Fyson Jeremy, Chapman Laura, Tatton Michael, Raos Zoë
Department of Medicine, North Shore Hospital, Auckland, New Zealand.
Department of Gastroenterology, North Shore Hospital, Auckland, New Zealand.
Intern Med J. 2018 May;48(5):572-579. doi: 10.1111/imj.13741.
Paracentesis is a common invasive procedure performed by junior doctors. Audit of procedure conduct at two New Zealand hospitals in 2012 revealed poor performance across a range of quality measures, including documentation of informed consent, excessive catheter dwell times and inappropriate albumin prescription. Complication rates were 12.7%, compared with published rates of around 9%. A local procedure protocol did not exist.
To evaluate the effect of a standardised procedure checklist (PC) and equipment kit (EK) on procedural quality and complication rates for abdominal paracentesis.
After presenting the 2012 audit results to resident doctors, we reviewed the paracentesis literature and developed a local procedure protocol (PC and EK). These tools were made readily available after an education campaign. Paracenteses performed after the intervention were studied to determine the impact on procedural quality and safety.
Seventy-four paracenteses (14 diagnostic; 60 therapeutic) were performed in 10 months after the introduction of PC and EK. Significant improvements were observed with the use of PC including documentation of informed consent (97% vs 74%, P = <0.01) and aseptic technique (100% vs 62%, P = <0.01). Catheter dwell times <6 h improved (72% vs 48%, P = 0.02). Inappropriate albumin prescriptions were less frequent (21% vs 66%, P = <0.01). Complication rates decreased from 12.7% to 2.8% (P = <0.01).
The PC and EK improved rates of informed consent, appropriate documentation and protocol adherence. Significantly fewer procedure-related complications occurred after introduction of these tools.
腹腔穿刺术是初级医生进行的常见侵入性操作。2012年对新西兰两家医院的操作行为审核发现，在一系列质量指标方面表现不佳，包括知情同意书的记录、导管留置时间过长和白蛋白处方不当。并发症发生率为12.7%，而公布的发生率约为9%。当时不存在本地操作规范。
评估标准化操作检查表（PC）和设备套件（EK）对腹腔穿刺术操作质量和并发症发生率的影响。
向住院医生展示2012年审核结果后，我们查阅了腹腔穿刺术相关文献并制定了本地操作规范（PC和EK）。在开展教育活动后，这些工具随时可供使用。对干预后进行的腹腔穿刺术进行研究，以确定其对操作质量和安全性的影响。
在引入PC和EK后的10个月内进行了74例腹腔穿刺术（14例诊断性；60例治疗性）。使用PC后观察到显著改善，包括知情同意书的记录（97%对74%，P =<0.01）和无菌技术（100%对62%，P =<0.01）。导管留置时间<6小时的情况有所改善（72%对48%，P = 0.02）。不当白蛋白处方的情况减少（21%对66%，P =<0.01）。并发症发生率从12.7%降至2.8%（P =<0.01）。
PC和EK提高了知情同意率、适当记录率和规范遵守率。引入这些工具后，与操作相关的并发症显著减少。
