TP9.1.2We must do better - An audit assessing local compliance with NICE Guidelines (2014) on giving patient discharge advice regarding driving following traumatic brain injury

Introduction Driving is a complex activity involving the coordination of a number of cognitive and physical skills, which may be impaired after head injury. It is a legal requirement that patients’ inform the licensing authority when they have sustained a head injury. Failure to do so results in possible fines, invalid insurance and prosecution. NICE recommends printed patient advice about driving once discharged following a head injury. Methods A retrospective analysis of all traumatic brain injury admissions under the surgical team over a 6 months was performed. The aim was to identify current practice regarding assisting patients to return to safe driving after head injury. Information related to patient demographics, documented driving status and advice (verbal and written) related to driving, was sought. Descriptive statistics were used to portray the results. Results 56 patients were admitted following a traumatic head injury. The average age was 77 (range of 24 to 94) Patients spent on average 4 days in hospital. Only 2 patients had their driving status documented. These two patients also had a documented occupation dependent on driving. No patients received advice specific to DVLA guidelines. Conclusion This study demonstrates that there is poor compliance with NICE guidelines. Indeed, there is a need for change in our practice. We have a duty of care for our patients and in ensuring the safety of the general public. The main limitation of this study relates to the adequacy of documentation. We provide solutions in order to tackle the findings of this audit.

636 Optimising Operative Capacity for Hand Trauma - An audit

Aim Assess compliance with departmental and BSSH guidelines for hand trauma. Optimise operative capacity within the department. Promote minor ops experience among the junior doctors. Method Retrospective review of the overbooked patients seen in the Hand trauma Unit (HTU) in August 2020 using the eTrauma system and time to operation using the Lorenzo patient record system. Results Overall Local Compliance rates Overall BSSH Compliance rates Main area of non-compliance was waiting time for tendon operations, with a 30% breech rate (>5 days waiting time). Conclusions Interventions before re-audit: On call junior doctor to be based in HTU for the whole day- will allow for minor procedures (nail beds and skin lacerations) to be done at bedside. The above will free up capacity in the minor ops theatre for tendons.

Natural vibrations of nanostrips with cracks

Employing the main equations of the theory of plates accounting for the rotational inertia the transverse vibrations of nanobeams and nanostrips are investigated. The nano strips under consideration have piecewise constant dimensions of cross sections. The nanosheets are weakened by cracks at re-entrant corners of steps. While the material behavior corresponds to the Eringen’s nonlocal theory of elasticity it is assumed that the cracks produce additional local compliance, which can be evaluated with the aid of the stress intensity factor at the cracktip. A numerical algorithm for determination of natural frequencies of nanosheets is developed.

Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)

AimsConstipation in patients on Clozapine is the biggest cause of mortality. We have no set protocol in LPT for how to manage and monitor Constipation in Clozapine initiation in the inpatient setting. Internationally protocols, (such as the Porirua protocol) exist but have not been widely used locally.We wanted to assess local compliance with monitoring constipation in patients admitted to hospital and started on Clozapine. We also wanted to assess whether patients are prescribed PRN or regular laxatives, before considering implementing a local protocol.MethodIn LPT we use the ZTAS system for prescribing Clozapine. They provided us with a list of patient IDs who had recently started on Clozapine.We captured data on patients started on Clozapine. 1.What date was this started?2.What date was either PRN or regular laxatives started?3.Was a bowel chart recorded?4.Any evidence of constipation or significant bowel issues relating to Clozapine?ResultWe initially analysed 30 patients, (20 of whom were initiated on Clozapine as inpatients, and 10 as outpatients). A bowel chart was started in only 1 inpatient. Laxatives were started in 50% (15, only 3 of whom were outpatients). 14 were regular and 1 was a PRN prescription. 12 inpatients had constipation, and 1 outpatient suffered with constipation. 2 patients suffered with diarrhoea but there were no other significant issues with bowel problems.ConclusionFrom our initial data we can see that there are many inconsistencies in practice.Existing patients on Clozapine attend a local clinic, (Clozapine clinic) where ongoing monitoring of constipation, (and other parameters, e.g. ECGs etc are completed).We have written a new protocol which we will share, that the trust has implemented, that identifies when PRN and regular laxatives should be prescribed. We have also expanded the protocol to agree for initiation of Olanzapine bowel charts and PRN laxatives should be used.

