Nerve root injection cancellations due to incomplete anticoagulation administration.
Br J Hosp Med (Lond). 2018 Aug 02;79(eight):465-467
Authors: Robinson E, Shahipasand S, Liantis P, Mandegaran R, Zavareh A
BACKGROUND: Computed tomography-guided steroid injection is a well-recognized, conservative therapy of localized spinal ache on account of aspect arthropathy and radiculopathy secondary to nerve root compression. An especially uncommon complication is the event of an epidural haematoma with potential to trigger everlasting neurological injury, so anticoagulation on the time of process is contraindicated. Routinely injections are carried out as an outpatient requiring the referring doctor to implement a peri-procedural anticoagulation plan. Anecdotal expertise urged that cancellations have been occurring as sufferers remained on anticoagulation on the time of their appointment. The authors due to this fact assessed the prevailing service in opposition to anticipated requirements to establish the causes of cancellations and discover methods to enhance the service.
AIMS: This audit aimed to establish the incidence of cancelled computed tomography-guided nerve root injections secondary to incorrect peri-procedural anticoagulation administration, develop an intervention to assist scale back the incidence of cancellations after which re-audit to evaluate the impact of the intervention.
METHODS: The audit commonplace was that 100% of outpatients attending for computed tomography-guided nerve root and aspect injections ought to have an applicable anticoagulation plan carried out. Baseline knowledge assortment passed off prospectively between 1 September and 30 November 2016. The examine inhabitants was elective computed tomography-guided spinal nerve root and aspect injections scheduled on the radiology info system on the authors’ belief. Descriptive evaluation was accomplished. The intervention concerned a revised digital request type being carried out with new obligatory fields regarding antiplatelets and anticoagulants. Re-audit post-intervention concerned potential knowledge assortment between 1 September and 30 November 2017 utilizing the identical strategies.
RESULTS: Baseline audit discovered that of three out of 55 (5%) sufferers had cancellations. On re-audit, there have been zero cancellations out of 93 sufferers.
CONCLUSIONS: The brand new request type prevented 5% of sufferers referred for computed tomography-guided nerve root injection being cancelled due to incorrect anticoagulation administration. Extrapolated over the 12 months the potential financial savings by stopping misplaced exercise are £3445.56.
PMID: 30070943 [PubMed – in process]