765 Reducing ‘At Risk’ Skin in Neck of Femur Fracture (NOF) Patients – A Quality Improvement Project Standardising Catheterisation and Peri-Operative Care

Introduction A service evaluation audit highlighted significant variation in our practice as regards catheterisation in NOF patients. A pilot protocol was developed with real time data monitoring to see if we could improve our patients’ pathway. Method The protocol focussed on early catheterisation, monitoring the condition of patients’ skin, documentation around catheter care and removal instructions and surveillance for urinary tract infection rates (UTI) Results 150 patients were included in the pilot. There was a reduction by more than 50% of patients assessed as having at risk or broken skin. 94.5% of patients were catheterised out of theatres (previously only 4%) saving an average of 14 minutes of theatre time per case. Delays in catheter removal after documented request reduced by 2 days and our UTI rates were relatively unchanged (3.3% compared to 2.7%). Documentation significantly improved. We also noted that overall length of stay was reduced by 2 days. Conclusions Standardising our care pathway has improved our patient care and documentation. It has benefitted theatre efficiency and also nursing of fragile skin in 'at risk' patients. Prompting early removal and compliance may have also had a positive impact on overall length of stay. This has been a successful quality improvement project in our department.