10th EORNA Congress Stavanger, Norway | 12 - 15 May 2022 ePosters 56 eP15 “Major Haemorrhage Trolley” Bloody Brilliant! A quality initiative improving patient safety M. Given1 1Sligo University Hospital, General Theatre, Sligo, Ireland Major haemorrhage occurring in the operating theatre (OT) requires a rapid response from the multi-disciplinary team (MDT). Approximately 50% of blood products transfused take place in the OT (De Biasio, 2016). A major haemorrhage protocol is defined as a standardized response that enables the MDT to organise activities quickly and efficiently in order to treat the patient in the most time effective manner (Porteous, 2015). The protocol encourages improved communication, cohesive action, minimal delay and staff support. Developing the protocol involved the MDT coordinating its progression and initiation. Simulation training with debriefing and evaluation occurred. Recommendations were instigated. Evaluation identified weaknesses in the provision of essential equipment efficiently and effectively, resulting in delayed intervention for the patient and stress for staff. This was identified as a system and process failure, which if not rectified could contribute to an adverse event (Reason, 2000). Following debriefing and collaboration, it was identified that vital equipment should be more readily available to optimize patient care by promoting a lean approach and improving process. This was identified as a transformative learning opportunity that would improve quality of care (Riehle & Hyrkas, 2012). Consequently, staff embraced the project and the major haemorrhage trolley was created. All essential equipment including flash cards for role identification, mobile phone for communication and white board for documentation are systematically laid out on this trolley. This quality improvement initiative demonstrated a quality culture by examining practice and implementing effort to improve performance interlinking familiarizing, using and evaluating (Ruhe et al. 2009). Evaluation by survey suggested this simple idea improved patient safety. With staff extolling its merits it is now an essential element of the process when the major haemorrhage protocol is activated, reviewed regularly and replicated in other departments in the hospital. (References available). eP16 Intraoperatively local infiltration anaesthesia in hemiarthroplasty patients reduces the needs of opioids: a randomized, double-blind, placebo-controlled trial with 96 patients in a fast-track hip fracture setting J.K. Hofstad1, J. Klaksvik1, T.S. Wik1 1Norwegian University of Science and Technology, NTNU Trondheim, Norway, Orthopaedic Research Centre, St Olavs Hospital Trondheim, Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim, Norway Background and purpose: Local infiltration analgesia (LIA) is commonly used as a component in multimodal analgesia. Pain management directed towards hip fracture patients operated with hemiarthroplasty is often based on knowledge on pain treatment following elective surgery. In this elderly patient population, it is of value to clarify whether adding local infiltration analgesia (LIA) to the postoperative analgesic regimen might reduce postoperative pain or have an opioid reducing effect. Patients and methods: 96 hip fracture patients undergoing hemiarthroplasty surgery in spinal anaesthesia were included. All patients received multimodal pain regimen and were randomized to receive either ropivacaine or placebo. All patients received dolcontine as depoid-opioid and morphine as rescue medicine postoperatively. The primary endpoint was pain during mobilization in the recovery unit the day of surgery. Secondary endpoints were pain during mobilization the day after surgery and postoperative opioid requirements the first postoperative day. Results: The levels of pain during mobilization both in the recovery unit and on the day after surgery were similar in the 2 groups with median 4 and 0.5 in the placebo group and median 3.5 and 1 in the ropivacaine group respectively. Total consumption of opioids on day 0 and day 1 were 4.6 mg lower in the ropivacaine group (P=0,04). Pain during mobilization were registered only for 44 of 96 patients due to several reason including lack of mobilization. Interpretation: There were similar pain scores in both the local infiltration and placebo group postoperatively however, a substantially reduced opioid consumption was found in patients receiving LIA.
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