scholarly journals 303 Adherence to Nil by Mouth Guidelines in A Tertiary Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Muscat ◽  
I Fabre ◽  
K Mohiuddin
Keyword(s):  
Closed Loop ◽  
Stomach Contents ◽  
Junior Doctors ◽  
General Anaesthetic ◽  
Minimum Duration ◽  
Nice Guidelines ◽  
Staff Members ◽  
Tertiary Centre ◽  
Specific Teaching ◽  
Risk Of Aspiration

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.

EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Georgios Karagiannidis ◽  
Omar Toma
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Lower Limb ◽  
Plaster Cast ◽  
Junior Doctors ◽  
National Audit ◽  
Lower Limb Injuries ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Limb Injuries

Abstract Aims Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast. Methods A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017. Results 83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy. Conclusions We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.

Preoperative fasting durations for adult elective surgical patients: Convenient for the professional, but detrimental to the patient? A narrative review

2019 ◽  
Vol 29 (12) ◽  
pp. 393-397
Author(s):  
Emma King
Keyword(s):  
Perioperative Complications ◽  
Stomach Contents ◽  
Evidence Based ◽  
Preoperative Fasting ◽  
Review Of The Literature ◽  
Evidenced Based ◽  
Risk Of Aspiration ◽  
Induction Of Anaesthesia ◽  
Evidenced Based Practice ◽  
By Products

Preoperative fasting is necessary in reducing the risk of aspiration of stomach contents when undergoing a procedure that requires anaesthesia. There are numerous guidelines based upon evidence-based practice that outline the safe duration of a fast prior to the induction of anaesthesia. Common practice however is to give advice that unnecessarily starves the patient leading to perioperative complications. There is a breadth of literature analysing the fasting durations of various institutions, with a consensus of fasting from midnight being the norm, and side effects of nausea and dehydration being unfortunate by-products of fasting. A review of the literature examines the continued poor compliance of evidenced-based practice.

scholarly journals The Clinical Frailty Scale: Do Staff Agree?

Geriatrics ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 40 ◽  
Author(s):  
Rebekah L. Young ◽  
David G. Smithard
Keyword(s):  
Medical Staff ◽  
Allied Health ◽  
Screening Method ◽  
Occupational Therapists ◽  
Junior Doctors ◽  
Case Scenario ◽  
Allied Health Professionals ◽  
Clinical Frailty Scale ◽  
Allied Health Professions ◽  
Staff Members

The term frailty is being increasingly used by clinicians, however there is no strict consensus on the best screening method. The expectation in England is that all older patients should have the Clinical Frailty Scale (CFS) completed on admission. This will frequently rely on junior medical staff and nurses, raising the question as to whether there is consistency. We asked 124 members of a multidisciplinary team (consultants, junior doctors, nurses, and allied health professionals; physiotherapists, occupational therapists, dietitians, speech and language therapists) to complete the CFS for seven case scenarios. The majority of the participants, 91/124 (72%), were trainee medical staff, 16 were senior medical staff, 12 were allied health professions, and 6 were nurses. There was broad agreement both between the professions and within the professions, with median CFS scores varying by a maximum of only one point, except in case scenario G, where there was a two-point difference between the most junior trainees (FY1) and the nursing staff. No difference (using the Mann–Whitney U test) was found between the different staff groups, with the median scores and range of scores being similar. This study has confirmed there is agreement between different staff members when calculating the CFS with no specific preceding training.

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover

2015 ◽  
Vol 39 (2) ◽  
pp. 197 ◽  
Author(s):  
Daniel Brooks Reid ◽  
Shaun R. Parsons ◽  
Stephen D. Gill ◽  
Andrew J. Hughes
Keyword(s):  
Health Service ◽  
Discharge Summary ◽  
Junior Doctors ◽  
Department Heads ◽  
Clinical Handover ◽  
Staff Members ◽  
Quality Health ◽  
Service Standards ◽  
Discharge Summaries ◽  
Summary Procedure

