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Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department
INTRODUCTION: Lumbar puncture (LP) for the collection of cerebrospinal fluid is an important diagnostic tool for the evaluation of febrile or ill-appearing infants. This invasive procedure is painful for patients; inadequate analgesia may have lasting effects. The American Academy of Pediatrics reco...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190259/ https://www.ncbi.nlm.nih.gov/pubmed/32426647 http://dx.doi.org/10.1097/pq9.0000000000000292 |
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author | Balay, Erin E. Hendrickson, Marissa A. Harvey, Brian Dewald, Jennifer Johnson, Brittany Louie, Jeffrey |
author_facet | Balay, Erin E. Hendrickson, Marissa A. Harvey, Brian Dewald, Jennifer Johnson, Brittany Louie, Jeffrey |
author_sort | Balay, Erin E. |
collection | PubMed |
description | INTRODUCTION: Lumbar puncture (LP) for the collection of cerebrospinal fluid is an important diagnostic tool for the evaluation of febrile or ill-appearing infants. This invasive procedure is painful for patients; inadequate analgesia may have lasting effects. The American Academy of Pediatrics recommends analgesia during all LP procedures, and oral sucrose alone does not offer sufficient analgesia. Our objective was to identify analgesic use trends during infant LP in our emergency department and create a system of analgesic administration. We aimed for complete compliance with one method of analgesia and an increase in our use of 2 or more methods to 85% over 12 months. METHODS: We utilized Plan-Do-Study-Act cycle methodology and retrospective chart review. Five interventions focused on staff communication, collaboration, and education. Inclusion criteria: infants <60 days who underwent LP procedure due to fever >38°C, hypothermia <36.5°C of unknown origin, or ill-appearance. RESULTS: One hundred infant LPs analyzed: 52 preintervention and 48 intervention. The use of one analgesic increased from 98% preintervention to 100%. The use of 2 or more analgesics increased from 58% preintervention to 87%. Topical lidocaine use increased from 56% preintervention to 73%. LP success rates were high in both groups, with no statistically significant change in the success rate. CONCLUSION: We created a streamlined process to ensure all infants undergoing lumbar puncture received at least 1 analgesic and increased the proportion of infants treated with 2 or more analgesics. This work could be expanded to improve analgesia during other invasive procedures in the emergency department. |
format | Online Article Text |
id | pubmed-7190259 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-71902592020-05-18 Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department Balay, Erin E. Hendrickson, Marissa A. Harvey, Brian Dewald, Jennifer Johnson, Brittany Louie, Jeffrey Pediatr Qual Saf Individual QI Projects from Single Institutions INTRODUCTION: Lumbar puncture (LP) for the collection of cerebrospinal fluid is an important diagnostic tool for the evaluation of febrile or ill-appearing infants. This invasive procedure is painful for patients; inadequate analgesia may have lasting effects. The American Academy of Pediatrics recommends analgesia during all LP procedures, and oral sucrose alone does not offer sufficient analgesia. Our objective was to identify analgesic use trends during infant LP in our emergency department and create a system of analgesic administration. We aimed for complete compliance with one method of analgesia and an increase in our use of 2 or more methods to 85% over 12 months. METHODS: We utilized Plan-Do-Study-Act cycle methodology and retrospective chart review. Five interventions focused on staff communication, collaboration, and education. Inclusion criteria: infants <60 days who underwent LP procedure due to fever >38°C, hypothermia <36.5°C of unknown origin, or ill-appearance. RESULTS: One hundred infant LPs analyzed: 52 preintervention and 48 intervention. The use of one analgesic increased from 98% preintervention to 100%. The use of 2 or more analgesics increased from 58% preintervention to 87%. Topical lidocaine use increased from 56% preintervention to 73%. LP success rates were high in both groups, with no statistically significant change in the success rate. CONCLUSION: We created a streamlined process to ensure all infants undergoing lumbar puncture received at least 1 analgesic and increased the proportion of infants treated with 2 or more analgesics. This work could be expanded to improve analgesia during other invasive procedures in the emergency department. Wolters Kluwer Health 2020-04-14 /pmc/articles/PMC7190259/ /pubmed/32426647 http://dx.doi.org/10.1097/pq9.0000000000000292 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Individual QI Projects from Single Institutions Balay, Erin E. Hendrickson, Marissa A. Harvey, Brian Dewald, Jennifer Johnson, Brittany Louie, Jeffrey Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department |
title | Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department |
title_full | Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department |
title_fullStr | Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department |
title_full_unstemmed | Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department |
title_short | Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department |
title_sort | optimizing analgesic use during infant lumbar puncture in the emergency department |
topic | Individual QI Projects from Single Institutions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190259/ https://www.ncbi.nlm.nih.gov/pubmed/32426647 http://dx.doi.org/10.1097/pq9.0000000000000292 |
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