bluuebunny/crossref_metadata_2025_split huggingface dataset:
254 An Audit to Assess the Completion of Consent Forms in the Department of Trauma and Orthopaedics
Authors: Sultana E 
Published: October 2021

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.
261 The Use of MRCP to Investigate Bile Duct Stones
Authors: Ma J , Jethwa P 
Published: October 2021

Abstract

Aim
Association of Upper Gastrointestinal Surgeons (AUGIS) latest guideline advocates stratification of patients with gallstone disease to determine their risks of common bile duct (CBD) stone and to perform Magnetic resonance cholangiopancreatography (MRCP) for those at intermediate risk. The study assessed the appropriateness of our local hospital’s MRCP requests in accordance to the AUGIS standard.

Method
Inpatient MRCP requests for suspected ductal gallstones between June and December 2019 were identified retrospectively. Admission history, ultrasound, MRCP findings and liver function tests were collected from hospital electronic records. Patients with previous cholecystectomy were excluded. Patients were categorized into ‘low risk’, ‘intermediate risk’ and ‘high risk’.

Results
67 patients were included in the study and 24 patients were discovered to have CBD stones on MRCP. The majority of patients (54%) were considered ‘intermediate risk’, whilst the ‘low risk’ group consisted of 13% of the MRCP requests and ‘high risk’ group comprised of 33 %. Amongst those in the ‘low risk’ group, only 1 of 9 patients (11%) had cbd stone identified on MRCP. 19% patients in the intermediate group were found to have CBD stone, whilst 73% patients in the high-risk group were identified to have CBD stone. On average, patients underwent MRCP within a day of request.

Conclusions
A high proportion of patients at high risk for CBD stone were referred for MRCP, contrary to AUGIS guideline. Inpatient MRCP referrals should be considered carefully in this category as it potentially increases length of stay without change in clinical management.
277 Smoking and Alcohol Use Assessments in Head and Neck Surgical Inpatients: An Audit to Improve Health Promotion
Authors: Crossley E , Findlay C , Sipaul F 
Published: October 2021

Abstract

Aim
Head and neck cancer incidence is expected to rise, with smoking and alcohol consumption the greatest risk factors. The related CQUIN target encourages identification of patients who smoke and drink harmful amounts of alcohol. Locally these questions are integrated into discharge summaries. We aimed to review questionnaire completion and encourage staff to give advice to minimise patients’ future head and neck cancer risk.

Method
We conducted a retrospective audit of adult patients admitted locally under head and neck surgeons in a three-month period. Local audit standard was completion of the questionnaires in 95% of patients. Intervention was education of ENT juniors (foundation and core trainees) alongside ward-based prompts. Re-audit was conducted for two-months following intervention.

Results
Initial audit reviewed 99 discharge summaries, and re-audit reviewed 115. Following intervention there was improved documentation of smoking status from 27.3% to 48.7% (n = 27/99 vs n = 56/115) and alcohol use from 36.3% to 51.3% (n = 36/99 vs n = 59/115) respectively. However, even in re-audit a significant proportion were documented as ‘unable' to answer (smoking 41.7%, alcohol 42.6%); of these the majority were day case procedures (smoking n = 35/48, alcohol n = 42/49).

Conclusions
Staff education can encourage doctors to discuss smoking and alcohol and represents health promotion and a reduction in risk of malignancy. Many day case patients were documented as ‘unable’ to answer; this may reflect that discharge paperwork is frequently completed in the immediate post-operative period. Further improvement could be achieved with educational interventions for registrars and consultants, and consideration of the practical challenges negatively impacting questionnaire completion for day case patients.
295 Secondary Prevention of Cardiovascular Risk Factors in Patients Admitted Under the Vascular Service - Full Cycle Audit
Authors: Abadi P H , Forsyth J , Drury D 
Published: October 2021

Abstract

Aim
Peripheral arterial disease (PAD) is strongly associated with general cardiovascular morbidity and mortality. This audit aimed to monitor and improve compliance with NICE guidelines CG147 & TA607 for PAD patients that presented to our vascular service.

Method
Patients were audited from September to October 2020. The audit reviewed prescription of anticoagulant/antiplatelet agents, lipid modification, optimisation of diabetes control and smoking cessation advice. Our intervention was to conduct a single teaching session for junior doctors that emphasised medication checks, checking HBA1c/ensuring appropriate diabetic referrals, and implementation/documentation of any smoking cessation advice. We also introduced a dedicated computer for conducting the vascular surgery morning ward round. Re-audit was undertaken between November to December 2020.

