Initial Audit Research Articles

EP.TU.854Happy Patients and Updated Open Wound Management Protocols

Abstract Introduction Open injuries have a potential for serious bacterial wound infections and may lead to long term disabilities, chronic wound or bone infection, and even death. This QI study was undertaken to ring in changes to the current management protocol and align them as per WHO guidelines. Method Implementing changes through a Plan-Do-Study-Act (PDSA) cycle post an initial clinical audit among 38 patients of the organization. Re-audits were done to measure the outcome against the standard and establish a new protocol. Results Initial audit showed only a dismal 37% (n = 14) of patients being managed as per WHO protocol. Patient satisfaction percentage (as measured by a questionnaire) was also low with only 54% of patients satisfied with the treatment. Significant variations were noted post implementation of changes after the first PDSA cycle where >90% (n = 35) of patients reported that they noticed better wound healing, transition to optimal performance and were satisfied with treatment outcomes. Conclusions Timely wound dressings, appropriate antibiotic prophylaxis and increased patient’s awareness on wound hygiene through means of regular educational sessions and updated management protocols have led to healthier patients, lesser long term disabilities and happy patients.

SP2.2.11Improving the quality of the documented weekend surgical handover: Implementation of a handover sticker within an urban teaching hospital

Abstract Aim Effective, high-quality patient handovers between the surgical team are essential for safe transfer of responsibility for patient care whilst ensuring continued patient-safety and supporting good clinical governance. Weekend handovers provide a particular challenge, with error potential, when patients are cared for by multiple different healthcare professionals. This project aimed to improve the documentation of the weekend handover for the surgical inpatients of a busy UK teaching hospital. Method Quality Improvement project performed within a single General Surgical department between August and October 2020. An initial casenote audit on 3 consecutive Fridays compared available handover information against RCS guidance. A comprehensive surgical weekend handover sticker was designed and all members of the surgical team educated in its use. Following sticker introduction, handover quality was similarly re-audited. **=p<0.00001 using Chi-squared/Fisher exact. Results 138 inpatient records were evaluated in cycle 1 and 135 in cycle 2, with the proportion containing a weekend handover increased post-intervention (96 vs. 82%,p=0.0004). Handover quality improved following sticker introduction with more frequent documentation of: diagnosis (96 vs. 21%**); need for imaging review (94 vs. 29%**); intravenous fluid plan (84 vs. 21%**); blood test requirements (94 vs. 24%**); mode of nutrition (90 vs. 24%**); antibiotics (90 vs. 30%**); drug monitoring (90 vs. 1%**); discharge planning (94 vs. 44%**) and escalation plan (87 vs. 0%**). Conclusion Introduction of a sticker has significantly improved the quality of documented handover available to the responsible on-call team. Future work will assess sticker impact on quality of care and clinical outcomes.

EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit

Abstract Aims Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO. Methods A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation. Results 70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr. Conclusions Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes.

EP.FRI.495 A retrospective audit of electronic venous thromboembolism risk assessment compliance across three surgical wards in a district general hospital

Abstract Aims Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths; with hospital-acquired VTEs accounting for 50% to 60% of all VTEs seen. This project aims to review and improve the number of VTE risk assessments completed for surgical in-patients. Methods This retrospective, cross-sectional study involved data collection from surgical in-patients (n = 648) over three consecutive months, using an electronic VTE risk assessment tool. Data was categorised into ‘First VTE prophylaxis risk assessment completed within 24 hours of admission’ and ‘Second VTE prophylaxis risk assessment completed within 48 hours of admission’. This was further sub-categorised into surgical specialties. Results were presented in departmental meetings and educational posters were displayed. The study was re-audited using the same method over one month (n = 216). Results Results demonstrated improvement from the initial audit cycle, particularly in relation to the mean number of VTE risk assessments completed for patients undergoing breast surgery (100% from 95.3%), colorectal surgery (93.3% from 90%) and general surgery (88.0% from 86.6%). The mean number of first VTE risk assessments completed in 24 hours across all surgical wards remained above 65%, whilst the mean number of second VTE risk assessments completed in 48 hours improved from 36.1% to 47.6%. Conclusions Variation in compliance is still evident across the surgical in-patient wards. Going forward, responsibility to complete outstanding VTE risk assessments will be handed to the FY1 on the late shift. Following this intervention, a further audit cycle will be performed, with the aim of 100% compliance in VTE risk assessment completion.

