Improving the Safety of Tourniquet Use in a Trauma Theatre According to the British Orthopaedic Association Guidelines: A Closed Loop Audit.

Introduction Tourniquets are used widely in trauma and orthopaedic surgery to reduce blood loss and facilitate better visualisation of the operative field; however, some complications can result from improper use such as pressure sores, chemical burns, compartment syndrome, and deep vein thrombosis. We audited the use of intraoperative tourniquets in our trauma theatre against the guidance published by the British Orthopaedic Association (BOA) in 2021. Methods This was a closed-loop audit evaluating 80 trauma operations that utilised tourniquets. In the first cycle, we audited 40 operations (23 upper limbs vs 17 lower limbs) over a period of two months through a review of operation notes and theatre documentation. We presented our findings and implemented changes including the addition of tourniquet use to the operation note template and labels on the tourniquet machines aiding the calculation of tourniquet pressures. A re-audit was then performed involving a further 40 operations (20 upper limbs and 20 lower limbs). Statistical analyses were performed to compare the two cycles. Results Tourniquet time was on average similar across both audit cycles (60.7 vs 70.0,