568 Audit of Laceration Management and DocumentationA Kremneva
Evaluate adherence of emergency department (ED) staff to NICE guidelines on laceration management. Evaluate quality of laceration management documentation in ED. Re-evaluate the above following the introduction of a laceration template for ED clerking.
ED documentations of 53 adult patients presented with laceration in November 2022 were analysed and evaluated based on the presence of the following components: wound size, infection risk, tetanus vaccination status & appropriateness of booster administration, wound cleaning, appropriateness of wound closure method, type of dressing, appropriateness of antibiotic prescribing, and wound care instructions (e.g., suture/ dressing removal time).
49% of documentations mentioned the laceration size. Only 9% commented on the wound infection risk, making it impossible to comment on appropriateness of antibiotic prescribing in most cases; 6% of the cases were prescribed antibiotics despite the wound being closed, against guidelines. Most cases had wound cleaning (72%) and appropriate closure method (77%) documented. Dressing type was only documented in 19% of cases. Just over the half of the patients had tetanus history clarified and booster administered appropriately (59%). Only 36% of the patients received detailed wound care instructions.
The first audit cycle highlighted concerning gaps in ED clerking. This may lead to the NICE guidelines being incorrectly applied, which in turn presents a significant risk to patients. A laceration clerking template will be introduced in 2023 with compulsory elements that will encourage more rounded history taking. Therefore, a re-audit will be performed in February to assess efficacy of changes.