practices.

Patient information leaflets (PILs) are documents that are standardized in nature and provide guidance for patients or caregivers on the safe and effective use of medicines. Previous evidence suggests that written information is linked to enhancing the amount of information remembered. Currently, patients have become more involved in digital searches for information. However, there is variability in the quality and reliability of information obtained from the web. According to Saudi Food and Drug Authority regulations, pharmaceutical manufacturers are required to supplement each pharmaceutical product entering the Saudi market with a digital leaflet in addition to a paper leaflet. This research aimed to evaluate patients' attitudes and practices towards PILs. A cross-sectional study design using an anonymous online self-administered questionnaire was adopted. The study took place in Saudi Arabia between October and December 2022. A convenience sampling strategy was used to recruit the study participants. The questionnaire was adapted from previous research that investigated patient attitudes and practices towards PILs. A total of 463 participants agreed to take part in the study and completed the questionnaire. Physicians were the top utilized source for getting medicine information (92.7%), followed by pharmacists (84.7%), PILs (67.4%), searching the Internet (53.6%), and consulting family and friends (31.7%). About 78% of the participants reported often or always reading PILs for new drugs (78.2%), but this percentage was lower (45.4%) for repeat prescriptions. A positive perception towards PILs was observed among the study participants. While 54.6% of the participants indicated a preference for having both paper and digital information leaflets, 33.3% reported a preference for paper leaflets, and 12% indicated a preference for digital formats. Although patients had positive perceptions towards PILs, physicians were the top-consulted source for medicine information. Pharmacists should educate patients about the importance of referring to PILs which can also be accessed electronically in the case of a preference for a digital format, as the quality and reliability of the information obtained from the web cannot be confirmed.

Efficiency of Printed Patient Information Leaflets Written for Total Knee and Hip Arthroplasty Patients to Reduce Their Fear of Surgery.

Background: Patient education plays a key role in health care. In our study, we created a new information guide for patients waiting for total knee (TKA) or hip (THA) arthroplasty. The goal of our study was to create patient education material that would reduce patients' fear of surgery and improve their postoperative lifestyle. Methods: Patients in the intervention group (n = 44) received newly developed paper-based patient education material before surgery. The surgical fear questionnaire (SFQ) was used to assess fear reduction. A self-designed assessment questionnaire was used to measure the effectiveness of the leaflet among the intervention group patients. Results: The SFQ scores decreased significantly both in patients with TKA (median 37.50 IQR 30.00-40.00 vs. median 20.00 IQR 16.00-24.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 20.00 IQR 16.00-22.00). A control group with TKA (median 37.50 IQR 30.00-40.00 vs. median 64.50 IQR 54.00-82.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 73.00 IQR 56.00-81.00) was also included. An assessment of the content, usability, and clarity of the new leaflet showed that patients rated the new leaflet as almost entirely usable (median score 12.00-10.00). Conclusions: Our results suggest that new printed patient education material may reduce the fear of surgery.

Out of sight, out of mind. Rights, consent, and electroconvulsive therapy

This article is a commentary on an audit of Electroconvulsive Therapy (ECT) patient information leaflets in Northern Ireland, Scotland, and Wales, which found that they do not comply with the ethical principle of informed consent. Stigma, rights, and trauma are discussed through the authors personal experience of multiple ECT treatments and research, and potential actions to address these failings are suggested.

BabyBreathe trial: protocol for a randomised controlled trial of a complex intervention to prevent postpartum return to smoking

IntroductionMany people quit smoking during pregnancy, but postpartum smoking relapse is common. Maintaining smoking abstinence achieved during pregnancy is key to improving maternal and child health. There are no evidence-based...

1135 Evaluation of Management of Fifth Metatarsal Fractures in University Hospitals of North Midlands Fracture Clinics from March to May 2021

Abstract Aim The primary objective is to ascertain if fracture clinic follow-up of simple, isolated fifth metatarsal fractures is required, or if discharging patients from Accident & Emergency and Minor Injury Units with clinical advice and a contact number is a safe, cost-effective alternative. We also aim to design a protocol and treatment pathway to enable safe discharge and patient-initiated follow-up (PIFU) where required. Method All patients with metatarsal fractures between March and May 2021 had their radiographs, e-records and clinic letters retrospectively reviewed with a one-year follow up. Patients with neuropathy, open fractures and polytrauma patients were excluded. The remaining patients with simple, isolated fifth metatarsal fractures were evaluated. Results 75 patients with an isolated fifth metatarsal fracture were reviewed across three months, with 165 appointments dedicated to them (in person and via telephone). 72% were treated with a metatarsal shoe and 17.3% with a walker boot. One patient required surgery for non-union. £12,018 was spent by the trust for the above appointments, either in person (£152 per unit) or via telephone (£20 per unit). Conclusions Simple, isolated fifth metatarsal fractures should be discharged directly from A&E in a metatarsal shoe with an information leaflet and PIFU. Neuropaths, open fractures or polytraumas should follow a referral protocol which has been designed for our department based on our findings.

