Amro Ghoraba
ST1 Trauma and Orthopaedics, MRCS, United KingdomPresentation Title:
Closed loop audit: Perioperative medications for elderly hip fractures
Abstract
Objectives: Hip fractures are the most common cause for admission to an acute orthopaedics ward in the UK, and typically affect elderly with comorbidities. Our Trust has recently updated on the guidelines regarding perioperative medications prescribed on admission for elderly patients with hip fractures as a crucial step to avoid post-op complications, enhance recovery, shorter hospital stays. Despite its importance and presence, our knowledge and adherence to these guidelines as junior doctors has not been up to standard. We have done a surgically themed audit with two closed loops to evaluate our local practice to our latest local trust (NBT) guidelines (updated 2022) in prescribing correct medications and dosage for elderly patients admitted with hip fractures. Key elements of the perioperative optimization of patients following admission with a hip fracture include effective analgesia, laxatives, antiemetics, and nutrition.
Methods:
Design: retrospective data collection of patients health records
39 patients (1st cycle), 31 patients (2nd cycle)
1st cycle time period: from 01/06/2022 to 31/07/2022.
2nd cycle time period: from 01/01/2022 to 31/10/2022
Results:
Surprisingly, in the first cycle 30-40 % of patients did not have either regular laxatives, antiemetic, preoperative drinks, or regular nutrition. Our second loop included 31 patients with two months in between in which we conducted regular teaching sessions and posters. Interestingly, results of re-auditing showed a significant improvement in prescribing for all medications. Electronic prescription has been applied now in the trust.
Conclusions:
Our unbiased audit highlights a very crucial and common issue not only at our trust but also at all trusts across the NHS. Hence, if not addressed properly it will have a high burden of morbidity and mortality as well as significant financial cost. It is also important to discuss causes of these issues and possible solutions.
Biography
I have completed my MMBS in 2019. I have worked in the UK for over 2 years in Trauma and Orthoapedics including 8 months in a major trauma center. I have completed my MRCS in October 2023. I have completed my core surgical competencies in the UK. I am in the process now of applying to Trauma and Orthoapedics registrar jobs. I have attended multiple courses such as ATLS, BSS, BOA casting courses.On an academic level, I have done total of six ortho audits and QIPS across different hospitals that I have worked in. I have also been involved in 2020 in 2 research projects about COVID.I presented multicentric study and won 1st prize at the Fred Heatley meeting in 2023.I am passionate about teaching. I was able to organise teaching program to medical students.I was responsible for organising and delivering regular journal club meetings to the department. I am in the process of completing PG certificate on surgical education.
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