Personal Audits (from 2007)

  1. Neuromuscular Monitoring Audit. 2016. Showed that the use of qualitative monitoring appears better than was expected. Nerve stimulators are not used from induction. There has been a change in practice regarding choice of relaxant. There is a high use of sugammadex. Quantitative monitoring makes a significant difference to the final TOF ratio.
  2. A clinical audit of the cardiopulmonary resuscitation chest compression technique in members of the Cardiac Arrest Team. 2016. Showed that chest compressions are often performed sub-optimally in clinical practice, even by highly trained individuals. A significant improvement (p<0.001) in CPR quality was demonstrated after objective feedback from a manikin. More frequent use of the feedback manikin, ideally integrated into the daily routine of clinical staff, could help improve the quality of CPR delivered by member of the resuscitation team.
  3. A clinical audit of the practical knowledge surrounding Cardiopulmonary Resuscitation in members of the Cardiac Arrest Team. 2016. Showed that there is a variation in the advanced life support knowledge of members of the resuscitation team, where some key facts which might influence outcome in cardiac arrest were not well recalled. Suggested that frequent assessment could be integrated into the daily work routine of members of the resuscitation team to help aid knowledge recall.
  4. Capnography Monitoring in Post-Anaesthesia Care Unit (PACU). 2015. Showed that the introduction of capnography in PACU should be welcomed but not seen as a substitute to existing monitoring and clinical observation.
  5. Quality of handover of patient’s care in the Post Anaesthetic Care Unit (PACU), Main theatres, ARI. 2016. Showed that handover of patient information is a crucial part of patient safety. Compliance with the current standards can be improved at ARI. Action plans suggested.
  6. Peri-operative Anaemia and Arthroplasty. 2015. Showed that pre-operative anaemia significantly increases postoperative transfusions and length of hospital stay. Preoperative anaemia should be investigated and treated.
  7. Paper and cardboard recycling within the operating theatre. 2015. Showed that significant volumes of paper and cardboard can be recycled safely within the operating theatre environment with huge potential financial and environmental implications
  8. Handover of responsibility for patient’s care in the post anaesthetic care unit (PACU) in a district general hospital (DGH). 2015. Showed that recovery handovers at Dr Gray’s were maintained at high standards. Recommendations are made to improve further.
  9. Alcohol withdrawal audit. 2015. GMAWS score may be a useful tool to predict and treat alcohol withdrawal at Dr Gray’s Hospital
  10. Does size really matter to foundation doctors in anaesthetics? 2015. A DGH provides significantly more consultant-led supervision and positively influenced career choice for FY1’s in anaesthetics compared to a teaching hospital
  11. Anaesthetics in a district general hospital: Experience of foundation doctors. 2015. Highlighted that allowing FY doctors to undertake an anaesthetics rotation early in their career with 100% consultant supervision can influence the future career pathways of these trainees
  12. Obtaining feedback for revalidation – a survey of patient preferences. 2015. Showed that patients would prefer to give feedback after their operation. This is in contradiction to the paternalistic recommendations of the RCoA
  13. Does attendance at the pre-assessment clinic alleviate anxieties experienced by patients in regards to their subsequent surgery and anaesthetic? 2014. It showed that attendance at the PAC at Dr Gray’s Hospital had a statistically significant positive effect on alleviating patient’s anxieties in regards to their anaesthetic and surgery. Patients are generally highly satisfied with the service they receive from the PAC.
  14. Patient Feedback Audit. 2013. Showed that most patients were happy with completing the form in an electronic format and made less errors doing so.
  15. Communication, patient satisfaction and ability to make an informed consent after pre-assessment. 2013. Showed that pre-assessment improves patient confidence to make an informed anaesthetic consent and increases patient satisfaction in anaesthetic communication. In addition, written information is an important adjunct to verbal advice.
  16. Patient satisfaction with post-operative anaesthetic information in the day case pathway. 2013. Showed that routine post-operative review by the anaesthetist is not required in day case surgery provided good quality follow-up care is given by nursing staff. Further work is needed to ascertain whether patients’ expectations of pain relief are met in the community.
  17. Key Indicators Pilot Audit. 2013. Showed that all anaesthetists at Dr Gray’s provided excellent postoperative control of pain and nausea and vomiting and met the standards for the RCoA. Whilst peri-operative thermoregulation provided overall good control, it was not as good as our last audit – this needs to be addressed.
  18. Peri-operative Hypothermia Audit IV. 2011. Showed a reduction in compliance with normothermia, mainly from the orthopaedic and urology theatres. Recommendations were made to address the issues in these areas.
  19. Audit of recovery handover. 2011. Showed that recovery handovers at Dr Gray’s were better than previously published results for other hospitals in the UK.
  20. Paediatric dental pre-assessment satisfaction audit. 2010. Showed that all patients were satisfied with the pre-assessment process.
  21. Patient satisfaction with Pre-assessment. 2010. Patients who are pre-assessed are more satisfied with the information provided than those who are not pre-assessed.
  22. Peri-operative Hypothermia Audit III. 2010. Showed a significant improvement in compliance with temperature recording, and a marked improvement in the number of patients arriving in Recovery with normal temperatures.
  23. Peri-operative Hypothermia Audit II. 2009. Implemented NICE guidelines for Peri-operative temperature management in Orthopaedic Patients. We have shown improvements in care.
  24. Peri-operative hypothermia Audit I. 2008. We have a high incidence of hypothermia peri-operatively, and need to implement the NICE guidelines.
  25. Audit of Emergency Work undertaken by Anaesthetic Department. 2006 to present (ongoing Annual Audit). This audit allows correct job planning, and improved efficiency of emergency working.
  26. Audit of Cancelled Cases through Theatre. 2006 to 2012.  This assesses the impact that a pre-assessment Service would have on Dr Gray’s, and will monitor the impact of the Pre-assessment Clinic when it is introduced.
  27. Audit of post-operative pain management after Caesarean Section. 2007. This audit has changed our departmental practice to using intra-thecal Diamorphine for Caesarean Section, which improved satisfaction and pain releif, and reduced side effects for the patient. It is cost effective, and has improved staff satisfaction
  28.  Audit of Pain Relief Post-Shoulder Surgery. 2007. Pain relief after shoulder surgery seems to be adequate at Dr Gray’s, and this audit could lead to shoulder surgery being performed as day cases, improving hospital utilisation and efficiency.
  29. Nausea & Vomiting Audit. 2007. My incidence of 23% is lower than the national average of 30 – 40%

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