Background Since 2008, several doctors have attended the in-house Focused Abdominal UltraSound in Palliative Care (FASP) course each year. It teaches examination protocols for ascites, liver, urinary tract and groin deep vein thrombosis (DVT). The hospice has a SonoSite NanoMaxx portable ultrasound machine. An audit was done to see if ultrasound is used and whether scans adhered to course standards.
Audit standards Standards are set according to the FASP course:
Frequency of use of ultrasound
Ultrasound protocols were followed – clear indication for limited ultrasound examination
Impact of having ultrasound
Documentation for cleaning of transducer.
Results 1. Frequency of use
Over eight years, 189 scans were done. The average was 24 (range 17 to 40) scans per year. Six current medical team members use ultrasound. The majority of the scans were done on the ward, some in outpatients or at home, making good use of the portable machine.
In 100% scans, appropriate limited ultrasound protocols were followed. There may be more than one indication for a scan. They were for ascites (142/189, 75%), including identifying site for paracentesis (23, 12%), bladder (33, 17%); very few for kidney (2, 1%) and DVT (1, 0.5%), none for liver. The reasons were possibly due to lack of need or staff were less confident in doing these.
There was documentation for each scan that it helped clinical decisions. These included paracentesis, referring to hospital for PleurX drains and insertion of urine catheter.
From 2008 to 2013, documentation of cleaning of the transducers ranged from 75 to 98%. It improved to 100% in 2014 and 2015.
Conclusion Overall, ultrasound is used well and appropriately in the hospice. We plan to do biannual audit. We will provide training for staff who wish to attend refresher modules on liver and groin DVT in the annual course.
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