1. clinical audit 2024Audit Tool Burn June 2016.docx

clinical audit 2024

1. Audit Tool: Burn
Facility name Deder General Hospital
Department/unit Emergency and Critical Care
Audit Topic Burn patient management in the emergency room
Aim To Improve the quality of clinical care provided to burn patients
Objectives To ensure burn victims presenting to the emergency are evaluated appropriately
To ensure burn victims presenting to the emergency are investigated appropriately
To ensure burn victims presenting to the emergency are treated appropriately
To ensure burn victims presenting to the emergency are disposed appropriately
Period of Audit June 2016E.C
Inclusion criteria All moderate and severe burns (patients with burn injuries fulfilling admission criteria either to ward or burn unit) patients
aged 14 and above treated in the emergency department with-in the study period
Exclusion criteria (where applicable) Patients who sustained their burn injury >24 hrs. before arrival to the ED
Instructions For criteria- If completed give ‘Yes’ if not give ‘No’ ,give NA if the criterion does not apply to the individual patient
For sub-elements (ones in blue)- if completed give ‘1’ if not give ‘0’ , give NA if the sub-element does not apply to the individ-
ual patient
No Standards/criteria
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Actual
perfor-
mance
Perfor-
mance
against
target
Remark
1 IDENTIFICATION INFORMA-
TION IS RECORDED FOR A
PATIENT PRESENTING WITH
BURN
100% 100
%
67
%
100
%
89%
1.1Name
Patient
ED
Admission
Note
YesYesYes
1.2Age
YesYesYes
1.3Sex
YesYesYes
1.4Date of visit
YesYesYes
1.5Time of visit
YesNoYes
1.6MRN
YesNoYes
2
5
3

2. 2 APPROPRIATE EVALUATION
AND MANAGEMENT FOR
ACUTE LIFE THREATENING
INJURIES IS DONE A PATIENT
PRESENTING WITH BURN
100% 31
%
30
%
88
%
89%
2.1Decontamination is done if the
patient has chemical burn
Triangulate
Patient ED
Admission
Note, Order
Sheet, Pro-
cedure Note,
Medication
Sheet and
Vital Sign
Sheet
NANANA
2.2Evaluation of airway patency is
done (airway is clear/patent or
presence of secretion, presence of
foreign body or injury to the
face or presence of soot inside
nostrils is evaluated)
YesYesNA
2.3If patient has secretion secretions
are suctioned out
NANANA
2.4If foreign body is present it is
removed
NANANA
2.5Airway management is done (Oral
airway or insertion or supraglottic
device placement or endotracheal
intubation or surgical airway) if
airway patency is compromised
NAYesNA
2.6Evaluation of cervical stability is
done for patient with GCS score of
15 and concomitant other physical
trauma is identified
YesYesNA
2.7Cervical collar is secured for cervi-
cal injury for patient with concomi-
tant physical trauma
NANANA
2.8Appropriate breathing evaluation is
conducted
YesNAYes
Oxygen saturation measured
111
Respiratory rate counted
111
Respiratory movement symmetry
assessed
111
Chest is auscultated
111
2.9Oxygen is provided using nasal
prong or face mask for patient with
SpO2 < 90%
NANANA

3. 2.10Ventilation is provided using me-
chanical ventilator for patient who
have evidence of severe inhalational
burn
NANANA
2.11Appropriate interventions are done
for other suspected/identified trau-
ma on the respiratory system (Chest
tubes for concomitant pneumo-
thorax and/or hemothorax,
needle thoracostomy done for
tension pneumothorax patients)
Triangulate
Patient ED
Admission
Note, Order
Sheet, Pro-
cedure Note,
Medication
Sheet and
Vital Sign
Sheet
NANANA
2.12Blood pressure is measured
YesYesYes
2.13Pulse rate is counted
YesYesYes
2.14IV line is secured: Peripheral
percutaneous Intravenous
access/ Intraosseous access/
Venous cut down/ Central
venous access established
YesYesYes
2.15Immediate fluid resuscitation with
Ringer’s Lactate is started if the
patient is in shock state
YesNANA
2.16GCS is calculated, pupillary size
and reaction are checked, motor
preference is checked and RBS is
measured
YesYesYes
2.17Dextrose is given if patient is hypo-
glycemic
NANANA
2.18Log-roll is done
YesYesYes
2.19Total burn surface area is calculated
using either rule of 9 and Lund and
Browder’s chart for adults and pal-
mar surface method for pediatric
patients
NoNoNo
2.20Assessment for presence of eshcar
at any site is done
NANA 
2.21If eshcar is present, eshcarotomy is
done
NANANA
2
5
4