Results
The first audit included 32 patients. It revealed 100% compliance with anticoagulant/antiplatelet prescribing. 82% were prescribed appropriate lipid modification. There was 75% compliance with diabetic referrals for patients with high HBA1c results. There was only 19% compliance with smoking cessation advice/documentation. The re-audit process included 27 patients. There was 100% compliance with antiplatelet/anticoagulant prescriptions. 26 (96%) patients were prescribed appropriate lipid modification. There was now 100% compliance with appropriate referral to the diabetic team. There was also 100% compliance with smoking cessation advice/assistance/documentation.

Conclusions
A single teaching session for junior doctors familiarising them with the current national guidelines, and introduction of a dedicated computer for ward rounds significantly helped improve our compliance with national guidelines for secondary prevention of vascular disease.
303 Adherence to Nil by Mouth Guidelines in A Tertiary Centre
Authors: Muscat E , Fabre I , Mohiuddin K 
Published: October 2021

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.
307 Awareness and Reporting of Needle Stick Injury Amongst Junior Doctors in a General Surgery Department
Authors: Mistry R , Mahamud I 
Published: October 2021

Abstract

Introduction
This audit was performed to see if a new cohort of junior doctors in a general surgery department had received legally required sharps injury training, assess knowledge on what to do if a needle stick/splash injury were to occur; and to provide necessary training.

Method
Questionnaires about trust needle stick policy training including current job grade, awareness of general principles, reporting of previous needle stick injuries and barriers to reporting of needle stick injuries were filled in. Training was provided on needle free devices and trust needle stick/splash injury protocol. After training, a second questionnaire was filled in to see if there was better understanding of the trust protocol and the necessary steps after injury. The same group of junior doctors were re-audited at a later date to see if the knowledge gained from training had been retained.

Results
All junior doctors (total of 11) in general surgery reported receiving no formal needle stick/splash training since starting at the trust on the trust policy and no formal induction on needle-free devices and what to do in the event of a needle stick injury since starting at the trust. All doctors felt aware of what to do after training provided with time pressures being identified as a barrier for not reporting all needle stick injuries. Re-audit one month later demonstrated all doctors had awareness of the trusts needle stick/splash injury protocol.

Conclusions
The training provided was effective in providing legally required training and improving staff and patient safety.
343 Knowledge and Confidence of Nursing Staff in Burns Management
Authors: Bakhiet A 
Published: October 2021

Abstract

Background
Nursing staff play a pivotal role in the management of burns patients. It is essential that nurses are confident in following the various protocols for these patients. Due to Covid-19, many nursing staff have been redeployed to other specialties, with reduced availability of Burns teaching days also impacting on Burns care. The aim of this audit was to determine the level of education and confidence of burns management amongst nursing staff.

Method
Data collection proformas were handed out to all nursing staff working on a ward that receives burns patients. The data was subsequently collated, analysed and presented at a local meeting.

Results
A total of 44 proformas were distributed. The average confidence ratings of nursing staff (on a scale of 1-10) when managing 5%, 10% and 15% burns patients were 6.4, 5.2 and 3.8 respectively. 89% had received no formal burns education within the past 2 years.

Conclusions
Optimal burns care is dependent on a multidisciplinary approach, with burns nurses playing a central role. The complex requirements of these patients require nursing staff to have a broad range of knowledge and skills so as to coordinate the patient’s management. This study shows that confidence increases with experience and decreases with an increasing severity of burn. Through this study we were able to identify the main areas of knowledge discrepancy amongst the nurses, as well as determine their preferred means of learning. We are currently organising a Burns education programme for the nursing staff tailored to the feedback received in this audit.
376 Management of Breast Cancer in elderly patients
Authors: Moutsos I , Noronha J 
Published: October 2021

Abstract

Aim
To evaluate the care and outcomes for women with breast cancer over the age of 70 and to compare our performance at AUH against the national outcomes.

Method
Using the online database at AUH we gathered the following data: age, TNM status, surgical management, histology, adjuvant treatment (radiotherapy, chemotherapy, hormone therapy, targeted therapy) and reasons for alterations in planned therapy.

