Improving management of oesophageal varices in patients with cirrhosis.
OBJECTIVE
A retrospective audit of management of oesophageal varices in patients with cirrhosis identified the need to improve adherence to guidelines.


METHODS
Prospective audit of the effect of disseminating guidelines in 2004; prospective audit of the effect of a nurse coordinator for oesophageal variceal screening and surveillance from 2005 to 2008.


METHODS
A major public hospital in Australia 2001-2008. Patients with cirrhosis of the liver and those who had experienced a variceal bleed were studied.


METHODS
(1) Adherence with primary prevention protocols for prevention of primary variceal bleeding in patients with cirrhosis of the liver. (2) Adherence with protocols for acute management of variceal bleeding and secondary prevention of bleeding.


METHODS
Local protocols were developed and disseminated. A nurse coordinator was introduced to manage the primary prevention process according to a clinical protocol.


RESULTS
The introduction of a nurse coordinator to manage the primary prevention process resulted in dramatic and rapid improvements in primary prevention. This has been maintained with our target of 90% adherence being achieved for the last 3 years.


CONCLUSIONS
Disseminating guidelines had little effect on primary prevention practice. Less than 1 year after a nurse coordinator was introduced to manage primary prevention, adherence to primary prevention guidelines increased from 13% to 79%. However, significant improvements in the management of acute variceal bleeding where medical staff have a clear responsibility for patient care were achieved through the development and dissemination of clear clinical protocols and the introduction of auditing and feedback mechanisms.
Wundke
Rachel
R
Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, Australia.
Altus
Rosalie
R
Sandford
Jayne
J
Wigg
Alan
A
D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000451:nursing*; D005260:Female; D019983:Guideline Adherence; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006779:Hospitals, Public; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008403:Mass Screening; D008485:Medical Audit; D008875:Middle Aged; D024802:Nurse's Role; D012189:Retrospective Studies; D013021:South Australia