4. 2.22Patient is evaluated for presence of
compartment syndrome if circum-
ferential burn is diagnosed on distal
extremities
YesYesYes
2.23Bed side ultrasound is done (FAST/
eFAST) for patient with concomi-
tant physical trauma
NANANA
3 DETAILED HISTORY AND
PHYSICAL EXAMINATION
PERFORMED FOR A PATIENT
PRESENTING WITH BURN
100% 100
%
100
%
71% 90%
3.1Detailed history of the burn inci-
dent is recorded (Duration of burn,
the type of burn experienced by
the patient; if the burn occurred
in
closed or open area; other materials
that were burned during the inci-
dent; if it was electrical burn, the
voltage of line and entry site)
Patient’s ED
Admission
Note
YesYesNo
3.2Patient’s current complaint is
recorded
YesYesYes
3.3Past medical and surgical history
is taken
YesYesYes
3.4History of food or medication
allergy is taken
YesYesYes
3.5Current medications patient is on
medications are identified
YesYesYes
3.6Time of last meal the patient took is
identified
YesYesYes
3.7Vital signs are retaken (Time
specified)
Patient’s
Vital Sign
Sheet
YesYesNo
Blood pressure
001
Pulse rate
001
Respiratory rate
001
Oxygen saturation(SpO2)
001
Temperature
001
Pain score
000
2
5
5

5. 3.8Head to toe physical examination is
performed
Patient’s ED
Admission
Note
YesYesNo
Detailed report of burned areas
with full description of size, depth
and local complications is written
111
Pulse rate counted
111
Respiratory rate is counted
111
Oxygen saturation(SpO2) measured
111
Temperature measured
010
4 RELEVANT INVESTIGATION
ARE DONE FOR A PATIENT
PRESENTING WITH BURN
100% 00100
%
33%
4.1Baseline CBC, RFT and serum elec-
trolytes (Na, K) are determined
Triangulate
Patient ED
Admission
Note with
investigation
papers
and/ or
investiga-
tion summa-
ry
NoNoYes
4.2ECG is done for electrical burn
patient
NoNANA
4.3Other investigations as per indica-
tion are done
NoNoYes
5 APPROPRIATE DIAGNOSIS IS
MADE FOR A PATIENT
PRE- SENTING WITH
BURN
100% 40
%
80
%
100
%
73%
5.1Primary diagnosis is written Triangulate
the history
and P/E
findings
with the
diagnosis on
Patient ED
admission
Note with
ED admis-
sion Order
Sheet
YesYesYes
5.2Severity of burn injury is identified
YesYesYes
5.3TBSA is calculated
NoNoYes
5.4All degrees of burn the patient
sustained are specified
NoYesYes
5.5Diagnosis of additional observed
conditions and complications is
made NoYesYes
6 APPROPRIATE TREATMENT
IS PROVIDED FOR A
100% 71
%
67
%
56
%
65%
2
5
6

