766 Audit of Stratified Treatment Escalation Plan Completion and DNACPR in Patients with Femoral Fractures – 4th Cycle

Aim Assess how many patients admitted on the fragility fractures ward (including hip, shaft, distal, periprosthetic fractures) had escalation (STEP) forms completed. We audited whether this was done in a timely fashion, which specialties and grades filled in the forms, if was there a weekend effect in form completion, and if the decisions were communicated with patients or relatives. Method In this 4th cycle of the audit, notes of patients admitted on the fragility fracture ward in the period 14/09/23 - 25/10/23 were examined prospectively. Paper and electronic notes were assessed for presence of escalation and DNACPR forms completion, and for evidence of discussion. Standards were set as internally as 100% for all measures: evidence of STEP form completion, completion done within 24 hours, and evidence of escalation plan discussion. Results 30 patients were audited. STEP form completion was 100% however 13% contained minor errors, needing correction; STEP completed within 24 hours of admission to the ward = 77%; documentation of discussion if for less than full escalation 58% (cognitively intact) and 64% (cognitively impaired). Conclusions All patients audited had a STEP form completed. STEP form completion within 24 hours improved from cycle 3. Documentation of discussions did not meet the standard for cognitively intact and cognitively impaired patients for less than full escalation. To improve future care, posters will be displayed, audit mentioned in junior doctors' inductions, and email reminders sent to all grades. Further cycles are being planned, and e-documentation system utilisation for improvement is under consideration.