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Do we have too many instruments on our surgical trays? A prospective audit of septoplasty trays in a DGH
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Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
of specific TAB clinics, further training of staff and direct appointment booking by nursing staff. http://dx.doi.org/10.1016/j.bjoms.2015.08.010 P3 Safety of radiologically inserted gastrostomy for head & neck cancer patients in a District General Hospital setting – a pilot study S. Bhopal ∗ , K. McBride, J. Morrison Queen Margaret Hospital, NHS Fife, United Kingdom Study design: Retrospective review. Aim: The objective of this pilot study is to evaluate the safety of radiologically inserted gastrostomy (RIG) for head and neck cancer patients in a district general hospital (DGH) setting. Background: Gastrostomy feeding is an effective method of long term feeding in patients with head and neck cancer. There are currently no guidelines for the most appropriate gastrostomy or optimal timing of placement. An increasing number of tubes are being placed prophylactically following multidisciplinary Head & Neck team decision. Fife head and neck cancer patients undergo surgery, chemotherapy and radiotherapy at tertiary centres in Lothian. Prophylactic RIG placement is carried out at a secondary district general hospital where the specialist service is available. Method: A retrospective review was performed of 83 head and neck cancer patients undergoing RIG insertion from January 2011 to December 2014. Results: No patients experienced any major complications. One patient had acute disproportionate pain post operatively requiring prolonged analgesia. Four patients had peritubal cellulitis treated with local wound hygiene measures. Conclusion: RIG insertion is a safe method in head and neck cancer patients in a DGH setting. Additional advantages include ease of scheduling of these patients within a local treatment centre. http://dx.doi.org/10.1016/j.bjoms.2015.08.011 P4 Do we have too many instruments on our surgical trays? A prospective audit of septoplasty trays in a DGH D. Broderick ∗ , M. Motamed, E. Gossnel Fairfield Hospital Bury, United Kingdom Introduction: Clinical efficiency has a direct impact on cost of implementing a surgical service. One way of improving efficiency and decreasing the cost of providing a service is to ensure that surgical trays have the minimum amount of instruments required.1 The aim of this audit was to quantify the percentage use of instruments in a standard septoplasty
tray for a septoplasty. Our standard is that 100% of instruments are used. Materials and methods: A prospective audit of all septoplasties performed, by various surgeons, over a 2 month period was carried out using a standardised proforma. The instruments used by the surgeon were recorded by the scrub nurse. The data was analysed to assess percentage utilisation as well as analysing if there was any correlation as to whether which instruments were never used. Results: 20 septoplasty procedures were included. Each tray contains 42 instruments. A range of 7–12 instruments were utilised for all 20 procedures. An average of 9.6 instruments were used. Of the 42, 29 instruments were not used by any surgeon. Conclusion: This audit suggests that there is significant under utilisation of instruments within a septoplasty tray. We aim to revise the trays and reaudit our practice. With >250 septoplasties performed annually in our department, there is a significant potential cost saving. We aim to extrapolate this audit to other trays both within and outside our specialty. This approach adopted nationally could lead to significant savings.
Reference 1. Protecting resources, promoting value, a doctors guide to cutting waste in clinical care. Academy of Medical Royal Colleges; 2014.
