AB147. SOH25_AB_377. An audit of the prescription and implementation of spinal precautions in patients with actual or suspected spinal cord injuries at a level 3 university teaching hospital

Background: Spinal injuries with suspected spinal cord injury are a common presentation to emergency departments (EDs). Best practice guidelines advise prescription of various spinal precaution measures regarding immobilisation, manual handling, transfer, and patient inclination in anticipation of definitive diagnosis and treatment. Appropriate spinal precautions can prevent further injury, facilitate communication, and enhance patient safety. Inappropriate precautions can inadvertently contribute to patient harm and stress. The aims of this clinical audit are two-fold: firstly, to measure the degree of adherence with, and implementation of, spinal precautions according to our local spinal precaution guideline. Secondly, to measure the appropriateness of prescribed precautions, relative to the injury sustained.

Methods: Local spinal precautions proforma was used as the standard against which current practice was measured. Admissions and ED referrals to the orthopaedic surgery service were prospectively screened over 3 months for patients sustaining spinal injuries. Data pertaining to completion of local spinal precautions proforma was collected from medical notes. Results were analysed and presented to the orthopaedic department with a teaching session on implementation of spinal precautions. Audit cycle will be repeated following a 1-month period, closing the audit loop.

Results: Current preliminary data demonstrated sub-optimal adherence with appropriate spinal precautions implementation. Notably, a discordance between prescribed range of inclination, and inclination implemented was observed.

Conclusions: We believe completion of this closed-loop audit cycle can enhance adherence with, and implementation of, appropriate spinal precaution measures. This can facilitate patient safety, and enhance communication among healthcare professionals. We believe this also demonstrates the importance of continuous audit and quality improvement (QI) in clinical practice.

Keywords: Trauma; spinal cord injury; spinal precautions; clinical audit; quality improvement