P149 A service evaluation of skin biopsies completed across a local dermatology department, following a never event

Abstract The British Dermatological Nursing Group, British Association of Dermatologists and Royal College of Nursing’s ‘Clinical Dermatology Nursing Role Descriptors’ guides clinical practice for nurses working within the dermatology department, performing skin biopsies [Griffiths T, Jackson K, Lawton S et al. Clinical Dermatology Nursing Role Descriptors: guidance on scope of practice. AFC bands 5–8. Available at: https://bdng.org.uk/wp-content/uploads/2017/02/Clinical-Dermatology-Nursing-Role-Scope-of-practice-guide-bands-5-8-FINAL2.pdf (last accessed 19 February 2025)]. Following a local never event of a skin biopsy taken from an incorrect site, a service review took place, concluding that all skin surgeries should be performed by band 6 nurses and above, with head and neck biopsies only performed by band 7 nurses and above. Initial retrospective analysis was conducted of all skin biopsies performed in the department between 1 and 31 July 2024, using the local skin biopsy logbook. Extracted data included the site of skin biopsy (involving or below head and neck) and the grade of surgeon. By evaluating compliance to the above guidance, service change was highlighted and established. Further retrospective evaluation was subsequently conducted between 8 November and 8 December 2024. Between 1 and 31 July 2024, 107 skin biopsies were performed: 25 (23.4%), 72 (67.3%) and 10 (9.3%) by band 5, 6 and 7 nurses, respectively. In total, 56 biopsies were performed of the head and neck: 16 (29%), 34 (61%) and 6 (11%) were performed by band 5, 6 and 7 nurses, respectively. Following service development, between 8 November and 8 December 2024, 85 skin biopsies were performed: 0 (0%), 21 (25%), 60 (71%) and 4 (5%) by band 5, 6 and 7 nurses, and a clinical fellow doctor, respectively. All 36 biopsies of the head and neck were conducted by a band 7 nurse (34, 94%) or clinical fellow doctor (2, 6%). The initial service evaluation showed that 23.4% of biopsies below the head and neck were not done by a band 6 nurse or above, and 89% of biopsies of the head and neck were not done by a band 7 nurse of above. Following the recommendations and service reconfiguration, 100% of all skin biopsies, from any site, are now performed by the appropriate level of nurse as per the Clinical Dermatology Nursing Role Descriptors.