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Introduction The Bowel Screening Wales (BSW) Network Multi Disciplinary Team (NMDT) and National Referral Centre (NRC) pilot was established in October 2011 to offer the opportunity for expert opinion and discussion of therapeutic options for participants with complex benign polyps detected on the Welsh bowel screening programme. Methods Participants with lesions that satisfied the agreed criteria were referred to the NMDT for advice from the expert panel regarding management. Recommended outcomes included local endoscopic or surgical treatment or referral to the NRC for endoscopic or surgical treatment. Between the 17 th of October 2011 and the 20 th August 2012 October 2012 100 cases from all over Wales were discussed at NMDT meetings by video conference. Referrals were received from all 6 Health Boards in Wales and 11 of the 14 Local Assessment Centres (LAC) during this time frame. Referral data and NMDT decisions were prospectively stored on a shared drive and a comprehensive data set entered onto the BSW registry for complex polyps. Results The first 100 cases discussed at NMDT meetings satisfied the following referral criteria: 21 lesions with difficult to access 17 lateral spreading tumours > 2cms 11 participants with polyps greater than 4cms 20 participants with polyps in the right colon > 2cms 7 participants with residual polyps 24 others 52 cases were referred back to Local Assessment Centres for treatment, and 48 to the NRC for treatment. Detailed data on procedure type and final outcome will be presented in June. All cases referred to the NMDT for discussion were thought to be benign at the time of referral which was confirmed by initial biopsy. Final histology was found to be adenocarcinoma in 6 cases. Data analysis will continue and include recurrence rates at 3, 6 and 12 months, post procedure complication rates and final number of procedures undertaken per participant for each lesion removed. Conclusion The BSW NMDT and NRC have facilitated equity of service for participants of the bowel screening programme in Wales with complex benign polyps. Referrals to surgery for benign disease have been reduced as a result. This process has also facilitated central referral for specialist endotherapy and surgical procedures. Disclosure of Interest None Declared.

Introduction Large flat or sessile lesions are not uncommon on a screening colonoscopy list and endoscopic removal is often technically challenging. The assessment process for screening colonoscopists in Wales does not assess therapeutic skill and variation in rates of referral to surgery suggest that clinician skill level may influence management decisions. A Network Multi Disciplinary Team (NMDT) and National Referral Centre (NRC) pilot was established to offer the opportunity for expert opinion and discussion of therapeutic options for participants of the welsh bowel screening programme. Methods The six month pilot began in October 2011 by taking referrals from Screening Colonoscopists and local MDT’s. The aim was to provide a service that would reduce variation of practise with potential value for education on lesion recognition, EMR technique and decision making. Expressions of interest were invited and expert advisors appointed for Colonoscopy, Pathology, Radiology and Surgery. Specialist Screening Practitioners and management staff were appointed and the NMDT established as a virtual group to meet biweekly. Referral criteria were agreed based on a composite of size, morphology and accessibility of lesion. Participants with lesions satisfying the criteria were referred to the NMDT electronically. Local Assessment Centres were provided with image capture devices and staff trained to record and edit video clips which were subsequently saved on a share drive, reviewed by expert advisors and discussed at NMDT meetings. Expertise in complex polypectomy is often limited to few centres and the NRC was designated in a unit accessible to colonoscopists with appropriate skills. It was established in Cardiff at University Hospital Llandough via an agreement with Public Health Wales. Depending on outcomes of NMDT discussions participants were given the option of accessing local surgery or travelling to the NRC for therapeutic endoscopy where appropriate. Results During the initial pilot phase 13 meetings were held. No meeting was cancelled due to availability of advisors, 1 was cancelled on a bank holiday and 1 because of technical difficulties. Thirty eight cases were referred for discussion and 15 of them referred to the NRC for therapeutic procedures. Challenges including image quality, video transmission and interface with local MDT’s were discussed at a multidisciplinary workshop and solutions identified for future development. Evaluation of the pilot indicates that the service has been well received by participants, NMDT members and local teams. Conclusion This development has been logistically feasible, safe and successful in providing an equitable service for participants of the bowel screening programme in Wales and has contributed to a reduction in referrals for surgery for benign lesions. Disclosure of Interest None Declared.

