Use and wear of anti-embolism stockings: a clinical audit of surgical patients

Abstract Aims Management of perianal abscesses continues to revolve around prompt surgical drainage. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines state that all patients should have incision and drainage within 24 hours and antibiotics are not indicated in routine uncomplicated perianal abscesses. We aimed to study the antibiotics prescription after surgical drainage in a London university teaching hospital against the national standard. Methods A single-centred retrospective analysis of all emergency surgical admissions for incision and drainage of perianal abscess was carried out for a 6 month period. Patients’ demographics, Co-morbidities, local and systemic complications and readmissions were studied. Results A total of 36 patients, (mean age 43, 64% males) were included in this study, 21 received incision and drainage without antibiotics prescription, while 15 received empirical post-operative antibiotics. Indications for antibiotic therapy in this group included diabetes, immunocompromise, local complications (necrosis, cellulitis) and recurrence. There was no clear indication for antibiotics in 60% of patients who received them. 86% of patients had surgical drainage within 24 hours of presentation. One patient was readmitted for a second drainage 3 months later. Most common empirical agent used was co-amoxiclav (53%), followed by (33%) combination of co-amoxiclav and metronidazole. Conclusion Although surgical drainage was generally carried out in timely manner according to guidance, there was excessive post-operative antibiotic prescriptions. Increase awareness of guidelines is required to improve antibiotic stewardship in these surgical patients in order to avoid unnecessary drugs’ prescription.

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EP.WE.617A clinical audit analysing the completion of junior clerking at the Surgical Admissions Unit at an acute District General Hospital, as impacted by short-staffing due to CoViD-19

British Journal of Surgery ◽

10.1093/bjs/znab308.076 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Riya Sawhney ◽

Enora Seite ◽

Artemis Fedder

Keyword(s):

Thematic Analysis ◽

Clinical Audit ◽

District General Hospital ◽

Surgical Patients ◽

Free Text ◽

Major Theme ◽

Teaching Session ◽

Review Section ◽

The Impact

Abstract Aims The quality of junior clerking is essential to patient safety and care; it provides information vital to the management of surgical patients. This audit aimed to evaluate the completion of the General Admission Document (GAD) on the Surgical Admissions Unit to identify the impact of staff absences secondary to CoViD-19. Methods Admissions to the unit over a 5-day period (n = 92) were evaluated against a checklist of the 26 items included on the GAD utilised by the trust, and daily handover sheets were used to identify staff absences. Mean completion was measured alongside thematic analysis of free-text remarks. Results Handover sheets identified staff absences on 3 days. The overall mean completion of the GAD was 50.88% (95%CI: 46.65, 55.11, p < 0.05). This was not significantly (p = 0.074) impacted by staffing; mean completion was 48.47% (95%CI: 42.75, 54.20, p < 0.05) on days with junior doctor absences, and 54.98% (95%CI: 49.14, 60.82, p < 0.05) without. The major theme identified was deferring to the ‘senior review’ section of the GAD, suggesting a lack of awareness among juniors regarding the importance of a full junior clerking. Conclusions Staff shortages secondary to CoViD-19 absences did not significantly impact the quality of junior clerking. However, the baseline completion of the GAD was noted to be poor regardless. Therefore, a teaching session during induction of the next cohort of doctors could be a sensible intervention to reiterate the importance of a full clerking.

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Improving the Healthcare of People with Learning Disabilities: Clinical Audit Project Examples. Kirsty MacLean Steel & Claire Palmer. Gaskell Publications Department, Royal College of Psychiatrists, London. 1999 45 pp., f12.50 (pbk). ISBN 19012242 40 4.

Journal of Intellectual Disability Research ◽

10.1046/j.1365-2788.2000.0309b.x ◽

2000 ◽

Vol 44 (6) ◽

pp. 700-701

Author(s):

David Brooks

Keyword(s):

Learning Disabilities ◽

Royal College ◽

Clinical Audit ◽

Audit Project

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Long-Term Follow-Up of Surgical Patients Extolled

Skin & Allergy News ◽

10.1016/s0037-6337(06)71614-x ◽

2006 ◽

Vol 37 (10) ◽

pp. 52

Author(s):

KAREN DENTE

Keyword(s):

Surgical Patients ◽

Long Term Follow Up

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Abstract #1226: E-Glycemic Management System Safely Maintains Glycemic Targets with a Low Incidence of Hypoglycemia for Nondiabetic Cv Surgical Patients in the Inpatient Setting

Endocrine Practice ◽

10.1016/s1530-891x(20)42455-3 ◽

2015 ◽

Vol 21 ◽

pp. 287-288

Author(s):

Joseph Aloi ◽

Paul Chidester ◽

Jagdeesh Ullal ◽

Amy Henderson ◽

Robby Booth ◽

...

Keyword(s):

Management System ◽

Surgical Patients ◽

Inpatient Setting ◽

Low Incidence ◽

Glycemic Targets ◽

Glycemic Management

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Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽

10.1024/0301-1526/a000082 ◽

2011 ◽

Vol 40 (2) ◽

pp. 123-130

Author(s):

Klein-Weigel ◽

Richter ◽

Arendt ◽

Gerdsen ◽

Härtwig ◽

...

Keyword(s):

Renal Function ◽

High Risk ◽

Quality Management ◽

High Risk Group ◽

Surgical Patients ◽

Medical Patients ◽

Risk Status ◽

Vte Prophylaxis ◽

Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and hot spots quality management-audits proved to be valuable instruments.

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