Care of Transgender Patients: A General Practice Quality Improvement Approach

Background: With increasing numbers of gender minority/ trans patients, primary care must ensure high quality lifelong care is offered. Aim: To improve the quality of medical care for gender minority/ trans patients. Design and Setting: Initiation of a quality improvement project using population census, patient cohort and audit of standards in a single general practice. Method: Retrospective notes review against an audit standard. Results: One practice has 68 trans patients (population prevalence of 337/100 000). Monitoring guidelines from multiple private and NHS gender identity clinics (GICs) were found to be inconsistent. It was not possible to use an appropriate primary care audit standard as no UK-wide guidance was identified. Initial audit against an international secondary care guideline which was developed following a recognised process suggests health monitoring of transgender patients may be substandard in nearly two thirds (62%) of cases. Patients with gender dysphoria are experiencing long waits for NHS GICs (mean 26 months) and frequently self refer to private services. They receive a mean 2.7 assessment appointments prior to treatment, which consists of 85% hormone prescription uptake. 20% of patients stopped hormone treatment, of which half detransitioned. All detransition has occurred in the last three years. Conclusion: There is a need to develop consistent, national evidence-based primary care guidance that includes standards for monitoring and dealing with complications, including detransition. Funding: None to declare. Declaration of Interest: None to declare. Ethics Approval Statement: The study went through IRAS process, but formal ethics committee permission was not required for a quality improvement retrospective review of notes auditing against standards.

Hypertrophic Granulation Wounds Treated With Silver Nitrate Sticks or With Topical Steroid: Rate of Wound Closure.

Hypertrophic granulation (HG) is abnormal granulation tissue raised above the level of surrounding intact skin and is thought to delay wound healing. Effective treatment to eliminate HG could speed healing, but this is not well studied. Two common treatments are chemical cautery with silver nitrate, and the use of topical steroids. In a Midwestern burn and wound clinic, both of these treatments are employed. A quality improvement project compared wound size reduction for HG wounds undergoing the two treatment modalities. Retrospective chart review identified HG wounds treated during a 1-year period, and compared wound size prior to and after 1 month of treatment (length, width, and surface area). Results were presented to the clinic staff, and 1 year later the quality assurance project was repeated. The initial audit found data on 18 patients treated with silver nitrate cautery, and 16 patients treated with 1% hydrocortisone cream. Median length and width were decreased by 5 mm with silver nitrate cautery treatment, and by 14 mm with 1% hydrocortisone treatment (P < .05). The repeat audit 1 year later found 10 patients treated with silver nitrate, and 38 treated with hydrocortisone. Median length and width decreased by 0 and 2 mm respectively for silver nitrate cautery treatment, and 15 and 10 mm for 1% hydrocortisone treatment (P < .05). In conclusion, this uncontrolled review suggests faster healing in HG wounds treated with 1% hydrocortisone compared with those treated with silver nitrate cautery. Confirmation with controlled and randomized studies is warranted.

1030 Paediatric Appendicectomy - Appropriateness of Operative Intervention

Abstract Aim Acute appendicitis is one of the most common paediatric surgical emergencies. Prompt diagnosis and interventions reduce the risk of perforation and prevents complications. The aim of the audit was to determine the appropriateness of operative intervention and to improve patient care by implementing changes. We assessed several performance indicators including the percentage of appendicectomy performed within 12 hours of decision to operate, the percentage of negative appendicectomy and the 30 days re-admission rate. Method All consecutive paediatric patients who had appendicectomy in our district general hospital from Jan 2017 to 2019 were included in the initial audit. For re-audit, we collected data from July 2019 to March 2020. Patients were identified from the theatre system and ward notes, theatre charts and biochemistry and histology results were collected from the electronic patient records. Results A total of 193 patients were included in the initial audit. Results showed that 52.8% of patients were reviewed by a consultant prior to surgery, 92% of patients had surgery within 12 hours of the decision to operate. The rate of negative appendicectomy rate was 25%. Conclusions Following this audit, several changes have been implemented including improving consultant review of paediatric patients, increasing imaging done by radiologists for paediatric patient. Re-audit showed that 86.7% of patients were reviewed by a consultant preoperatively. Negative appendicectomy rate remained the same at 24.4%. Admissions within 30 days of discharge improved from 13.8% in the initial audit to 11.5% in re-audit.

