385 Neurovascular Status Documentation in Fracture Manipulation
S Hashim, I Wilkes, N Sivanadarajah- Surgery
Abstract
Aim
To improve standards of documentation of neurovascular status before and following manipulation in keeping with standards set by the British Orthopaedic Association (BOAST guidelines: Peripheral Nerve Injury1).
Method
At a major trauma centre, we retrospectively collected data on thirty orthopaedic patients who underwent fracture manipulation in October 2022. Data included documentation of sensory, motor and vascular neurovascular status, prior and following manipulation. Posters were displayed in the emergency and orthopaedic departments on adequate neurovascular documentation, and an autotext proposed to aid senior house officers with electronic documentation. Prospective data was then collected on the subsequent thirty patients.
Results
Prior to manipulation, sensory neurological status was documented in 40% of patients and motor neurological status in 43.3% in patients. Post-manipulation documentation was 10% and 13.3% respectively. Documentation of vascular status prior to and post-manipulation was 40% and 16.7%. Following our intervention, pre-manipulation documentation of sensory and motor neurological status was 60% and 63.3%; post-manipulation was 20% and 13.3%. Documentation of vascular status prior and post-manipulation was 70% and 20%.
Conclusions
Following our intervention, there was an improvement in documentation of both sensory and motor neurological status prior to manipulation, however there was no change in motor status post-manipulation. The intervention used may not provide a sustainable improvement in documentation. Use of a designed electronic form, which can be accessed easily for electronic documentation, may improve results further.