1405 Improving Documentation of Per Rectal (PR) Exams in An Acute Surgical Unit

Abstract Aim A PR exam is routinely performed as part of the complete examination of surgical patients. The General Medical Council (GMC) has provided guidance on the use of chaperone during intimate exams stating that consent should be obtained, and a chaperone offered to all patients and documented accordingly. We aimed to assess and improve our documentation of PR exams. Method Data was collected prospectively from surgical admission documentation. The number of patients with consent and presence of chaperone documented during PR exam was recorded. Following a period of data collection, a proforma was implemented with education on correct documentation as per guidelines. A second audit cycle was performed where formal inclusion of the sticker in the admission booklet was implemented. Results 20 patients were included in the initial data collection, 95% of which had incomplete documentation of PR exam on admission. A sticker was designed to prompt accurate documentation and inserted into the acute admissions booklet. Following this, 50% of PR exams were correctly documented. The remaining 50% without documentation had no sticker in the admission booklet. The second intervention included changing the hardcopy of the admission booklet. Following this, 80% of patients had consent documented and 90% had documented chaperone. Conclusions GMC guidelines state that documentation of consent and the presence of chaperones during intimate medical examinations are crucial. The implementation of a prompt in our admissions booklet has greatly improved our documentation in PR examination.

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An audit cycle of consent form completion: A useful tool to improve junior doctor training

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.182246 ◽

2016 ◽

Vol 49 (01) ◽

pp. 72-75 ◽

Cited By ~ 1

Author(s):

Catherine Leng ◽

Kavita Sharma

Keyword(s):

Junior Doctor ◽

General Medical Council ◽

Consent Form ◽

Junior Doctors ◽

Medical Council ◽

Emergency Setting ◽

Consent Forms ◽

Surgical Practice ◽

Audit Cycle ◽

Practice Methods

ABSTRACT Background: Consent for surgical procedures is an essential part of the patient's pathway. Junior doctors are often expected to do this, especially in the emergency setting. As a result, the aim of our audit was to assess our practice in consenting and institute changes within our department to maintain best medical practice. Methods: An audit of consent form completion was conducted in March 2013. Standards were taken from Good Surgical Practice (2008) and General Medical Council guidelines. Inclusion of consent teaching at a formal consultant delivered orientation programme was then instituted. A re-audit was completed to reassess compliance. Results: Thirty-seven consent forms were analysed. The re-audit demonstrated an improvement in documentation of benefits (91–100%) and additional procedures (0–7.5%). Additional areas for improvement such as offering a copy of the consent form to the patient and confirmation of consent if a delay occurred between consenting and the procedure were identified. Conclusion: The re-audit demonstrated an improvement in the consent process. It also identified new areas of emphasis that were addressed in formal teaching sessions. The audit cycle can be a useful tool in monitoring, assessing and improving clinical practice to ensure the provision of best patient care.

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SP10.1.2 Increased Access to Computed Tomography Reduces Acute Surgical Admissions: Lessons Learnt During the COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab361.175 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

S Davidson ◽

L Cornett ◽

K McElvanna

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Ct Scan ◽

Surgical Patients ◽

Lessons Learnt ◽

Retrospective Audit ◽

Time Period ◽

Number Of Patients ◽

Scan Data ◽

Surgical Admission

Abstract Aim With increased bed pressures due to COVID-19, keeping patients out of hospital became critical. Computed Tomography (CT) utilisation was increased to aid in the assessment of acute surgical patients. The aim of this study was to assess if increased access to CT reduced inpatient admissions. Methods A Retrospective audit of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required a CT scan. Data collected from Electronic Care Records and NIPACS, including patient destination at time of CT and decision following CT. For comparison, the same time-period in 2019 was assessed. Results In 2020, 301 patients required a CT compared to 207 in 2019. 84.7% (255/301) had a CT direct from ED in 2020 vs. 56.5% (117/207) in 2019 (p < 0.001). Of those who had CT direct from ED in 2020 18.4% (47/255) were discharged, compared to 1.7% (2/117) in 2019 (p < 0.001). 9.8% (25/255) were directed to an alternative specialty in 2020 vs. 2.6% (3/117) in 2019 (p = 0.014). 2.7% (8/301) were discharged for an ambulatory CT in 2020, an increase from 0.5% (1/207) in 2019 (p = 0.07). Overall, there was a 24% reduction in the number of patients requiring acute surgical admission in 2020 vs. 2019. Conclusions There was a significant increase in the number of CT’s carried out directly from ED. This enabled a significant number of patients to be discharged or transferred to a more appropriate specialty. These results demonstrate that increased access to CT can reduce the need for acute surgical admission.

