VP13: A Closed-Loop Audit on the Management of Adult Facial Lacerations in a Busy Tertiary Centre Accidents and Emergency Department

INTRODUCTION: Laceration injuries are thought to comprise up to 8% of A+E visits annually. Given the high number of presentations, it is vital that A+E staff are aware of their best management.1 The aim of this audit was to assess the management of adult facial lacerations against NICE recommendations in Morriston Hospital A+E Department – a busy tertiary center with Plastic and Maxillofacial Surgery specialties available. MATERIALS AND METHODS: Practice was assessed between 5/07/20 - 23/09/20. A three-fold intervention was subsequently implemented, namely educational presentations to all A+E staff grades and a departmental poster to raise awareness of NICE Guidelines. Practice was re-audited from 01/19/21 – 05/04/21. Two reviewers independently assessed ED documentation from all patients. Criteria assessed included examination of neurovascular (NV) status, risk assessment for tetanus, infection risk stratification, and antibiotic choice. RESULTS: Data from 98 patients attending A+E with facial laceration in total was collected: n=51 in the first loop; n=47 in the second. From the first loop, prior to intervention: 36.96% of cases had documented NV status, 32.61% assessed tetanus risk/offered prescription, 17.39% considered infection risk, and antibiotic choice was documented in 20% of cases (10% vs 90% for Flucloxacillin vs Chloramphenicol). 39.13% considered analgesia and 45.65% of cases were safety-netted. Re-auditing showed 75.76% of cases had documented NV status, 66.67% tetanus prophylaxis, 72.74% documented infection risk, and 100% considered antibiotic choice. 84.85% of cases documented analgesia and 78.79% of cases were safety-netted. Plastic Surgery Doctors and Maxillofacial Surgery Doctors showed the highest compliance to NICE guidelines. CONCLUSION: A three-fold intervention led to improved observation to all measures of NICE guidelines in the management of facial lacerations across all staff grades. Based on these results, the authors recommend regular auditing of the management of facial lacerations against national, gold-standard guidelines to ensure adherence to highest clinical practice.