Abstract

Open fractures constitute serious injuries which range from small puncture wounds trauma to high energy traumatic injuries. The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons have established evidence-based instructions for the assessment and management of open fractures in the pre-hospital and hospital setting. BOAST 4 (British Orthopaedic Association Standards for Trauma 4) guidelines have introduced nineteen instructions which are aiming to address the problems that arise in the management of open fractures. Additionally, these guidelines provide detailed guidance to the clinicians regarding the decision-making process and raise awareness for the most common complications in order to enhance patients’ care and safety.

This article aims to review the evidence of BOAST 4 guidelines and suggest modifications based on the current literature.

Keywords:open fracture, BOAST guidelines, management, literature review

Audit of weekend handover note in GI surgical patients

Introduction:

Handovers are an essential part of daily medical practice in the United Kingdom. It is a process that must have appropriate planning and management to anticipate, recognize, and prevent deterioration in patients' clinical conditions.

 This clinical audit aimed to assess and improve the weekend handover documentation and communication within GI surgical units with 100% compliance with Guidance from the Royal College of Surgeons.

Methods:

40 patients were reviewed over two consecutive Fridays before the weekend ward rounds as follows :

 1) Creation of a checklist to record the presence of different criteria during the ward round before each weekend. 

2) Patients under GIT units were included, and cases under the Emergency Surgery unit were excluded.

3) 20 patients were included on each Friday with 40 patients in total. 

Results:

Overall, compliance with the RCS guidelines was excellent, and the standard criteria' presence was 95% - 100%. However, there needs to be increased compliance with appropriate documentation of antibiotic and nutritional requirements.

Conclusions

GI weekend handover processes remain safe and effective; however, there is a need for improvement in different areas. Particularly with the documentation regarding antibiotic stewardship and patient's tailored nutritional requirements. A new weekend hand over template has been designed.