1135 Improving Surgical Discharge Summaries

Abstract Introduction Discharge summaries are a means of communication to the patient, the GP and for medical records. An initial audit showed surgical discharge summaries contained misleading information and sometimes omitted relevant information. Changes were implemented to improve the accuracy of surgical discharge summaries. Method The initial audit assessed the accuracy of discharge summaries over a two-week period and the re-audit was conducted after implementation of change over a similar time period. Data was extracted from electronic patient records (EPR). Change implementation included educating the surgical team on the need for accurate discharge summaries. The EPR team was notified of the intrinsic error in the PowerChart system which is widely used in various NHS Trust. Results Incidence of misdiagnosis or misleading diagnosis in discharge summaries reduced from 42% to zero, lack of relevant investigations decreased from 7% to 1%, No follow up status reduced from 23% to 10% (usually post appendicectomy patients which are not routinely followed up but this needs to be stated in the discharge summary for clarity), at both initial audit and re-audit all patients had relevant surgery or procedures done included in their discharge summaries while the rate at which relevant medications were not stated in the discharge summary decreased from 4% to zero. Conclusions Discharge summaries are vital for record keeping and are usually the only written information a patient receives regarding their hospital stay. It is important that errors in EPR systems be flagged up for review.

1222 Improving Consenting for Emergency General Surgery During The COVID-19 Pandemic

Abstract Aim Patients undergoing surgery during the Covid pandemic are exposed to increased risks of pulmonary complications and mortality. These novel risks need to be documented on the consent form. We carried out various interventions to ensure appropriate consenting and documentation following an initial audit that revealed poor compliance with published guidelines. Method The initial audit reviewed consent forms of patients undergoing emergency surgery over two-weeks in May 2020 while the re-audit was over a two-week period in June 2020 following implementation of interventions. Inclusion Criteria: Age &amp;gt;18-years, urgent or emergency laparoscopic surgery Exclusion criteria: Age &amp;lt;18-years, Open surgery, ‘Covid-light’ areas, NELA. Results 57 consent forms were assessed during the audit loop: 22 laparoscopic appendicectomies and diagnostic laparoscopies, 14 incision and drainage, 8 laparoscopic cholecystectomies, 4 hernia repairs, and 9 other procedures. Consenting for covid pneumonia increased from 70% to 89%, potential ITU admission 56% from 25% and the risk of death 63% from 21% Conclusions The covid pandemic changed our surgical practice. There are many unknowns regarding the risks to surgical patients, however, evidence shows increased risks of covid pneumonia, ITU admission and death in the perioperative period. Our consenting and the documentation of such conversations with patients must reflect our new reality.

699 Does Pre-Operative Imaging Improve Negative Appendicectomy Rate?

Abstract Aim Appendicectomy is one of the most commonly performed emergency operations. There is no set guideline for an acceptable negative appendectomy rate (NAR) in the UK. Based on previous studies, a NAR of 15-30% is typically accepted. We sought to define our local practice NAR in our initial audit, introduced an appendicitis pathway based on this initial data, and then re-audited to assess whether there had been an improvement in the NAR. Method All emergency appendicectomies carried out over a 1-year period from April 2018 – April 2019 were initially analysed. The subsequent audit analysed data from August 2020 - November 2020, after the pathway had been introduced. Histological analysis was used to determine positive or negative appendicectomy. Results A total of 207 patients had an appendicectomy over the initial 1-year time frame. In our re-audit, 38 patients had an appendicectomy. Demographics were similar in both groups. The NAR increased from 17% to 18%. Conclusions On first glance, the NAR does not seem to have improved. On a closer look, all patients over the age of 18 in our re-audit had a pre-operative CT, and there were no negative appendicectomies in these patients. The issue arises with younger patients, in whom justifying the radiation associated with a CT scan may be difficult. Although ultrasound does not carry the same radiation risk, previous audits at our trust have shown both its sensitivity and specificity for appendicitis is below 50%. We may have to explore alternative imaging modalities in the paediatric population or accept the higher NAR.

