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PTU-287 Abdominal paracentesis – improving practice with a multi-disciplinary proforma
  1. A Boyd,
  2. J Dallimore,
  3. E Turner-Moss,
  4. G Carnaby,
  5. J Kennedy,
  6. E Brown,
  7. U Chelvaratnam
  1. Southmead Hospital, Bristol, UK

Abstract

Introduction Abdominal paracentesis is a common procedure performed both on Gastroenterology wards and as a day procedure. Although Foundation Doctors and Core Medical Trainees do not have to be independent at this procedure for satisfactory progression of training,1,2it is an important part of any Gastroenterology rotation. Furthermore it is an essential sign-off for CCT in General Internal Medicine. Within the Core Medical Training curriculum it is identified as a “potentially life-threatening” procedure.2We sought to assess trainees’ attitudes to the procedure and implement a proforma to help improve both confidence in performing the procedure and documentation.

Method Foundation doctors and Core Medical Trainees were surveyed about their attitudes towards abdominal paracentesis both before and after the implementation of a multi-disciplinary proforma. The survey consisted of four questions with free text responses: trainees’ confidence in performing the procedure, common worries about the procedure, what has previously gone wrong and whether a proforma would be useful. Documentation of important steps in the procedure and results were audited both before and after implementation of the proforma.

Results Only 25 percent of respondents were confident in performing abdominal paracentesis independently and 67 percent of respondents felt a proforma would be useful. Common areas of uncertainty were surrounding bleeding risk and regimes of albumin replacement. Documentation of many key steps in the process of abdominal paracentesis was poor; following the introduction of the proforma documentation rates hit 100% for steps including informed written consent, number of passes to insert the drain and assessment of bleeding risk. The proforma was well received with 100% of respondents, both medical and nursing colleagues, agreeing it was a useful addition.

Conclusion Introduction of a simple, multi-disciplinary proforma has improved documentation in abdominal paracentesis. In addition, it clearly sets out best practice and addresses many of the concerns identified by junior doctors.

Disclosure of interest None Declared.

References

  1. UK Foundation Programme Training Curriculum file:///home/chronos/u9d51564d35947b93f52a5afa31247c656f09b206/Downloads/Fp_Curriculum_2012_updated_for_2014_WEB_FINAL.pdf

  2. Specialty Training Curriculum for Core Medical Training, JRCPTB http://www.mrcpuk.org/sites/default/files/documents/2009-CMT-Curriculum

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