Results
We audited 176 patients between 2018 and 2019. Age varied between 70 and 95 years old. 10 patients suffered from DCIS, 152 from invasive breast cancer and 14 from de novo metastatic breast cancer. 40% of patients with DCIS with underwent WLE, 40% underwent mastectomy and 20% were not offered an operation as they were unfit. Invasive breast cancer accounted for the majority of cases. 86% were ER/PR positive and 12.2% were Her-2 positive. 35.7% underwent mastectomy, 64.4% underwent WLE and 0.8% VAB excision. 51.7% had Sentinel node biopsy, 15.3% underwent axillary clearance and 1.7 % had axillary sampling. 7.9% of patients presented with metastatic disease. 2.6% of those patients had palliative radiotherapy. Primary endocrine therapy was commenced on 21.1% of patients. Factors that lead to PET were that 47% of patients were unfit for an operation, 20.6% refused surgical intervention, 11.7% had concurrent aggressive malignancy and 8.8% were inoperable.

Conclusions
Overall, successful results were achieved for this group of patients compared to the national outcomes. 99.4% of patients in our centre had triple assessment prior to MDT. Further review of functional status and service outcomes will be required to be audited.
379 Improving Flow: A Quality Improvement Project on The Processing of Vascular Surgical Microbiology Samples
Authors: Wang L , Gilbert J , Ireland D , Samarasinghe D , Sritharan G 
Published: October 2021

Abstract

Aim
Tissue samples taken during vascular surgical operations are commonly sent for microbiological analysis, owing to the relatively high incidence and serious consequences of infection in these cases. Delays in obtaining results from these samples can hinder clinical management, leading to prolonged inpatient stay and adverse clinical outcomes. The aim of this audit was to identify causes for delay in obtaining microbiology results and to improve the service.

Method
A closed loop quality improvement project performed at a tertiary vascular centre in London. We initially identified all tissue microbiology samples sent from vascular surgical operations performed during April 2019 and record the time when samples reach microbiology laboratory and the time when results were made available. Re-audit data was collected in November 2019.

Results
Initial audit showed that on average, results were available for clinicians 9.1 days after the sample was taken and 7.3 days after the sample had reached the laboratory. Samples required an average of 44 hours to transit to the laboratory and notably there is delay if surgery is performed on Friday (71 hours). Additionally, one sample was missing. Following utilization of the urgent sample pathway and raising awareness amongst staff, re-audit data showed significant reduction in average time of transit (33 hours) with much reduced transit time on Friday (36 hours). Results were available 7.7 days following sample date, compared to 9.1 days before.

Conclusions
Utilization of existing pathway and staff training can reduce delays in microbiology sample processing. However, further analysis is necessary to ensure sustained improvement.
396 A 6-Month Audit of Initial Diabetic Foot Assessment and Documentation for Patients Undergoing Major Lower Limb Amputations in An Orthopaedics Ward
Authors: Lai L , Wong L Y , bin Hassan Z 
Published: October 2021

Abstract

Aim
To determine if adequate diabetic foot assessment and documentation were done at the Orthopaedics ward for patients undergoing a below-knee amputation (BKA) or above-knee amputation (AKA).

Method
Retrospective data from August 2019 to January 2020 were taken from paper documentation and e-records from the Orthopaedics ward and operation theatre. Diabetic foot assessments were based on the ASEANPlus guidelines for diabetic foot wounds which included foot inspection (for dermatological or musculoskeletal abnormalities), vascular (palpation of dorsalis pedis and posterior tibial pulses, ABSI measurement) and neurological assessments (testing of sensation and ankle reflexes). The assessments were deemed “adequate” or “inadequate” based on the information found on documentation.

Results
Only 67/81 data pieces were available for analysis (AKA=26, BKA=41), with an average age of 60 years. Inspection of the foot was most adequately assessed and documented (100%), followed by vascular and neurological assessment. For vascular assessment, palpation of pulses was done in 94% cases, and ABSI was performed in 76%. For neurological assessment, assessment of sensation was performed in 55%, while ankle reflexes were only assessed and documented in 25% cases.

Conclusions
Overall, the local practice had poor documentation of diabetic foot assessment, especially in vascular and neurological assessments. Possible reasons for poor practice include lack of guidance for incoming junior doctors starting their Orthopaedics rotation, and subsequently, the lack of skills and confidence in performing said assessments. Measures that could be done to improve the quality of practice include teaching key examinations to junior staff and having closer monitoring of notes documentation during ward rounds.
421 Closed loop analgesia audit, a Single Centre Experience in Raigmore Hospital, Inverness, Scotland
Authors: Chan J H 
Published: October 2021

Abstract

Aim
Assess are we following the analgesic step ladder accurately and if not are the reasons clear and documented?

