Compliance with BSG/BASL decompensated cirrhosis care bundle

Abstract

Background: This audit focuses on Compliance with the British Society
of Gastroenterology (BSG) and British Association for the Study of the
Liver (BASL) Decompensated Cirrhosis Care Bundle as decompensated
liver cirrhosis is becoming a burden on the current NHS.
Objectives: The study aims to ensure that future admissions with decompensated
cirrhosis adhere to the care bundle, identify areas of poor compliance,
and pinpoint areas for improvement.
Methodology: Over the course of 6 months, a sample of 29 patients, ranging
in age from 29 to 77, were evaluated at Hinchingbrooke Hospital.
Presentations and compliance were examined using manual medical take
clerking searches.
Findings: Common presentations included jaundice, ascites, and variceal
bleeding. In-hospital mortality stood at 31%. While basic investigations
were generally compliant, there were significant non-compliance rates for
septic screen (38%), ascitic tap (37%), and USS abdomen (24%). Partial
compliance was noted in recording alcohol intake (87%) and prescribing
IV Pabrinex (89%), with non-compliance for CIWA (74%). Variceal
bleeding management showed non-compliance in prophylactic antibiotics
(60%), terlipressin (70%), and vitamin K (43%), while adequate lactulose
dosing in encephalopathy was non-compliant in 71% of cases. VTE
prophylaxis prescribing showed high compliance at 92% in appropriate
cases.
Conclusion: The audit highlights the need to adhere to the use of decompensated
cirrhosis care bundle. It shows gaps in compliance which can be
areas for improvement and education.