Intellectual disability, epilepsy and bone health: Quality improvement in a specialist epilepsy service

Accessibility summary People with an intellectual disability and epilepsy may suffer with weaker bones as they grow older. There are many reasons for this, including seizures and the medicines used to treat seizures. Taking vitamin D everyday will help stop this happening. Vitamin D comes in many forms including tablets and liquid. Vitamin D is safe with very few side effects. AbstractBackgroundPeople with epilepsy and intellectual disability should be considered at high risk of developing metabolic bone disease. Risk is increased with number of comorbidities and polypharmacy, particularly anti‐seizure medications. One way of improving bone health is to ensure that every one has adequate levels of vitamin D through supplementation.MethodsThis audit phase of a wider quality improvement (QI) project monitors the implementation of a Bone Health Project (BHP) for people with epilepsy and intellectual disability. Key Clinical Standard 1 of the BHP aims to ensure that where appropriate everyone prescribed anti‐seizure medication is offered vitamin D supplementation. This audit standard is based upon the Scientific Advisory Committee on Nutrition Guidance. The complete audit cycle was undertaken for the entire patient cohort under the care of a specialist epilepsy service and followed QI methodology.FindingsFrom the initial audit, the total number of patients prescribed vitamin D supplementation increased significantly from 95 (29%) to 182 (79%) by the end of the cycle. For those prescribed enzyme‐inducing anti‐seizure medications, the number of patients prescribed vitamin D supplementation increased significantly from 52 (49%) to 89 (90%).ConclusionsWorking collaboratively with people with intellectual disability and epilepsy can enhance engagement. Vitamin D supplementation at 800IU has been established as safe and largely efficient in ensuring most people have adequate levels of serum vitamin D. There will be people who require vitamin D replacement therapy, and this requires further intervention including monitoring of bone profiles and referral to other specialists.

303 Adherence to Nil by Mouth Guidelines in A Tertiary Centre

Abstract Aim Fasting before general anaesthetic aims to decrease the volume and acidity of stomach contents during surgery, which therefore reduces the risk of aspiration. This is a second cycle closed loop reaudit which had implemented Nil by mouth (NBM) guidelines during the first cycle as an intervention to improve knowledge. Preoperatively, adult patients should remain fasted for a minimum duration as below: During the second cycle interventions were included such as: teaching to junior doctors and nurses including specific teaching during induction of new surgical doctors and posters displaying the NBM guidelines were placed in surgical wards. These were carried out despite restrictions during the COVID-19 pandemic. Method The same questionnaire was redistributed amongst staff members (nurses and HCA) throughout various surgical wards and junior doctors. Results were compared with the initial audit during this second cycle to assess whether any improvements had been made after implementation of interventions. Results Total number of staff: Conclusions A significant improvement in knowledge and understanding of the NBM guidelines was demonstrated with all members of staff and practice was in accordance with NICE guidelines.

1396 Improving Documentation During A General Surgical Ward Round

Abstract Introduction Clear documentation at ward rounds is essential to patient safety. The purpose of this audit was to identify areas that could be improved in the documentation at surgical ward round. Method A retrospective audit of the most recent ward round entry, in two surgical wards, was carried out against the Royal College of Physicians ‘Generic Medical Record Keeping Standards’. Patient name, Health &amp; Care number (HCN), date, time(24hr), senior doctor present, signature, printed name, GMC/contact details of the scribe were analysed. After data collection, the standards were circulated to all doctors during departmental teaching and displayed on note trollies. A re-audit was then undertaken. Chi-square test was used to compare the two audit cycles and p value of &amp;lt; 0.05 was considered significant. Results 21 patient notes were analysed in the initial audit. Patient name and HCN was noted in 86%(18/21) and 67%(14/21) respectively. 100% of notes included date and senior doctor. Time of entry, signature and printed name/Bleep/GMC number were noted in 81%(17/21), 90.5%(19/21) and 57%(12/21) respectively. 24 patients were included in the re-audit. Results revealed improvement in all parameters as follows: patient name (95.8% 21/24;p=0.23); HCN (91.6%; 22/24;p=0.036),; date and senior doctor (100% as before); time (87.5%; 21/24;p=0.55); signature (100%; 24/24), and printed name/GMC/bleep (87.5%; 21/24;p=0.022). Conclusions This closed loop audit demonstrates an overall improvement in the quality of surgical documentation at ward rounds with a very simple intervention. Additionally, a statistically significant improvement was noted in recording HCN and printed name/GMC/bleep.

