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7 Improving the documentation of risk assessments and discharge advice in anti-coagulated patients with head injuries and normal imaginghead injuries & anticoagulation
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  1. Natasha Dole
  1. John Radcliffe Hospital, Oxford University Hospitals

Abstract

Background Patients on systemic anticoagulation are at risk of delayed bleeding following head injury despite normal head imaging.There are no current unified guidelines to help clinicians assess the risk of this delayed bleeding and advise patients on anticoagulation, however,a detailed trust guideline exists.

Aim We aimed to audit the documentation of risk assessments of delayed bleeding and of discharge advice to temporarily withhold or continue anticoagulation for 7 days as per local guidance across 2 sites, with a head injury and normal initial CT Head.Various interventions were implemented and subsequently re-audited with the aim of a 50% improvement in 6–9 months.

Methods We retrospectively audited 100 eligible patient encounters(Nov-Feb 2020) using patient records to assess documentation of risk assessment and discharge advice against our Trust policy.Interventions consisted of an amendment to the Trust head injury leaflet and CT Head Form Requests to include an anticoagulation section,structured teaching to raise awareness including in patients and e-mailing the local policy to all A&E staff with regular entries into the Staff Bulletin/Intranet,Induction of New Joiners and Weekly Safety Message.50 eligible patient encounters were re-audited (Apr-Jun 2020).

Results Audit 1 revealed that 37% of encounters contained documentation of both risk assessments/discharge advice whereas 51% of encounters documented neither.Audit 2 had improved with 44% of encounters containing documentation of both and only 28% of encounters containing no documentation.

Conclusion This project demonstrates that simple measures such as education and sign-posting local guidance have the potential to improve complex decision-making and ensures adequate safety netting.Additional work is underway to identify other interventions which may improve documentation further and to ascertain the durability of these changes.

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