Introduction Risk management is an essential part of the clinical governance framework and central to this is adverse event reporting. The aim of this study is to increase the number of adverse events reported to Bowel Screening Wales (BSW). Methods The primary research method included a literature review. The focus for the study was adverse event reporting and recording methods. Referral patterns were recorded prior and post intervention and the data compared. The literature review informed the various processes adopted in an attempt to increase referrals for adverse events from the Local Assessment Centres (LACs). The interventions took place in all LACs throughout February 2011. They included defining and providing examples of adverse events, educating the Specialist Screening Practitioners (SSPs) and providing a more flexible approach for reporting. A file using Microsoft Office Excel was developed to categorise referrals by subject and consequence. Referrals from the beginning of the programme were collated, categorised, given a consequence score and recorded in this file. This allowed for a baseline to compare against future referrals. Results The number of adverse events reported from the launch of BSW on 27 October 2008 until 30 January 2011 was 54. This compared to 100 adverse events reported during the time period 1 February 2011 to 27 November 2011. Referrals have increased fivefold since the intervention took place. Standardising the categories and consequences allowed for monitoring and comparison on the types of events reported to BSW per LAC. This helped to focus appropriate intervention including further education for reporting where it was needed. The type and severity of adverse events reported post intervention increased for the more minor and more serious adverse events. The less serious categories 1 and 2 saw almost a sevenfold increase in the rate of reporting while the more serious categories 3, 4 and 5 experienced an increase of 1.5. There was concern that serious incidents went under-reported prior to the intervention. However, this evidence is re-assuring in that the rate of reporting is far higher for the more minor events post intervention than for the more serious events. The information for the more serious events was cross-checked retrospectively with the SSPs around Wales who confirmed these findings. Conclusion The primary aim of the study was achieved and the annual rate of adverse events reporting to BSW has increased fivefold. Ongoing education is required to ensure adverse event reporting does not get forgotten and certainly until the process has become embedded in practice. The process and framework has enabled BSW to collate information providing a consistent approach for regular review and monitoring of adverse events by the BSW programme. Competing interests None declared.

Objective Patients in paediatric intensive care (PICU) are often fluid restricted and require a high volume of intravenous infusions, allowing little volume for nutritional intake. Bespoke parenteral nutrition (TPN) is associated with higher costs and increased staff time compared with use of standard TPN. This study looks at the desired, prescribed and actual nutritional intake of patients having parenteral nutrition on PICU. Would a standard TPN formulation improve the nutritional intake for these patients? Method Patients with central venous access requiring TPN on PICU were included in the data collection; patients receiving any enteral intake were excluded. Weight, fluid allowed, TPN prescription, TPN intake, volume of continuous infusions and reasons for withholding TPN were recorded. The desired calorific intake was calculated using values from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) TPN guidelines. A proposed standard PICU TPN bag formulated was compared with actual intake of the patients included the study. Results 16 patients with a mean of 4.24 kg (range 0.88–18 kg) received 159 days of parenteral nutrition during the data collection period. Over two thirds of TPN days allowed 100% maintenance fluid or above to be given, however on 42 (26.4%) days the patients were restricted to less than 80% of normal daily fluid allowance. On 62 TPN days the patients were receiving over 10% of their allowed fluid intake as drug infusions. The mean daily fluid allowance given as TPN was 74% of the prescribed fluid allowance. On 62 (38.9%) TPN days over 95% of the prescribed TPN was delivered to the patient, however on 41 (25.7%) days less than 80% of the prescribed TPN reached the patient. Only 66 (41.5%) TPN days provided the desired nutritional intake, 42 days provided between 80 and 95% of the patients required intake and on 51 TPN days the patient received less than 80% of their desired nutritional intake. In 43 of the 51 TPN days where less than 80% of the desired intake was achieved, the proposed PICU standard bag could have been fully administered. More calories would have been delivered on each of the 51 days. Conclusion The calories a PICU patient prescribed TPN frequently does not provide the desired nutritional intake due to a number of factors. This study shows that a fluid restricted PICU patient will receive more calories from a standard TPN bag than a bespoke formulation; and this may provide financial and productivity savings for PICU.