PTU-287 Abdominal paracentesis – improving practice with a multi-disciplinary proforma

Abstract

<h3>Introduction</h3> 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. <h3>Method</h3> 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. <h3>Results</h3> 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. <h3>Conclusion</h3> 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. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> UK Foundation Programme Training Curriculum file:///home/chronos/u9d51564d35947b93f52a5afa31247c656f09b206/Downloads/Fp_Curriculum_2012_updated_for_2014_WEB_FINAL.pdf Specialty Training Curriculum for Core Medical Training, JRCPTB http://www.mrcpuk.org/sites/default/files/documents/2009-CMT-Curriculum

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