Objective To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. Methods Department heads were invited to complete a questionnaire about departmental discharge summary practices. Results Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. Conclusions The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation’s practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice. What is known about the topic? The Australian National Safety and Quality Health Service Standards (Standard 6) require health service organisations to implement documented systems that support structured and effective clinical handover. Discharge summaries are an important and often the only form of communication during a patient’s transition from hospital to the community. Incomplete, inaccurate and unavailable discharge summaries are common and expose patients to greater health risks. Junior staff members find completing discharge summaries difficult and fail to receive appropriate education or support. There is little published evidence regarding the discharge summary practices of inpatient health services. What does this paper add? The paper demonstrates that there is substantial variation in practice regarding discharge summaries in a large regional health service. Departments have different processes and vary in the degree of attention and quality assurance provided to discharge summaries. Variable organisation procedures make completing discharge summaries more difficult for junior doctors, who regularly move between departments. Variable practice is likely to increase the risk of absent, untimely, incomplete or incorrect communication between acute and community services, thereby reducing the quality of patient care. It is likely that similar findings would be found in other hospitals. What are the implications for practitioners? To be accredited under the National Safety and Quality Health Service Standards, health organisations must ensure that adequate processes are in place for safe and effective clinical handover. Organisations should reduce the practice variability by standardising processes, monitoring compliance with processes, and training and supporting junior doctors.

The utility of lateral neck radiographs in the management of fish bones

2019 ◽  
Vol 133 (12) ◽  
pp. 1064-1067
Author(s):  
T Pitts-Tucker ◽  
T C Biggs ◽  
N N Patel
Keyword(s):  
Treatment Algorithm ◽  
Fish Bone ◽  
Aerodigestive Tract ◽  
University Hospital ◽  
Junior Doctors ◽  
General Anaesthetic ◽  
Lateral Neck ◽  
Upper Aerodigestive Tract ◽  
Fish Bones ◽  
Anaesthetic Assessment

AbstractBackgroundLateral neck radiographs are commonly used in the investigation and management of patients presenting with suspected fish bone impaction. The effectiveness of these is questioned, as many fish do not have radio-opaque bones.ObjectiveThis study evaluated the utility of lateral neck radiographs in the management of patients presenting with fish bones retained in the upper aerodigestive tract, with the creation of a treatment algorithm to guide further management.MethodsAn audit of practice was undertaken at the University Hospital of Southampton, identifying all patients admitted with potential fish bone impaction in the upper aerodigestive tract. Following analysis, a treatment algorithm was constructed for use by junior doctors.ResultsIn total, 34 per cent of patients with a normal radiograph were subsequently found to have a fish bone present under local or general anaesthetic assessment. The sensitivity of radiographs in the detection of fish bones was found to be 51.6 per cent.ConclusionLateral neck radiographs have limited value in the management of suspected fish bone impaction, and should only be used following detailed clinical examination of the upper aerodigestive tract.

EP.FRI.258 A closed loop audit of deep vein thrombosis prophylaxis in the acute surgical receiving unit of a large teaching hospital; reducing morbidity and mortality, and improving cost-effectiveness

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jun Yu Chen ◽  
Fraser Norman ◽  
Paul Paterson-Byrne ◽  
Gary Nicholson
Keyword(s):  
Closed Loop ◽  
Significant Risk ◽  
Cost Effective ◽  
Morbidity And Mortality ◽  
Thrombosis Prophylaxis ◽  
Junior Doctors ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Deep Vein Thrombosis Prophylaxis ◽  
Considerable Morbidity

Abstract Aims Acute surgical patients have a significant risk of venous thromboembolism (VTE) due to factors such as surgery, immobility, dehydration, and existing comorbidities. All patients admitted to an acute surgical unit should have their VTE risk assessed. Our aim was to assess VTE prophylaxis practices. Methods We performed a closed loop audit on DVT prophylaxis using the Scottish Intercollegiate Guidelines Network proforma. Data on anti-embolic stockings (AES) and low molecular weight heparin (LMWH) were collected and presented at a local audit meeting. The intervention included reinforcing the importance of VTE prophylaxis compliance amongst junior doctors and nursing staff, and provision of posters within the department and on patient trolleys. Data was collected to complete the audit cycle. Results A total of 171 patients were included. Prior to the intervention, 13.9% did not receive LMWH when indicated and 37.4% were non-compliant with AES. Overall, 40% had insufficient DVT thromboprophylaxis. Post implementation, 8.9% did not receive LMWH when indicated and 46.4% were noncompliant with AES. Overall, 50% had insufficient DVT thromboprophylaxis. LMWH compliance was 5.0% higher on re-auditing however AES compliance was 9.0% lower. Conclusions Adherence to thromboprophylaxis regulations was below expected standards. Thromboprophylaxis is cost-effective and prevents considerable morbidity and mortality, so ongoing audits alongside analyses of potential causes should be encouraged. We acknowledge the data’s limitations in that the reasons for low compliance cannot be ascertained here, but results suggest that there exists room for more interventions aiming to encourage a marked improvement both in LMWH and AES compliance.

