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93 An audit of a hospice paracentesis service before and during Covid19
  1. Anna Gray and
  2. Corinna Midgley
  1. St Francis Hospice, Romford


Background Our 18 bedded hospice, St Francis in Romford, Essex, sought to evaluate a new paracentesis admissions process, compliance of our inpatient paracentesis against safety guidelines and whether our service was affected by Covid19.

Methods A retrospective search of the patient electronic records database for patients who had a paracentesis between 8.4.19 and 30.6.20. Primary diagnosis was recorded and the number of paracenteses performed before and after revision of our referrals pathway (8.10.19). Compliance against safety guidelines was reviewed against a check-sheet for all paracentesis from 8.10.19 to 30.6.20. This allowed comparison between the pre-Covid 19 crisis period and during the ‘first wave’, which began to affect local services, and our bed state, from 2.3.20.

Results Paracentesis rates increased from less than monthly to every 2 weeks after the pathway was revised. This improved rate was unaffected by the Covid19 pandemic, despite immediate reduction in beds to 10 (2.3.20), before normalising at 16 (from 20.4.20). Of eighteen paracenteses between 8.10.19 and 30.6.20, sixteen were ‘elective’ referrals. Elective referrals waited an average of 4.6 days. Their average length of stay was 5.9 days. No procedures fully complied with guidelines. 14/18 had an ultrasound pre-procedure. 16/18 had documented evidence of medications review. 16/18 had pre-procedure observations. 15/18 had aftercare instructions documented. 3/18 had no documentation of consideration for a permanent drain. Areas of particular concern were: poor documentation of the consent procedure (no documentation for 3/18; only ‘verbal consent obtained’ for 4/18), no documentation of blood testing/results for 8/18, and details of drain removal were missing for 9/18.

Conclusions Through streamlining the admissions process, the rates of paracentesis at our hospice improved from less than monthly to every 2 weeks and remained a component of care during Covid19. However, audit standards were not reached, and steps are being taken to address this.

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