P27 Multi-team approach to applying a patient care bundle in decompensated cirrhosis improves outcomes. (28th September 2020)

• Record Type: Journal Article
• Authors: Farrag, Georgia; Maheswaran, Tina
• Is Part Of: Gut. Volume 69(2020)Supplement 1
• Page Start: A20
• Page End: A21
• Publication Date: 2020-09-28
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2020-BASL.38
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : At our DGH multiple audits have identified that there is poor compliance to an existing evidence based care bundle for patients with decompensated liver cirrhosis despite previous attempts to improve consistent use. Varying applicability of the bundle causes variation in the quality of care patients receive. Presence of the existing bundle in the format of a sticker within the patient's medical notes was audited along with application of the 6 main cirrhosis care bundle domains. Data was collected prior to and following intervention. A questionnaire was sent to junior medical staff to ascertain knowledge of the bundle and competency of performing paracentesis. Length of stay and 28 day mortality were used as patient outcome measures. It was shown that adherence to the cirrhosis care bundle was poor. No patients had all of the recommended investigations carried out and none of the patients with ascites had an attempt to perform a diagnostic paracentesis. When asked 74% of junior doctors reported not feeling confident to perform paracentesis unsupervised. 45% of junior doctors were unaware of the existence of the cirrhosis care bundle. 48% of survey responders were foundation doctors. The cirrhosis care bundle was redesigned into a printable format that can be accessed via the trust intranet because of concerns that the sticker might not always be available in clinical areas The layout of the bundle was altered to improve usability and tick boxes were added to encourage the user to consider and complete each step in the bundle. Doctors rotating between specialties and between trusts was also highlighted as an explanation of the high rates of unawareness of the bundle. It therefore became vital to target interventions to new cohorts of rotational staff and staff groups that are non-rotational. The decision was made to deliver teaching sessions as part of the foundation doctor induction. Teaching sessions were also delivered to nurses working in acute areas and to the medical consultants to embed the use of the bundle in the hospital and increase awareness amongst these permanent staff. Through reformatting an existing bundle, targeting education and considering other members of the multi-disciplinary team we were able to improve the consistency of care for patients presenting with decompensated liver cirrhosis long term. Improving frequency of use of the decompensated cirrhosis bundle ensured consistently high levels of care for patients and improved outcomes.