Background Malignant Bowel Obstruction (MBO) secondary to gynaecological malignancy is a common reason for admission to our tertiary referral cancer centre. Patients present with challenging symptoms that require complex management, involving a wide MDT of gynae-oncology, surgery, palliative care and dieticians. As such, there is a risk of inconsistent practice. Hospital guidelines exist to help standardise treatment and ensure good quality care.
Methods Using coding data and manual review of notes, we identified 17 patients (with 23 admissions) admitted over a six-month period (August 2020-January 2021) who had MBO secondary to gynaecological malignancy recorded on their discharge notification. Through retrospective analysis of medical records, we compared care received against 8 key audit standards identified from our guidelines. Our target for each audit standard was 80%.
Results We met our target for 5 of 8 audit standards: a prompt gynae-oncology review and surgical decision was made in 87% and 82% of patients respectively. Where possible 100% of surgeries were performed on a routine list and above 80% of patients had a documented decision on steroid treatment and NG tube placement. Only 52% of patients were referred to palliative care within 24 hours of admission and under 80% of patients had a documented decision on further systemic anti-cancer treatment (SACT) and need for parenteral nutrition (PN). Median time from MBO diagnosis to death was 54.5 days with 43% of deaths occurring in hospital.
Conclusions We identified three key areas of care including: earlier palliative care referral, individual assessment for SACT and decision making around the need for PN which required improvement. The results indicate that MBO is an indicator of poor prognosis and therefore earlier palliative care involvement is vital. We aim to improve concordance with the guidelines through education and training and ensure written guidance is easily available.
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