733 ERAS Audit: Junior Doctor Compliance with the Elective Colorectal Enhanced Recovery After Surgery (ERAS) Pathway at Bristol Royal Infirmary
K Memory, L Brennan, A Smith, A Simpson, M Kobetic, R Griggs- Surgery
Abstract
Introduction
The Enhanced Recovery After Surgery (ERAS) pathway is an evidence-based protocol aiming to reduce morbidity and improve post-operative outcomes. Two important recommendations included are early prescribing of post-operative nutritional drinks and avoidance of post-operative opioids. Junior doctors are integral to ensuring the compliance of these guidelines. Therefore, this audit aimed to review junior doctor adherence to ERAS recommendations with regards to nutritional drink prescribing and opioid avoidance within the colorectal department at the Bristol Royal Infirmary.
Method
Inpatient data was collected retrospectively from all patients undergoing elective colorectal surgery on the ERAS pathway from January to June 2022. Patients’ notes were analysed on two parameters: post-operative opioid prescribing and prescribing of post-operative nutritional drinks (fortisips/fortijuice). Educational interventions were implemented; face-to-face education to new colorectal junior doctors, and posters displayed in the doctor's office.
Results
104 patients were identified, 16 excluded for insufficient data. Of those 88 included, early post-operative nutrition and/or solid food intake was achieved by 60 patients (68.2%) and nutritional drinks were prescribed for 39 patients (44.3%). The average time to prescribe nutritional drinks was 3 days. Avoidance of systemic opioids was achieved by 7 patients (7.9%).
Conclusions
This audit highlights that improvements are required to ensure better adherence to the ERAS protocol within our department. Junior doctors can facilitate this by ensuring nutritional support is promptly prescribed post-operatively, and by prompting discussions regarding opioid prescribing. A second cycle post intervention will allow review of our chosen outcomes to ensure we are optimising post-operative outcomes for elective colorectal patients.