1334 Improving Patient Flow Through the Hand Trauma Pathway

Abstract Aim A full-cycle audit was conducted at our plastic surgery unit, assessing adherence to hand trauma standards by the British Society for Surgery of the Hand. These stipulate that time from referral to clinic for open injuries and closed fractures should be within 24 hours and 72 hours respectively and time to theatre from date of injury (DOI) within 4 and 7 days, respectively. Method Data for the initial audit was collected from Nov 2019-Feb 2020 and for the re-audit from Aug-Dec 2020. Lists were generated of 50 patients with open injuries including flexor tendon, extensor tendon and nerve injuries and 50 hand fractures in both cycles. Data was collected on DOI, date of referral, clinic review and surgery. Results The initial audit results showed poor DOI documentation (open injuries 30%, fractures 54%). For open injuries, 44% met standards for clinical review within 24 hours and 94% for time to theatre. For fractures, 94% met the standard for time to clinic and 90% for time to theatre. The interventions included adding the standards to the clinic booking form and creating a mandatory DOI field on the referral system. The re-audit showed improvement of DOI documentation (open injuries 95%, fractures 100%) and the proportion of open injuries seen within 24 hours to 60%. Conclusions The interventions had a positive impact on our hand trauma pathway. Areas for improvement include reducing the number of patient visits to the service and encouraging early decision-making, particularly for patients reviewed in the emergency department.

989 Sustained and Further Improvements in Management of Open Fractures at a UK Major Trauma Centre

Abstract Aim To re-audit pre-operative hospital management of open fractures following further interventions (junior doctor education and awareness, editing of trauma clerking form), after the initial audit and interventions led to improvements in all parameters. Method Pre-operative hospital management of open fractures was audited by reviewing patient notes using standards from the NICE (NG37) and BOAST/BAPRAS open fracture management guidelines. Patients included were treated by doctors with full exposure to the further interventions (due to junior doctor changeover the third cycle included fewer patients). Results All parameters remained improved in the third audit cycle compared to the first (before interventions were implemented). The following results compare the second (n = 30) and third audit (n = 14) cycles. Patients receiving correct antibiotics (96%vs100%) and in a timely manner (&amp;lt;2 hours) where not given pre-hospital (46%vs60%) improved. Initial neurovascular assessment (93%vs100%), specifying nerves assessed (60%vs71%), assessing all relevant arteries (60%vs71%) and nerves (63%vs71%) and using Medical Research Council (MRC) grading in nerve assessment (3%vs71%) improved, while specifying arteries assessed was similar (87%vs86%). Post-manipulation, neurovascular assessment (93%vs75%) and appropriate nerve examination (90%vs50%) deteriorated, however appropriate vascular assessment (60%vs75%) and use of MRC grading in nerve assessment (0%vs50%) improved. Documentation where neurovascular assessment was not possible, initially (50%vs93%) and post-manipulation (40%vs50%) improved. Photo availability deteriorated (70%vs64%). Tetanus cover (87%vs100%) and appropriate dressing use (47%vs71%) improved. Conclusions Most parameters showed sustained and further improvements. The haemodynamic stability variation of these patients may create difficulties in fully adhering to the management standard; in some cases, other acute concerns may take priority.

891 Fasting Times in Trauma List Patients

Abstract Introduction To reduce the risk of regurgitation and aspiration of gastric contents, patients are to fast before anaesthesia. However, prolonged periods of fasting have been found to be unnecessary and potentially harmful. Our aim was to compare pre-operative fasting times in trauma patients against the AAGBI (Association of Anaesthetists of Great Britain and Ireland) guidelines and highlight areas for improvement. The AAGBI recommends minimum fasting periods of: Method 50 patients were audited in each cycle. Data were collected prospectively using questionnaires in the initial audit and by interviewing patients in the re-audit. Patients in ITU and those with dementia were excluded. Questions included fasting instructions given, time of the last meal and drink (including kind of drink), IV fluids administration. Anaesthetic notes were checked for time of induction of anaesthesia. Results Average time fasted for food was 17.09 hours and 9.32 hours for water. In the re-audit, average time fasted was 16.43 hours for food and 5.27 hours for water. All the patients received information as to when they could eat or drink until. None of them was told ‘midnight’. Conclusions Although there was an improvement, this was still beyond the guidelines. The results highlighted the importance of regularly reviewing the fasting status throughout the day in order to achieve the standard.