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Documentation of chaperone presence in breast clinic, a complete audit cycle

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02634-y ◽

2021 ◽

Author(s):

Aqeel Alameer ◽

Amira Mohammed ◽

Sami Abd Elwahab ◽

Michael Boland ◽

Amr Elfadul ◽

...

Keyword(s):

Response Rate ◽

Breast Surgery ◽

Beaumont Hospital ◽

General Medical Council ◽

Medical Council ◽

Prospective Audit ◽

Breast Clinic ◽

Male Doctor ◽

Audit Cycle ◽

Irish Medical

Abstract Objective The General Medical Council (GMC) and Irish Medical Council (IMC) recommend the presence of a chaperone for all intimate examinations and that it should be clearly documented. The aim of this report is to assess doctors’ compliance with obtaining a chaperone and documenting their presence, determining possible causes of non-compliance and implement interventions to increase compliance. Methods Prospective audit of patients seen in the breast clinic in Beaumont hospital over the week starting 8th February 2021. The medical charts were reviewed for documentation of chaperone presence. Doctors were surveyed using (SurveyMonkey) for causes of non-compliance. Interventions included a stamp in the medical notes for chaperone presence and details, an educational email with GMC and IMC guidelines, and posters put up in clinic rooms. The intervention was reassessed at 1-week and 6-week intervals. Results In the assessment phase, 126 patients were recruited. A chaperone was present 100% of the time where a male doctor examined a female patient; however, chaperone presence was not documented in any of the medical charts (0/126). A survey was sent to 22 breast surgery doctors to explore causes of non-compliance. Response rate was 95%, 50% did not know documentation was necessary, and 25% forgot to document. One week after intervention, 64 patients were recruited. Chaperone documentation increased to 80% (51/64). Reassessment at six weeks included 120 patients, and chaperone documentation rate was 74% (89/120).

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EP.TU.371The introduction of standardised ward round notes in the Acute Surgical Unit

British Journal of Surgery ◽

10.1093/bjs/znab311.048 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Jonathan Johns ◽

Atiqur Rahman ◽

Katherine Pearson ◽

Frances Howse ◽

David Berry

Keyword(s):

Data Collection ◽

Patient Care ◽

Improve Patient Care ◽

Ward Round ◽

Successful Implementation ◽

Repeated Analysis ◽

Audit Cycle ◽

Result Analysis ◽

Improve Patient ◽

Surgical Unit

Abstract Introduction A standardised approach to note-keeping has been shown to improve patient care and experience. Aims This repeated audit cycle assesses the compliance with the introduction of a standardised proforma. Method Data collection was prospective. Round 1 (n = 83) after introduction of a ward round proforma, Round 2 (n = 94) following result analysis / education, Round 3 (n = 62) following proforma changes. Results (% Compliance with proforma) Conclusions Some improvements were seen in Round 2. A notable improvement was observed in EDD and CFD when a tick box option was implemented in Round 3. Successful implementation of a standardised note-keeping requires repeated analysis, education and modification of the proforma.

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The Duties of Doctors In Medical Education: A Letter To The Editor (Preprint)

10.2196/preprints.16418 ◽

2019 ◽

Author(s):

Sneha Barai

Keyword(s):

Medical Education ◽

Medical Students ◽

Role Models ◽

Role Model ◽

General Medical Council ◽

Future Generations ◽

Medical Council ◽

Positive Role ◽

The Uk ◽

And Training

UNSTRUCTURED The UK General Medical Council (GMC) explicitly states doctors have a duty to ‘contribute to teaching and training…by acting as a positive role model’. However, recent studies suggest some are not fulfilling this, which is impacting medical students' experiences and attitudes during their training. As such, doctors have a duty to act as role models and teachers, as specified by the GMC, which it seems are not currently being fulfilled. This would improve the medical students’ learning experiences and demonstrate good professional values for them to emulate. Therefore, these duties should be as important as patient care, since this will influence future generations.

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