EP.FRI.82 Using NCEPOD guidelines to develop an evidence based pathway for acute bowel obstruction

Bowel obstruction is a common presentation and poses a significant challenge for clinicians. This condition is associated with a high level of mortality and morbidity. The aim of this project was to assess the clinical pathway for patients presenting with bowel obstruction and improve the overall care they received. This was achieved using guidance from the 2020 NCEPOD report looking at bowel obstruction management. Best practice guidelines from the NCEPOD report were used to assess aspects of patient care such as the time to senior review, assessment of nutrition/fluid status and risk of mortality/morbidity assessment. This identified areas where the standard of care was good, such as the majority of patients being assessed by a consultant within 14 hours. However, it also identified areas such as hydration and nutritional status assessment, documentation of ceilings of care/treatment escalation plans and calculation of risk of mortality and morbidity, which required improvement. An admission checklist and nutritional scoring sheet was created to help prompt clerking doctors when admitting patients with acute bowel obstruction. All cases of bowel obstruction were then prospectively audited over a 2 month period to assess the impact of these changes. The findings were presented at the departmental meetings to increase clinician awareness. Following the audit period, local guidelines were amended to incorporate the NCEPOD recommendations, specific pathways were also made for adhesive small bowel obstruction and malignant large bowel obstruction due to the specific requirements of these conditions.