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Ramjeeawon A, Iqbal M, Abourisha E, Ahmad A, Hasan Y, Hawthorne R, Ashraf A, Deakin M. 989 Sustained and Further Improvements in Management of Open Fractures at a UK Major Trauma Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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 (<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.
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Affiliation(s)
- A Ramjeeawon
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - M Iqbal
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - E Abourisha
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - A Ahmad
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Y Hasan
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - R Hawthorne
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - A Ashraf
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - M Deakin
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
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Ramjeeawon A, Iqbal M, Hawthorne R, Ahmad A, Hasan Y, Abourisha E, Ashraf A, Deakin M. 180 Management of Open Fractures at Oxford University Hospitals NHS Trust Major Trauma Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
This audit was developed after noticing patients with open fractures had poor neurovascular assessment documentation (non-specific, none post-manipulation), and to check these patients received appropriate antibiotics. Review of open fracture management guidelines identified areas to be improved.
Method
Pre-operative hospital management of open fractures was audited using the NICE (NG37) and joint BOAST/BAPRAS guidelines on open fracture management. Interventions were awareness and education of junior doctors and editing the Trauma Clerking Form to prompt appropriate management and documentation, followed by re-audit.
Results
30 patients were assessed pre- and post-intervention. Correct antibiotic administration rate (93%vs97%) and speed (50% <2 hours where not given pre-hospital - in both groups) were similar. The initial neurovascular assessment frequency was identical (93%), however documentation of assessment of specific arteries (86%vs30%) and nerves (60%vs23%) and assessing all appropriate arteries (60%vs13%) and nerves (60%vs20%) improved. There were increased frequencies of documenting manipulation in A&E (90%vs47%) and neurovascular assessment post-manipulation (90%vs16%). Tetanus cover (87%vs77%), photo availability (70%vs40%), and appropriate dressing use (47%vs27%) improved.
Conclusions
Antibiotic management was consistent and appropriate. There were improvements in frequency and quality of neurovascular assessment, tetanus cover, availability of photographs of injuries and appropriate dressings used. Overall, pre-operative hospital management of open fractures improved.
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Affiliation(s)
- A Ramjeeawon
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - M Iqbal
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - R Hawthorne
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - A Ahmad
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Y Hasan
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - E Abourisha
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - A Ashraf
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - M Deakin
- Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom
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