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Increasing adherence to BOMSS guidelines for post-bariatric surgery micronutrient optimisation: A closed-loop Quality Improvement Project

N.Limaye1*

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Background and Aims

Bariatric surgical procedures have significant impact on postoperative nutrition and dietetics play a crucial role in optimising management. Re-configuration of GI anatomy in bariatric procedures can increase the malabsorption of micronutrients. (MN)

Identifying low MN levels both pre- and post-operatively can help plan and optimise patients’ overall surgical care.

Aims:

1. Retrospectively analyse patients undergoing specific bariatric procedures between 01/09/22- 30/01/23 with low preoperative MN values

2. Comparison with national (BOMSS (MN) guidelines 2014 and 2020)

3. Implementation of 3 Plan-Do-Study-Act (PDSA) cycles with individual interventions tailored to identify and manage postoperative MN deficiencies

4. Re-audit following each PDSA cycle to track and quantify change

5. Plan to embed changes to create sustainable quality improvement

Discussion & Quality improvement

3 PDSA interventions were applied following the initial audit analysis.

PDSA 1: Bariatric FY1 Word list on shared P drive (Fig.1)

PDSA 2: Visual posters placed in theatre areas (Fig.1) PDSA 3: Active handover/meeting with aims and goals of QIP given to next rotation of General Surgery FY1s

Table 1 demonstrating post-intervention reaudit by type of surgery :

Conclusions and Sustainability

This project has generated a successful statistically significant quality improvement and we hope this will be beneficial to patient outcomes in nutrition management and ERAS post bariatric surgery.

Sustainability was also a crucial consideration in this QIP, we have avoided excess cost through testing by identifying at-risk patients. We have also embedded our interventions for longterm, sustainable quality improvement.

References: Guidelines:

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