scholarly journals Radiological Investigations for AIS3+ Head Injuries in a Trauma Unit: A Closed Loop Audit of Adherence to NICE Guidelines

2017 ◽  
Vol 47 ◽  
pp. S63
Author(s):  
M. Vazirian-Zadeh ◽  
A. Bakr ◽  
O. Okoye ◽  
K. Evans ◽  
T. Amuthalingam ◽  
...  
Keyword(s):  
Closed Loop ◽  
Head Injuries ◽  
Nice Guidelines ◽  
Trauma Unit

Safe radiology for junior doctors: closed-loop audit

2016 ◽  
Vol 71 ◽  
pp. S19
Author(s):  
Mahmud Saedon ◽  
Hussein Kaderbhai ◽  
Sally Lewis ◽  
Akashdeep Nijjar
Keyword(s):  
Closed Loop ◽  
Junior Doctors

scholarly journals Are the staff in Heddfan Psychiatric Unit, Wrexham Maelor Hospital, are adhering to the personal protective equipment (PPE) guidance as per Public Health Education, England? a QIP

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S184-S184
Author(s):  
Asha Dhandapani ◽  
Sathyan Soundararajan ◽  
Rajvinder Sambhi ◽  
Catherine Baker
Keyword(s):  
Public Health ◽  
Health Care ◽  
Student Nurses ◽  
Public Health Education ◽  
Staff Nurses ◽  
Protective Equipment ◽  
Junior Doctors ◽  
Healthcare Staff ◽  
Staff Members ◽  
Care Support

AimsThe aim of this audit is to assess whether healthcare staff are correctly donning and doffing PPE when entering and leaving the wards (changed to donning and doffing PPE when within 2 metres vicinity of a patient).MethodConsultants/ Junior doctors/ Ward managers/ Staff nurses/ student nurses/ Health care support workers/ Occupational therapist/ Psychologists/ Student nurses/ Housekeeping staff, were all included in this Audit. None of the staff was aware of this Audit and this was an entirely random observation. We used a standard proforma in order to audit. Followed by the Audit, we trained the staff in the unit and then re-audited.Result98% of them wore mask whilst in the ward and 94% of them washed their hands after doffing. 36% did not wear them appropriately and about 10-14% did not wear PPE at all. A mere 7 out of 50 alone used hand gel. Overall the donning and doffing of PPE was not being followed and adhered to according to the standards from PHE as per the first Audit. In particular, during donning only 1/3rd of them donned the PPE as per guidance. Likewise, the doffing technique was also poor, with only half of them removing the apron and mask correctly. Unfortunately, only 7 of the 50 people were observed to have used hand gel in between the doffing. This could be potentially increasing the risk of the spread of the coronavirus.We had trained almost 150 staff members in the Heddfan unit with regard to PPE/ donning and doffing.Handwashing prior to donning was achieved by all the staff. All the staff, that is 100 % of them adhered to the donning technique in line with the guidance in comparison to just 64% during the first Audit. Whilst hardly just 1/2 to 2/3rd of the staff followed the doffing technique adequately, the second audit showed that only 2 of the 50 staff did not follow the guidance. A meagre/ handful of them followed the utilisation of hand gel in between the tasks of doffing during the first Audit. Almost 90% of them followed the technique properly during the second Audit. Thus showing that the PPE training was successful.ConclusionFollowing the PPE training that was provided to them there was a good response from the staff and this went on to show how effectively we have managed the prevention/ contamination of virus in our unit.

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