Oppurtunistic completion of the 9 diabetic care processes during inpatient admission to a mental health hospital: an audit of local practice

AimsDiabetes is more prevalent in people with mental illness than in the general population. Those with both mental illness and diabetes are more likely to have poor glycaemic control. Clients with mental illness and diabetes are less likely to receive the 9 NICE recommended annual diabetic care processes than the general population. In 2017, the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) and the Royal College of Psychiatrists released guidance recommending that inpatient psychiatric admissions should be used as an opportunity to complete diabetic care processes, and a named staff member should be responsible for this.We aimed to review local compliance with this JBDS-IP guidance, increase knowledge and improve local care for clients living with both mental illness and diabetes.MethodWe reviewed the notes of all current inpatients to general, forensic or learning disability wards at our centre and identified all patients with a known diagnosis of Diabetes. We identified which of the 9 care processes had been completed (or had the most recent result documented, or had a plan made for completion) during this admission. We identified if a named staff member was responsible for completing processes on each ward, and whether the care processes were documented in the patients’ notes.ResultWe identified 18 current diabetic inpatients at our centre (14% of inpatients). We found that none of these patients had a diabetic care processes review documented and none of these patients had had a foot check and urinary albumin performed during admission, or had the last community result identified and documented. We found that less than 15% of patients had a documented plan concerning the completion of retinal screening. One ward had a named staff member responsible for reviewing their diabetic patients’ screening. However, 6/9 care processes had been completed in the significant majority of patients (>75%).ConclusionOur centre is not compliant with the guideline audited. We have implemented a plan to increase awareness of care processes through posters, teaching (at junior and consultant level), creating documentation templates and ensuring wards nominate a staff member to review care processes. We have organised a re-audit. Organising foot examination, renal function testing and retinal screening during admission for clients who may have complicated social situations and may not be aware of (or be non adherent with) the long term management of their diabetes has the potential to significantly reduce morbidity in this client subgroup.

106 A Retrospective Study Comparing Histopathology Proformas For Anterior Resections Against the Royal College of Pathology (RCPath) Guidelines

Introduction Royal College of Pathologists (RCPath) published guidance on clinical information needed on histopathology forms accompanying colorectal cancer specimens. Inadequate information can significantly impact the ability of histopathologists to accurately interpret specimens; in turn correctly diagnose and stage cancers. The primary aim of our audit was to evaluate local compliance with the RCPath guidelines. Method Histopathology request forms of 50 patients undergoing anterior resections between January 2018-19 were retrospectively evaluated against the RCPath guidelines, ‘Standards and datasets for reporting cancers’ published in December 2017. Results Of the 50 patients, the site and type of tumour resection were documented in 94% and 56% of cases, respectively. 48% of cases specified whether the surgery was open or laparoscopic. However only 4% mentioned the preoperative tumour stage, and only 10% recorded whether any pre-operative therapy had been given. Furthermore, no cases reported whether there was a family history of bowel cancer or inflammatory bowel disease. Conclusions Information on colorectal histopathology forms is failing to meet RCPath guidelines. Significant information regarding preoperative treatment, associated malignancy risk factors and resection type is absent in over half of cases. This will have detrimental effects on the ability of histopathologists to accurately assess and interpret cancer specimens.

Fatigue Damage Monitoring of CFRP Elements by Thermographic Procedure under Bending Loads

For structural health of mechanical structures, non-destructive detection and material defect characterization represent the main useful tools for mechanical decay prediction caused by local composite damage phenomena. In this work, internal delamination due to alternate bending were characterized in flat specimens, performing fatigue and static tests, coupled with thermographic, optical, and ultrasonic analysis for damage detection and evolution purposes. Damage to rupture behavior of CFRP material through mechanical tensile tests is performed on several samples and non-destructive inspection procedures are optimized during successive HCF tests to detect in real time local compliance variations and damage initiation. Thermographic continuous monitoring and occasional ultrasonic analysis are implemented to analyze composite anomalies during fatigue life and to elaborate a procedure for identification of delamination induced damage before failure. IRT and UT results are computed with MATLAB analysis for damage evaluation with strain and compliance data acquired during tests.

Free vibration of rectangular nanoplate strips

Natural vibrations of nanobeams and nanosheets are investigated with the help of nonlocal theories of elasticity. The vibration analysis is based on the size-dependent non-local theory of elasticity developed by A. C. Eringen. It is assumed that the nano-structures under consideration have rectangular cross sections with piece wise constant dimensions and that the nanoplates are weakened with defects. The influence of the crack on the vibration of the nanoplate is assessed with the aid of additional local compliance developed in previous papers. Numerical results are presented for one- and two-stepped nanoplates.