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Total Knee Replacement Operation Notes Audit

Department adherence to BOA and BASK good clinical practice guidelines for total knee replacement operation notes

Results

References

1. British Orthopaedic Association and British Association for Surgery of the Knee. Knee Replacement: A Guide to Good Practice. London: BOA; 1999

2.The Royal College of Surgeons of England. Guidelines for Clinicians on Medical Records and Notes. London: RCSE; 1994

Background

British Orthopaedic Association (BOA) states that ‘good

records are a basic tool of clinical practice.’ (1)

Changes to Practice

RCS England states that medical records are ‘fundamental for clinical care and audit of surgical services.’ (2)

Increased awareness of the BOA and BASK good clinical guidelines on total knee replacements

Aim of Audit

To assess the adherence

Personal reflection amongst staff regarding their individual practice in accordance with the guidelines

of total knee replacement (TKR) operation

notes written at Altnagelvin Area Hospital to the BOA and British Association of Surgery of the Knee (BASK) guidelines 1

Await the introduction of a standardised TKR operation note template

Negative findings:

Recommendations

1. Education on best clinical guidelines may increase adherence

No operation note documented all 15 recommendations

Patients diagnosis not documented in 45%

Component alignment and rotation not documented in 70%

Post surgery flexion range not documented

Prosthesis / implant serial number not found in 1

Tourniquet time not documented in 4

Standards (1)

2. Checklist in orthopaedic theatre for reference

3. Standardised total knee replacement operation note template

Impact on Patients Care

4. Re-audit in 5 months

These recommendations are in place to:

1. Improve patient safety in the post-operative period

2. Aid with future research and the design of new operative strategies and prostheses

3. Contribute the appropriate information to

medico legal cases

  • Name of surgeon, assistant and responsible consultant
  • Diagnosis and procedure performed
  • Incision and additional procedures required to achieve adequate exposure
  • Findings
  • Soft tissue release procedures
  • Significant tissue excision, transposition or augmentation
  • Serial numbers of prosthesis and other implants
  • Bone grafting
  • Details of component alignment and rotation
  • Post-surgery flexion range
  • Tourniquet time
  • Sutures used
  • Difficulties / complications encountered and how they were overcome
  • Post op instructions
  • Surgeons signature and date of op

Methodology

5 month period (1st April - 31st August 2014)

Conclusion

41 patients identified as having TKR using Theatre Management System (TMS) under 4 different orthopaedic consultants (2:7:9:9)

Accurate operation note documentation impacts both patient and physician

14 patients notes unavailable, 27 patients notes obtained

Identified poor adherence to nationally accepted guidelines

Audit proforma was designed using Microsoft Excel as per the recommendations included in the BOA and BASK guidelines

Await implementation of standardised operation note template

Each operation note assessed for inclusion of

each recommendation

Re-audit aiming for 100% accuracy

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