The Journal of Hand Surgery - European Volume - April 2018 - 7

BSSH Spring meeting abstracts
Consent: Supported Decision Making - Are We
Compliant?
Mr Abdulla Ibrahim, Mr Stephen Ali and
Mr Thomas Wright
Southmead Hospital
Time in programme: Friday 4th May 2018 08:39

Aim: Following the Montgomery case there has been
a move from traditional paternalistic approaches of
consent towards those of a patient-centered focus.
Here, we evaluate the consent process within the
plastics trauma setting and discuss beneficial educational interventions.
Method: A prospective audit cycle was undertaken of
all acute adult plastic surgery patients that underwent surgery over eight weeks spanning February
and September 2017 within a major trauma centre.
All clinical notes and consent forms were reviewed.
Within this period, educational interventions were
undertaken to improve compliance against the
Royal College of Surgeon's standards. Exclusions
included missing notes/consent, and patients who
were unable to consent or declined surgery.
Results: 186 patients were included in the audit cycle;
102 in the first, and 84 in the second loop. Following
intervention, the following standards improved; black
ink use (100% vs 92%), legibility (100% vs 92%), avoiding abbreviations (81% vs 74%), consent discussion
(65% vs 9%), and confirmation of consent (18% vs
4%). Whilst all cases had correct patient demographics, no patients received a copy of their consent.
Conclusions: In the current healthcare climate, surgeon education can help meet the necessary legal
and regulatory requirements and protect patients'
rights to make informed decisions regarding their
treatment.

The Impact of Education and Guideline
Implementation on Antibiotic Prescribing in Acutely
Infected or Contaminated Hand Wounds and Bites
Dr Alice Wignall, Dr Gavin Barlow and Mr Richard Pinder
Hull Royal Infirmary
Time in programme: Friday 4th May 2018 08:43

Aims: Inappropriate prescribing contributes to antibiotic resistance, one of the three most important
public health threats. We recently developed consensus antibiotic guidelines for use in acutely infected or
contaminated hand wounds and bites. This study
aimed to assess the impact of the implemented
guidelines on antibiotic prescribing.

S7
Method: A multidisciplinary collaboration developed
antibiotic guidelines to align prescribing with local
and national stewardship and resistance agendas.
Before implementation, data on all patients presenting with traumatic or infected hand wounds over a 2week period were gathered. Following education and
implementation, further data were collected.
Results: Data were analysed for 110 patients (51
before, 59 after). Following education and implementation, correct decisions regarding indication for antibiotics increased in both the referring centres (RC)
(59% to 69%) and the specialist trauma clinic (STC)
(71% to 80%). Adherence with guideline antibiotic
recommendations rose in both the RC (28% to 60%)
and the STC (39% to 67%). This resulted in a reduction in the prescription of broad-spectrum antibiotics.
Conclusions: Following implementation there was a
notable decrease in broad-spectrum antibiotic prescribing. While education and guidelines can help
ensure appropriate narrow spectrum antibiotics are
prescribed, there is room for further improvement
with ongoing education and feedback necessary to
ensure improvement is sustained.

Management of Paediatric Trigger Thumb (PTT) -
Results From a UK-Wide Survey of Current Practice
Miss Jessica Harvey and Mr Chris Bainbridge
The Pulvertaft Hand Centre, Royal Derby Hospital
Time in programme: Friday 4th May 2018 08:47

Aims: The BSSH paediatric SIG endorsed our aim to
establish the normal UK management of paediatric
trigger thumb (PTT). Secondly we aimed to assess
the feasibility of a multi-centre trial of conservative
management.
Methods: An online survey was distributed to all
BSSH members in January 2018.
Results: 194 BSSH members responded, 117 of these
treat PTT. These included 63 orthopaedic and 41
plastic hand surgeons. Primary management was
conservative for 50% and surgical for 35%. The
remaining 15% nuanced their treatment depending
on the age of presentation.
48% declared they would monitor for up to 6
months, 29% for up to 1 year and 19% for up to 2
years. We had 88 free-text responses expanding on
the reasoning for their primary management choice
and the key points made were the importance of
involving the parents in the decision making. 56%
were interested in a multi-centre trial.
Conclusions: There is a lack of consensus regarding
management of this condition. Half of the surgeons

Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018