906 A Prospective Clinical Audit of Pre-Operative Fasting Practices at a Tertiary Care Hospital in India

Abstract Aim Even in the face of evidence-based recommendations, the ‘nil by mouth from midnight’ regimen has persisted because it is easy to administer and allows for theatre flexibility. We aimed to audit preoperative fasting practices at Kasturba Medical College Hospital Attavar, India against the Indian Society of Anaesthesiologists (ISA) national guidelines. Method Prospective clinical audit involving ASA 1 and 2 patients undergoing elective, non-obstetric surgery under general/regional anaesthesia or sedation. Data were collected from patient notes and from an interview on the morning of surgery (at least one hour prior to induction of anaesthesia). Results Baseline Data (N = 100) Median fasting durations of 10 hours and 12.5 hours from clear fluids and solids, respectively. 99% of patients gave an incorrect reason or did not know at all the reason for preoperative fasting. Interventions:Patient information leaflets (in English and the local language) were made and distributed to every ward; to be shown to elective surgery patients on the day before surgery.Surgical trainees, anaesthesiology trainees and nurses were made aware of the audit findings. Re-Audit (N = 40) Median fasting duration of 3 hours and 11 hours respectively clear fluids and solids. Thirty-five percent of patients knew the correct reason for preoperative fasting. 50% gave an incorrect reason, while 15% did not know the reason. Conclusions Prolonged fasting was observed initially despite guidelines. Significant reduction in clear fluid fasting duration was achieved (10 hours to 3 hours) by creating awareness.

868 Development & Implementation of a Patient Information Leaflet for Elective Daycase Laparoscopic Cholecystectomy – a Quality Improvement Project

Abstract Aim Daycase surgery reduces post-operative complications. Facilitating safe discharge is of paramount importance. One way of ensuring this is to enable patient access to reliable information. In this quality improvement project, we aimed to create and implement an information leaflet that would give succinct information to patients on what to expect on discharge, and signposting to further resources if required. It was felt that this would ultimately result in a better and safer patient experience. Method A leaflet was designed in conjunction with surgical, nursing, and anaesthetic colleagues, using information available from the Royal College of Surgeons and British Association of Day Surgery. This was then given to all relevant patients post-operatively. Subsequently, a cohort of patients were called and asked for feedback on the usefulness of this leaflet, using a questionnaire approach based on the psychometric Likert scale. Results A total of 15 patients were contactable, of which 14 (n = 15, 93%) reported having received the leaflet. A further 12 (n = 14, 86%) described the leaflet as useful, with comments such as ‘it was a comfort blanket’ and that ‘it allayed some anxieties I had about my recovery’. 2 people (n = 14, 14%) mentioned that some information was difficult to understand. Conclusions Information leaflets make a positive contribution to the post-operative patient experience. In future, we will look to conduct further study into whether the introduction of this leaflet has improved our day case rate, reduced re-admissions and whether patients have had an overall better experience of care.

1307 Infection After Surgical Fixation of Fractures – a Multidisciplinary Approach in the Prevention and Early Detection of Fracture-Related Infections

Abstract Aim Infection after surgical fixation of fractures is a serious complication in Trauma and Orthopaedic surgery. A recent study has reported that the incidence of fracture related infections (FRI) may be as high as 30% in patients with open fractures post-surgical fixation. FRI can have significant and devastating impact on the patients as well as causing a huge financial burden on the national healthcare system in the United Kingdom. According to the British Orthopaedic Association (BOA) guideline, all patients with surgically managed fractures should have readily available guidance on how to respond in the event of suspected fracture related infection. The purpose of this audit was to evaluate the standard of practice in the prevention of FRI at a large teaching hospital. Method Patient notes and discharge documentation for all Trauma and Orthopaedic patients with surgically managed fractures between 01/10/2022 and 31/10/2022 were reviewed and results analysed. Results During this study period, 58 patients underwent surgery for surgical fixation of fractures. Among these 58 patients, only 5 patients (9%) had readily available information on how to respond in the event of suspected fracture related infection in their discharge documentations. Conclusions The results from this first cycle of audit shows that our current standard of does not meet the BOAST guideline. Actions must be taken to address this critical issue promptly. We are currently implementing interventions such as patient information leaflets and multidisciplinary approach with the aim to improve our standard of practice. We plan to reaudit the effectiveness of these interventions in January 2023.