The first 24 hours is the most crucial timeframe for reducing morbidity and mortality in patients with decompensated liver cirrhosis and the use of the Cirrhosis Care Bundle in the first 24 hour has been shown to improve clinical outcomes in several tertiary centres across the UK. Our aim was to introduce the Cirrhosis Care bundle on the Medical Acute Unit (MAU) to improve the care of patients with decompensated liver cirrhosis.Methods
Two prospective audit cycles were conducted between Nov 2016 to April 2017. In each cycle, we prospectively reviewed all patients admitted with decompensated liver cirrhosis on the MAU. The first audit cycle was conducted between Nov to Dec 2016. Following which, several teaching sessions were organised to educate the MAU staff and doctors on the Cirrhosis Care bundle, one of which was delivered by Consultant gastroenterologist. Paper copies of the Cirrhosis Care bundle were also made available in the MAU. Second cycle was conducted after introducing the Cirrhosis care bundle.Conclusions
After formally adopting the Cirrhosis care bundle, we have seen an improvement in the frequency of ascitic taps performed, treatment of spontaneous bacterial peritonitis, prescription of VTE prophylaxis and hepatic encephalopathy. Our targets have certainly approved but not enough to meet quality standards. It was decided to conduct third cycle to improve our targets. We decided to educate doctors in A and E because patients spend more time there before being transferred to MAU due to pressures on NHS. The teaching involved identifying patients presenting with signs and symptoms of decompensated liver disease and education about the cirrhosis care bundle, its importance. Third cycle is in progress and showing promising Results.