6. PATIENT PRESENTING
WITH BURN
6.1Wound care is done regardless
of the severity of burn injury
Triangulate
Patient’s ED
Admission
Note with
ED Order
Sheet with
Medication
Sheet
YesYesYes
6.2Tetanus prophylaxis is provided for
the patient whose tetanus immuni-
zation status is not up-to-date
NANoNo
6.3Patients with partial thickness burn
>10% or full thickness burn
>2%, patients with burns to the
face, major joints, perineum or
hands, patients with high
voltage electri- cal burns or
lightening or patients with
chemical burns are kept in the
emergency until
admission/referral is facilitated
YesYesYes
6.4For severe burn patient (TBSA >
20% for adults or > 10% for chil-
dren except for 1st degree burns,
burns complicated by trauma or
inhalational injury, chemical burn
and high-voltage electrical burn)
appropriate monitoring is done
Triangulate
Patient’s ED
Admission
Note with
ED Order
Sheet with
Medication
Sheet
NANANA
Order is written to put patient on
cardiac monitor
NANANA
BP measured every 1hr
NANANA
PR measured every 1hr
NANANA
RR is measured every 1hr
NANANA
Patient is put on continuous oxygen
saturation monitor and finding
recorded every 1 hr.
NANANA
Temperature is recorded every 1 hr
NANANA
Urine output is measured every 1hr
1NANA
Pain score is determined every 4hrs
NANANA
6.5For non-critical burn patient, ap-
propriate monitoring is done
NAYesYes
BP measured every 4hrs.
011
2
5
7

7. PR measured every 4hrs.
011
RR measured every 4hrs.
011
Urine output is measured every
4hrs.
011
Pain score is determined every 4hrs.
011
6.6Parkland formula is used for cal-
culation of fluid resuscitation if the
patient presents within 24 hours of
burn incident (except for electrical
burn patients)
NANoNo
6.7Appropriate fluid loss estimation
and replacement is made for electri-
cal burn patient
YesNANA
Loss is estimated using urine output
000
Urine out put is measured
every one hour
000
Fluid loss is replaced based on urine
output with Ringers lactate
Triangulate
Patient’s ED
Admission
Note with
ED Order
Sheet with
Medication
Sheet
000
6.8Standing dose analgesia is provided
YesYesYes
6.9Topical agents are ordered to
be used during wound care
NoNoNo
6.10Temperature target is determined
and means of preventing
hypother- mia is
planned/ordered
NoYesNo
6.11Patient is monitored for additional
observed conditions and complica-
tions of burn
YesYesYes
Urine color, urinalysis, and serum
creatinine for patient with high
voltage burn (rhabdomyolysis)
Triangulate
progress
note with
investigation
papers
01NA
Airway condition for patient
with suspected inhalational
injury and facial and neck burn
NANANA
2
5
8

8. Progress
note
Signs and symptoms of compart-
ment syndrome for patient with
circumferential burn injuries
NA11
6.12Consultation to the burn unit is
made (Time of consultation spec-
ified)
Triangulate
Patient’s ED
Admission
Note with
ED Order
Sheet with
Consulta-
tion Sheet
NANANA
7 APPROPRIATE PATIENT DIS-
POSITION IS DONE FOR A
PATIENT PRESENTING WITH
BURN
100% 100
%
100%
7.1For patient with partial thickness
burn >10% or full thickness burn
>2%, patient with burns to the face,
major joints, perineum or hands,
patient with high voltage electrical
burns or lightening or patient with
chemical burns; patient is admitted
or referred to burn unit
Triangulate
Patient’s ED
Admission
Note with
ED Order
Sheet with
Transfer/re
- ferral
sheet
NANAYes
2
5
9

9. 8 IDENTIFICATION OF CARE
PROVIDER IS DOCUMENTED
FOR A PATIENT PRESENTING
WITH BURN
100% 100
%
100%
8.1Name and signature of the
phy- sician is clearly
documented on all ED
admission history and P/E
sheets
ED admis-
sion History
sheet
YesYesYes
8.2Name and Signature of the
physi- cian is clearly
documented on all ED progress
notes
ED progress
note sheet
YesYesYes
8.3Name and signature of the physi-
cian is clearly documented on all
ED order sheets
ED
order
sheet
YesYesYes
8.4Name and signature of the nurse
is clearly documented on all ED
medication sheets
ED medica-
tion sheet
YesYesYes
9 PATIENT DIAGNOSED WITH
BURN DIED WHILE BEING
MANAGED IN THE EMER-
GENCY WITHIN 24HOURS OF
ADMISSION TO ED
2% Triangulate
admission
note with
progress
note and
discharge
note.
NANANA
Total standards met per chart 80%
Percentage