An Audit ofCOVID-19 Vaccination in Elective Surgical Patients

Dr Grace Hillsmith and Dr Emma Gravett. Supervised by Dr Bhaskar Dutta

Introduction

• Growing numbers of elective surgical patients have received the COVID-19 vaccination

• The Royal College of Surgeons have released guidance on vaccination in regards to elective surgery

• Consistent documentation of vaccination status is imperative to ensure patient safety

Aims

Prevent ambiguity for patients and staff

Prevent on-the-day cancellations

Improve documentation

To complete the audit loop:

•Reassessment of baseline data

•Comparison of baseline and reassessment data

RCS Guidance and Literature Review

• RCS guidance:

• Non-urgent elective surgery can take place soon after vaccination

• Essential urgent surgery can take place regardless of vaccination status

• Surgery should be separated from vaccination by a few days (at most 1 week) to reduce confounding symptoms

• Literature evidence suggests between 48 hours and 7 days delay between vaccination and the date of elective surgery

Methods

Retrospective audit

Proforma of questions to patients undergoing elective surgery

Assessment of notes including preassessment documentation, surgical and anaesthetic notes

Audit cycle

• Baseline (cycle 1) data was gathered for 34 patients over a 2 week period starting from 1st March 2021

• This data was presented at the Anaesthetic Safecare meeting , where it was decided to adopt a policy of a 7-day gap preand post-surgery for vaccination, and to also document vaccination status at preassessment

• Information on these new policies was disseminated to the anaesthetic department and preassessment clinic staff.

• Reassessment (cycle 2) data was gathered for 29 patients over a 2 week period starting from the 19th April 2021

Baseline Results

• 47% of patients had received their first COVID-19 vaccination

• Only 7.6% of patients had their vaccination status documented in preassessment notes

• 21% of patients were given advice on vaccination and surgery, however the advice given was very varied

• Advice ranged from waiting between 4 days and 6 weeks between vaccination and surgery

• 2 patients had their COVID-19 vaccination within 7 days of their surgery.

Reassessment Results

• 90% of patients had received at least one vaccine, with 38% being fully vaccinated

• Documentation has much improved, with 86% having vaccination status recorded in their preassessment notes

• 59% of patients were given advice, the majority of which was a delay of 7 days between vaccination and surgery.

• No patients had their vaccination within 7 days of surgery.

Conclusions and Recommendations

• Increasing numbers of elective patients are fully vaccinated as the vaccine rollout continues across the UK

• Implementation of the policy of a 7-day gap between vaccination and surgery has been successful, with the majority of patients receiving the correct advice

• Documentation of vaccination status has improved but is not yet 100%.

• We recommend introducing a specific question on the preassessment document regarding COVID-19 vaccination to improve documentation to 100%

References

• https://www.rcseng.ac.uk/coronavirus/vaccinated-patientsguidance/#:~:text=Non%2Durgent%20elective%20surgery%20can,vaccination% 20or%20the%20operation%20itself.

• https://assets.publishing.service.gov.uk/government/uploads/system/uploads/a ttachment_data/file/147832/Green-Book-updated-140313.pdf