Aim
Upper limb tourniquets are widely for hand surgery but infrequently audited for safety. We conducted two audit cycles, comparing practices against British Orthopaedic Association Standards for Trauma (BOAST) standards and local operation theatre infection prevention and control policy, which mandate torniquet cuff marking after each use and disposal after six uses to minimize cross-infection.
Method
62 and 73 operative records were reviewed in the first and second audit cycles respectively, assessing documentation of tourniquet type, pressure, duration, skin integrity, and isolation/exsanguination methods. Tourniquet cuffs were checked for markings. After the first audit, a safety poster was displayed, reminders were given during team briefs, and teaching session on operative documentation were given for plastic surgery residents and consultants.
Results
Tourniquets were used in 69% of cases first cycle and 52% second cycle . Tourniquet time was recorded in 90% and 92% of cases in first and second cycles respectively. Tourniquet pressure documentation improved from 40% to 74%. Fixed pressure of 250mmHg was used in 98% of cases, leading to over-inflation above the BOASTrecommended pressure in 54% first and 76% second cycle. Compliance with cuff marking significantly improved from 0% to 93%. No complications were reported.
Conclusion
While tourniquets were generally used safely, our audits highlighted areas for improvement. Individualized pressure settings were underutilized, and initial compliance with cuff marking was poor. Adherence to safety standards and accurate documentation are critical for minimizing risks and ensuring best practices.
Authors
Aishwarya Goel
Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom
Nyo Win
Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom
Sharmila Jivan
Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom