831 Improving Documentation of Post-Operative Day 1 Checks After a Hip Hemiarthroplasty or Total Hip Replacement
M Rasquinha, B Oakley, N Bhangoo- Surgery
Abstract
Background
Post-operative day 1 checks (X-ray, bloods, dressing check and neurovascular status) are essential after hemi-arthroplasty (hemi) or total hip replacements (THR) to look for peri-prosthetic fracture, dislocation, anaemia, acute kidney injury, wound site bleeding and neurovascular impairment. Senior clinicians in the T&O department at the trust have raised concerns regarding documentation of post-operative day 1 checks in hemi/THR patients. Thus, offering no certainty to doctors reviewing patients at a later date that day 1 checks were carried out. Ultimately, raising the issue of patient safety.
Aim
The aim of this audit was to improve documentation of post-operative Day 1 checks in hemi/THR patients.
Method
Medical notes of those who underwent either a hemi/THR were reviewed. They were appraised on day 1 post-operative documentation of review of xray, acknowledgment of bloods results, dressing and NV status checks. Two PDSA cycles were carried out between September – November 2022. Interventions included: a) raising awareness on the junior doctor WhatsApp group; b) educating junior doctors via teaching sessions.
Results
40 medical notes were reviewed during each cycle. Results showed a clear improvement in quality of documentation. Pre-intervention (cycle 1): X-ray (37.5%), bloods (25%), dressing (52.5%), NV status (47.5%). Post-intervention (cycle 2): X-ray (71.5%), bloods (75%), dressing (72.5%), NV status (77.5%).
Conclusions
The relatively simple interventions have been found to have an improvement in documentation of post-operative day 1 checks in hemi/THR patients. Further recommendations include: raising awareness during induction and posters on the ward to prompt junior doctors to complete these checks.