836 DIEP Flap Monitoring Adherence

Abstract Aim The popularity of Deep Epigastric Perforator (DIEP) free flaps for breast reconstruction after mastectomies have increased due to their natural aesthetic results and reliability. Free flaps require strict post-operative monitoring by nursing staff during the early post-operative period where they should notify the surgeons to anticipate vascular compromise in order to salvage the flap. To ensure success the DIEP guidelines were introduced to Morriston Hospital, Swansea. This was a first cycle closed loop re-audit. Method Interventions from initial audit were implemented in 2018. Retrospective analysis of patient notes over an 8-month period (August 2019- March 2020) and compared with DIEP checklist. Clinical notes, nursing cartex and flap observations and medication charts were reviewed. Results 100% had bear huggers, antiemetics (87% in 2018), correct thromboprophylaxis (75% in 2018) and laxatives (37% in 2018). 100% had senior reviews daily post op (75% in 2018). 100% had flap observations performed as guidelines immediately post op. Conclusions This was a successful re-audit showing significant improvements in adherence rates amongst the surgical and nursing staff in the plastic surgery department. Implementation of the DIEP operation note template may help maintain such adherence amongst staff.

1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice

Abstract Aim The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals. Method An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020. Results In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November. Conclusions Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.

254 An Audit to Assess the Completion of Consent Forms in the Department of Trauma and Orthopaedics

Abstract Aim The objective was to audit how well the consent forms were being completed by junior doctors and registrars in the orthopaedic ward. This helped to assess whether the consent forms before orthopaedic procedures were being filled out according to the standards stated in the RCS and NICE guidelines. Method The initial audit was carried out in January 2020 in the three orthopaedic surgery wards at the Queen’s Medical Centre in Nottingham. Cross sectional data was collected by checking the consent forms to assess whether the important headings and sub-headings were filled out legibly with adequate information. Results All consent forms filled up in the study sample had the patient details and the name of the surgery written completely and accurately. 75.6% of the forms had the name of the Responsible Health Professional written, while the remaining had left the space blank or wrote an incorrect name. More than 90% of the forms had the intended benefit, and the possible risks of the orthopaedic operation written in the most suitable format. The likelihood of a blood transfusion being required was filled out in 78.6% of the forms. All consent forms were signed by a doctor, however, only 53% of the doctors provided both their name in print and contact number in the consent form. Conclusions Consent is an essential prerequisite for any operative procedure. By detecting the parts of the consent form that were frequently filled out inadequately, awareness was raised about the possible legal consequences of it.

1576 Safeguarding Tools in Paediatric Burns

Abstract Introduction When assessing paediatric patients presenting with burns, non-accidental injury always has to be considered. In our department, local policy dictates that all patients aged 18 or below should have a child safeguarding tool completed on initial clerking. Method A retrospective audit of all paediatric burns seen over one month was performed. Primary outcome measures included completion of a safeguarding tool and documentation of referral outcome. These results were presented locally and implementing changes were carried out. This was then re-audited over a further monthly period. Results Initial data collection showed a safeguarding tool completion rate of 69% and referral outcome documentation rate of 50% (n = 16). Implement changes included dissemination of initial audit results to the department, changing the layout of our clerking proformas and introducing posters in the unit which provided more information on risk assessing paediatric patients. The re-audit results showed a safeguarding tool completion rate of 100% and a referral outcome documentation rate of 100% (n = 14). Conclusions There was a significant improvement in both the safeguarding tool completion and referral outcome documentation rates following our interventions. Simple measures just such education and strategic adjustments of clerking proformas have been shown to be effective measures for increasing documental compliance of child safeguarding tools.