Title : Second loop of the Neck Of Femur (NOF) operation notes Audit
Abstract:
Background: Neck of Femur (NOF) fractures are common injuries associated with significant morbidity and mortality, requiring timely surgical management and high-quality perioperative documentation. Accurate operative notes are essential for ensuring continuity of care, guiding postoperative management, and reducing medico-legal risk. Previous local audit data demonstrated poor compliance with documentation standards set by the Royal College of Surgeons of England, with 0% of operation notes meeting full compliance prior to intervention.
Aim: To evaluate and compare compliance with national operative note documentation standards between the first and second audit cycles following the introduction of a standardized NOF operation note template, and to assess differences between template and non-template use.
Methods: A retrospective audit was conducted at Kettering General Hospital including all surgically managed NOF fracture patients over a two-week period between April and May 2023. Procedures included hip arthroplasty, dynamic hip screw fixation, and intramedullary nailing. Data were collected from electronic patient records (Bluespier and Mediviewer). Operative notes were assessed against RCS England guidelines, with subgroup analysis comparing cases where a standardized NOF template was used versus freehand documentation.
Results: Seventeen patients were identified in the second audit cycle. All operation notes (100%) were typed, demonstrating improvement in legibility and accessibility. The NOF template was used in 53% (n=9) of cases. Overall compliance with RCS guidelines significantly improved compared to the initial audit, achieving 100% adherence in key domains including postoperative instructions and follow-up planning. However, certain elements, such as documentation of suture removal, remained inconsistently recorded.
Conclusion: Introduction of a standardized NOF operative note template significantly improved compliance with national documentation standards and enhanced communication between surgical and ward teams. Wider adoption of the template is recommended to ensure consistency and further improve patient safety. Re-audit is planned to assess sustainability.
