Title : Audit of documentation of skin Integrity at ankle fracture site as per BOAST guidelines
Abstract:
Background: Early recognition of open ankle fractures is crucial for patient outcomes. Documenting skin integrity is vital in managing these fractures, as per the BOAST 2016 ankle fracture guidelines. Several open ankle fractures were missed at our hospital, prompting an audit on documentation rates.
Methods: The audit was conducted at Bristol Royal Infirmary (BRI), United Kingdom. Patients recognised to have open ankle fractures are immediately transferred from the BRI to the neighbouring orthoplastic centre for definitive treatment. Clerking notes from the BRI Emergency Department (ED) were analysed over two months in 2023 to record documentation rates of skin integrity. Awareness was raised through posters in the ED and Trauma and Orthopaedic (T&O) departments, local meetings, and a quiz on open fractures with a prize. Documentation rates were reassessed two months post-intervention.
Results: Pre-intervention, 46 patient notes from November-December 2023 were reviewed; 26.1% (12/46) lacked documentation of skin integrity. Fifteen clinicians took the intervention quiz, averaging scores of 68% ± 18%. They excelled in questions defining open fractures (100%) and clerking scenarios (85% ± 10.2%), but were poor in classifying open fractures using the Gustilo-Anderson classification (43% ± 7.3). Post-intervention, 45 patients were identified from April-May 2024; 21.1% (8/45) lacked documentation of skin integrity, showing a 5% improvement, though not statistically significant (X-squared = 0.21, df = 1, p = 0.65).
Conclusions: Before the intervention, 26.1% of ankle fracture clerkings did not meet BOAST guidelines for documenting skin integrity, potentially contributing to missed open fractures. Postintervention, documentation improved by 5%, though not statistically significant. Limitations, such as rotating staff, may have affected results. Adding a “tick box” for documenting skin integrity into the clerking proforma is recommended to improve compliance with BOAST guidelines and patient outcomes. BOAST 2016 “The Management of Open Ankle Fractures”
Audience Take Away Notes:
• Attendees will understand the critical role of documenting skin integrity in managing open ankle fractures, ensuring they do not miss crucial information that could impact patient outcomes
• Participants will learn effective strategies for raising awareness about the importance of documentation through posters, meetings, and interactive quizzes
• The process of conducting an audit and providing feedback is a valuable skill for continuous improvement in clinical practice
• The statistical approach used to measure the impact of interventions provides a model for evaluating other quality improvement initiatives
• The recommendation to add a tick box for documenting skin integrity on clerking proformas offers a practical solution to enhance compliance with guidelines
