Audit of compliance with NICE guidelines for preoperative tests


What does NICE say?

Patients
ASA 1
ASA 2
ASA 3
ASA 4

Surgery
Grade 1
Grade 2
Grade 3
Grade 4

Who need what?
Grade 1 surgery
ASA 1 < 16 yrs; grade 1 surgery.
ASA 1 <80> 80 yrs will need ECG. Age 40- 80 consider if indicated.
ASA 2 will only need relevant tests for their condition.
ASA 3 will need FBC and other relevant tests.

Grade 2 surgery
ASA 1 <16 year- nil
ASA 2- FBC in above 60 and ECG in above 80 yrs.
ASA 3 >16 will need ECG and renal functions; other tests as indicated.

Grade 3 surgery
ASA 1; <16 yrs- consider FBC, renal functions, urine analysis.
ASA 1, >16 yrs- FBC for all ECG and renal functions in >60 yrs. Others.
ASA 2; > 16 yrs- ECG, FBC, renal functions.
ASA 3; > 16 yrs- ECG, FBC, renal functions.

Grade 4 surgery
ASA 1; < 16 yrs- consider FBC, Urine, renal functions.
ASA 1; > 16 yrs-FBC, renal functions, ECG for >60 yrs.
ASA 2; >16 yrs-ECG, FBC, renal functions.
ASA 3- ECG > 40, FBC, renal functions, others.


This audit
Simple
Forms
Elective cases
25 forms collected

Data

Appropriate investigations
ASA 1- 2/6
ASA 2- 4/10
ASA 3- 4/8
ASA 4- 1/1

Inappropriate investigations
ASA 1- 4/6
ASA 2- 6/10
ASA 3- 4/8
ASA 4- 0/1

Summary
Juniors in surgery
Pre-assessment nurses
Local guidelines for the trust
Inappropriate use of tests
Tip of iceberg

Recommendations
More teaching in this field
Induction of juniors at the start of job
Ward nurses
NICE guideline cards
Charts on the walls
Re-audit

Thank you