Method
A closed-loop audit performed on the use of the WHO Analgesic ladder in surgical patients. We looked at the compliance of the analgesic ladder and are the reasons documented or explained when the ladder is not followed. The data was collated, analysed, and presented at an audit meeting. We then implemented changes in the form of educational sessions and information leaflets sharing, as well as email reminders among staff. Post-implementation showed an improvement in the documentation when the analgesic ladder was not followed.

Results
A total of 103 surgical patients were included. Prior to the implementation of interventions, 83.3% of patients had analgesia prescribed following the analgesic ladder. Of those remaining patients who had analgesia prescribed not according to the analgesic ladder, only 50% documented the indications and reasons. Post-implementation, the analgesic ladder compliance dropped to 50.9% with documentation improvement to 56%.

Conclusions
All surgical patients have prescribed analgesia when needed. Though WHO ladder compliance has shown reduction compared to the first data sample, the reasons are clinically justified, and improvements have been shown in documentation after intervention though there is still room for improvement for documentation. This is perhaps surgical teams are more aware of the choice of analgesia used post-intervention while taking the analgesic ladder into consideration. Stepwise multimodal analgesia prescribing will improve analgesic effect hence improves post-operative recovery hence reduce the length of hospital stay as part of the ERAS protocol.
572 Closed-Loop Clinical Audit on Blood Results in Urology Department During Ward Rounds
Authors: Sahni D S , Kosk P 
Published: October 2021

Abstract

Aim
Clinical governance states that blood results should be flagged during ward rounds to enable better assessment of inpatients. As per our institutional Protocol, each patient is assigned a blood sheet which should be updated every day with outstanding bloods flagged with a circle. The aim of the audit was to evaluate the quality of blood result sheets and to discuss results in order to enhance patient care.

Method
Data was collected from the Urology ward at Glasgow Royal Infirmary continuously during November 2020. We reviewed the flagging of abnormal bloods and whether clear documentation of baseline eGFR was included. Intervention was carried out by series of discussion with the nursing and the medical staff along with display posters throughout the ward and staff rooms.

Results
Overall, first cycle assessed 65 folders and second assessed 79. We noticed that the flagging of outstanding blood results increased from 70% to 74%. Documentation of baseline eGFR raised from 32% to 44%. Initially, only 73% of results were appropriately placed in the correct patient nursing folder which improved and reached 100% on review.

Conclusions
The first cycle of the audit demonstrated serious breach of protocols which could delay and affect patient care. The re-audit cycle post intervention illustrated that active efforts on the part of medical and nursing staff can significantly improve the outcomes. However, sustained intervention in the form of audits and induction program is needed to bring a sustainable change in the departmental practice.
580 Vascular Distal Bypass Early Surveillance Audit
Authors: Soliman H , Halawa M , Awad R , Tan J 
Published: October 2021

Abstract

Introduction
Due to inconsistency in Duplex surveillance following distal bypass for peripheral arterial disease at our district general hospital. We planned an audit aiming to assess our current early surveillance of distal vascular bypass.

Method
The latest twenty patients who underwent distal bypass were collected retrospectively from the theatre’s records. Their clinical and imaging records were analysed to ascertain the timing of 1st duplex after the procedure. We also examined the discharge medications. We chose the standard advised by Society for Vascular Surgery that every patient following the procedure ideally should have (Clinical examination + ABPI + Duplex) at 1, 3, 6 and 12 months then annually.

Results
8 patients (40%) had a Duplex within 1 month, while 10% did not have a scan at all. Time range between the procedure and first Duplex was 1-11 months with a mean of 4 months. All patients were discharged on at least a single antiplatelet agent while only 70% were prescribed statins. Six patients needed an intervention for blocked graft but eventually failed, only one patient had a Duplex in a timely fashion, the stenosed graft was salvaged by angioplasty.

Conclusions
There was no clear standardized surveillance protocol for vascular team juniors to follow. In addition, discharge of distal bypass patients sometimes is carried by general surgery team during weekends and unlikely that a Duplex is booked. We suggested booking the Duplex in theaters soon after performing the procedure to ensure inclusion in the surveillance protocol, education of junior doctors and re-auditing in 1 year.