Priyanka Bhandari
Introduction
Chest Wall Analgesia guidance was updated on 21.03.2025 by Royal Infirmary of Edinburgh (RIE) to triage and manage blunt chest wall injuries. It highlights four monitoring parameters important for assessment at least four times a day; pain, ability to cough effectively, ability to deep breathe and SpO2/O2 requirement. This audit investigated if monitoring requirements were met for the first three days of admission into wards.
Methods
This cycle 1 audit collected retrospective data from patients admitted to Cardiothoracic Surgery and Major Trauma wards of RIE over 6 weeks. NEWS charts and Trak notes to collect monitoring data.
Results
Monitoring documentation did not meet the standards outlined for the 24 patients who met the inclusion criteria. Over the three days of admission, zero patients had documentation of all four parameters monitored at least four times in a day. Pain was documented, per standards, for five patients on day 1, six patients on day 2 and five patients on day 3. Ability to deep breathe was documented for zero patients on all 3 days. Ability to cough effectively was documented for one patient on day 1 and zero patients on days 2 and 3. SpO2/O2 requirement was documented for fourteen patients on day 1, nineteen patients on day 2 and twenty-one patients on day 3.
Conclusion
A quality improvement project was started to implement changes so monitoring standards can be made. A re-audit will start from April assess if the changes implemented have made a significant difference to the monitoring documented.
Authors
Priyanka Bhandari, Walid Elbakbak
Royal infirmary of Edinburgh, Edinburgh, United Kingdom