http://dx.doi.org/10.1016/j.bjoms.2015.08.012 P5 Ensuring maxillofacial paediatric anaesthetics are justified in the Royal Devon and Exeter Hospital M. Bundy ∗ , S. Esson, K. Richard, M. Esson Royal Devon & Exeter Hospital, United Kingdom Introduction: Advisors to commissioning bodies are concerned that general anaesthetic (GA) is being used too frequently when extracting premolar teeth for orthodontic reasons. The association of Paediatric Anaesthetists of Great Britain and Ireland has produced a care pathway for paediatric patients needing dental extractions under GA. This states that the decision rests with a clinician who is experienced in paediatric dentistry; a judgement which is guided by recommendations from the Royal College of Surgeons who delineate specific situations in which GA is justified. Our aim is to ensure that our service is acting in line with the above guidance and that our patients are protected against unnecessary GA’s. Method: A retrospective audit of all 369 elective day case general anaesthetic cases undertaken in 2014 for patients aged 0–18 years. Results: 75% of cases had a valid indication documented in the patient record. The most common indication was a
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
of specific TAB clinics, further training of staff and direct appointment booking by nursing staff. http://dx.doi.org/10.1016/j.bjoms.2015.08.010 P3 Safety of radiologically inserted gastrostomy for head & neck cancer patients in a District General Hospital setting – a pilot study S. Bhopal ∗ , K. McBride, J. Morrison Queen Margaret Hospital, NHS Fife, United Kingdom Study design: Retrospective review. Aim: The objective of this pilot study is to evaluate the safety of radiologically inserted gastrostomy (RIG) for head and neck cancer patients in a district general hospital (DGH) setting. Background: Gastrostomy feeding is an effective method of long term feeding in patients with head and neck cancer. There are currently no guidelines for the most appropriate gastrostomy or optimal timing of placement. An increasing number of tubes are being placed prophylactically following multidisciplinary Head & Neck team decision. Fife head and neck cancer patients undergo surgery, chemotherapy and radiotherapy at tertiary centres in Lothian. Prophylactic RIG placement is carried out at a secondary district general hospital where the specialist service is available. Method: A retrospective review was performed of 83 head and neck cancer patients undergoing RIG insertion from January 2011 to December 2014. Results: No patients experienced any major complications. One patient had acute disproportionate pain post operatively requiring prolonged analgesia. Four patients had peritubal cellulitis treated with local wound hygiene measures. Conclusion: RIG insertion is a safe method in head and neck cancer patients in a DGH setting. Additional advantages include ease of scheduling of these patients within a local treatment centre. http://dx.doi.org/10.1016/j.bjoms.2015.08.011 P4 Do we have too many instruments on our surgical trays? A prospective audit of septoplasty trays in a DGH D. Broderick ∗ , M. Motamed, E. Gossnel Fairfield Hospital Bury, United Kingdom Introduction: Clinical efficiency has a direct impact on cost of implementing a surgical service. One way of improving efficiency and decreasing the cost of providing a service is to ensure that surgical trays have the minimum amount of instruments required.1 The aim of this audit was to quantify the percentage use of instruments in a standard septoplasty
tray for a septoplasty. Our standard is that 100% of instruments are used. Materials and methods: A prospective audit of all septoplasties performed, by various surgeons, over a 2 month period was carried out using a standardised proforma. The instruments used by the surgeon were recorded by the scrub nurse. The data was analysed to assess percentage utilisation as well as analysing if there was any correlation as to whether which instruments were never used. Results: 20 septoplasty procedures were included. Each tray contains 42 instruments. A range of 7–12 instruments were utilised for all 20 procedures. An average of 9.6 instruments were used. Of the 42, 29 instruments were not used by any surgeon. Conclusion: This audit suggests that there is significant under utilisation of instruments within a septoplasty tray. We aim to revise the trays and reaudit our practice. With >250 septoplasties performed annually in our department, there is a significant potential cost saving. We aim to extrapolate this audit to other trays both within and outside our specialty. This approach adopted nationally could lead to significant savings.
Reference 1. Protecting resources, promoting value, a doctors guide to cutting waste in clinical care. Academy of Medical Royal Colleges; 2014.
http://dx.doi.org/10.1016/j.bjoms.2015.08.012 P5 Ensuring maxillofacial paediatric anaesthetics are justified in the Royal Devon and Exeter Hospital M. Bundy ∗ , S. Esson, K. Richard, M. Esson Royal Devon & Exeter Hospital, United Kingdom Introduction: Advisors to commissioning bodies are concerned that general anaesthetic (GA) is being used too frequently when extracting premolar teeth for orthodontic reasons. The association of Paediatric Anaesthetists of Great Britain and Ireland has produced a care pathway for paediatric patients needing dental extractions under GA. This states that the decision rests with a clinician who is experienced in paediatric dentistry; a judgement which is guided by recommendations from the Royal College of Surgeons who delineate specific situations in which GA is justified. Our aim is to ensure that our service is acting in line with the above guidance and that our patients are protected against unnecessary GA’s. Method: A retrospective audit of all 369 elective day case general anaesthetic cases undertaken in 2014 for patients aged 0–18 years. Results: 75% of cases had a valid indication documented in the patient record. The most common indication was a