100 Assessing the Admission Proforma: A Multi-Cycle Audit Evaluating the Quality of Documentation of The Burnsadmission Proforma At the Regional Mersey Burn Unit

Introduction

A thoroughly completed Burns Proforma can provide vital information for the effective management of a burn and enables the sharing of information with other members of the multidisciplinary team.

Aim

We aimed to assess the quality of record-keeping of the new Burns Proforma, compared it with the previous cycle, and identified areas of improvement.

Method

Data on 76 fields on version 4.0 of the Mersey Burns Proforma was collected for 92 patients between January and February 2020. The data was compared to cycle 1of the audit collected in July 2019.

Results

Assessing the 61 comparable fields between audit cycles, 58 fields (95%) improved while 3 (5%) deteriorated. 21 fields achieved a completion rate greater than 80%. Vital information such as history, comorbidities, and drug history achieved 100% completion, up from 94%, 94%, and 95%, respectively. Total body surface area (TBSA) increased to 93% from 83%, the use of the Lund & Browder chart remained the same, treatment plan documentation increased to 95% from 91%, documentation of admission increased from 24% to 51%, consultant confirmation of TBSA increased to 10% from 5%, but this requires further improvement. Comments stated the proforma was clearer and provided a flowchart layout which made documentation easier.

Conclusions

The Burns Admission Proforma has made significant improvements. Working with the nursing staff and consultant body, we aim to improve our completion rates of vital information further. It sets a high standard for data collection and presents itself as a useful tool for other Burns Units across the United Kingdom.

99 Perfecting the Proforma – A Full-Cycle Audit on The Quality of Documentation of The Hand Trauma Proforma At the Regional Plastic Surgery Department

Aim

We aimed to assess the quality of record-keeping of the departments hand trauma proforma, identify areas of improvement, and to implement and assess the quality of an updated proforma.

Method

Data from 101 parameters was collected for 20 patients undergoing surgery for an upper limb injury in November 2019. An updated proforma was implemented and a further 20 patients were analysed in February 2020. All fields were compared between two audit cycles and comments were collected.

Results

The overall completion rate increased. Documentation of the responsible consultant increased to 100%, along with an increase in documenting of hobbies and injury mechanism. X-ray findings (55% to 85%) and antibiotic plan (35% to 80%) increased. Implementation of a free text box resulted in written descriptions of injury to compliment sketches. In the operation note, documentation of anaesthetic type used increased, along with tourniquet use and time. There was clearer documentation of the injury, findings, and procedure, with greater use of diagrams to illustrate the repair. There was a drop in the recording of post-op plans (100% to 85%), post-op antibiotics (90% to 75%), and follow-up plan (95% to 60%). Clinicians commented to increase the size of the free-text box and hand diagram on the operative page to facilitate easier drawings.

Conclusions

The Hand Trauma Proforma has made good progress from its original version but requires further adjustments to ensure complete data input. It sets a high standard for data collection and presents itself as a useful tool for units across the United Kingdom.

1541 Treating Patients with Respect: Assessing the Completion Rate of The ReSPECT Form for Patients Admitted to Hospital

Aim

To assess the current completion rate of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form, and to identify ways to improve the completion rate for all inpatients under our care.

Method

All notes of admitted patients were reviewed for a completed ReSPECT form over a two-week period. Data was collected on whether a form had been completed and its respective fields. This was repeated in three cycles, introducing interventions between each cycle – trainee education and reminders were sent through our WhatsApp messenger group between cycles 1 and 2, and posters implemented between cycles 2 and 3.

Results

For cycle 1, out of 40 patient notes, 9 (22.5%) had a completed ReSPECT form. This increased to 25 out of 57 patients (43.9%) for cycle 2. Cycle 3 found 1 out of 16 patients (6.7%) had a completed ReSPECT form.

Conclusions

Our data demonstrated a significant deterioration in our compliance as a department. This could be due to a number of factors ranging from the coronavirus pandemic and staff redeployment to increased workloads, higher patient turnover, and new staff. In any outcome, the poster has proven to be ineffective. Whilst we identified that reminders via electronic message appear to have had an improvement, this has shown to be temporary, and may not be effective in busier times. As such, this audit has revealed a significant need for departmental change and to develop new strategies to improve compliance.

101 Paediatric Burns and The Coronavirus Pandemic: Were Children Staying Safe in Lockdown or Did The Virus Increase Burns Admissions?

Aim

We aimed to identify if there was a change in the number of paediatric burns during the coronavirus pandemic and whether there was a change in the management of said burns.

Method

Data on ten parameters for all burns assessed on the Burns Unit at Alder Hey Children’s Hospital from April to May of 2020 was collected and compared to the same period from 2019.

Results

There was a decrease in the number of patients presenting to hospital, down to 24 from 32 in 2019. Scald injuries increased to 67% compared to 44%, while all other mechanisms of injuries decreased. Fewer very small burns (<1% TBSA) presented to hospital (28%) compared to 50% the previous year. There was an overall increase in the presentation of burns greater than 1% TBSA (1-5% TBSA increased to 47% from 31%; 5-10% TBSA increased to 19% from 3%; 10-20% TBSA increased to 6% from 3%). A comparable rate of burns was managed conservatively as an outpatient (89% vs 88%), admitted for dressing changes (81% vs 78%), and managed surgically (11% vs 13%).

Conclusions

The coronavirus pandemic resulted in a decrease in the number of children experiencing burns, while at the same time causing an increase in the number of scald injuries. Our data showed no significant change in the management of burns indicating that regardless of the pandemic, paediatric burns were managed appropriately as per national guidelines.