One-Year Prospective Audit of Truncal Blocks Using Regional Anesthesia Database App

10 May, 2018 jaccradmin 0 Comments

Vol 4 | Issue 2 | May-Aug 2018 | page: 9-14 | Hetal Vadera, Shiv Kumar Singh, Gurunath Murthy, Vedha Balasubramaniam.

Authors: Hetal Vadera [1], Shiv Kumar Singh [2], Gurunath Murthy [3], Vedha Balasubramaniam [4].

[1] Department of Anaesthesia, Sterling Hospital, Rajkot, Gujarat, India,

[2] Consultant Anaesthetist, Royal Liverpool University Hospitals, Convener of The Anaesthetic Society, India (TAS), TAS QI Team Member, UK.

[3] Consultant Anaesthetist, Modbury Hospital, Modbury SA 5092, RAD app and Database® Administrator, The Anaesthetic Society, India (TAS) QI Team Member; Co-Founder of Medusys, Australia.

[4] Consultant Anaesthetist, Mater Hospital, South Brisbane, The Anaesthetic Society, India (TAS) QI Team Member, Australia.

Address of Correspondence

Dr. Hetal Vadera,
Department of Anaesthesia,
Sterling Hospital, Rajkot, Gujarat, India.
E-mail: vaderahetal@gmail.com

Abstract

Aims and Objectives: Truncal blocks like chest and abdominal wall peripheral nerve blocks have been reported to be an effective method of providing analgesia for surgeries on the chest wall and the abdomen. We present results of a prospective audit of the practice and outcomes of these techniques using a novel mobile app and web-based e-audit tool (RAD app and national database ®) to identify safety and quality with description of newer blocks.

Design: Prospective single centre audit over a 1-year period using e-clinical audit tool (RAD app and national database®)

Setting: 210 bedded NABH accredited multi-speciality Private hospital.

Patients: All patients who had Peripheral nerve blocks for chest and abdominal surgeries

Measurements: Data on practice, clinical and patient related outcome measures were prospectively entered in the mobile app and web-entries. Data analysis is automated and summary statistics with comparison to national data is presented here.

Results: Data analysis is automated and summary statistics with comparison to national data is presented. 147 patients received 199 blocks between 3rd July 2017 to 2nd July 2018.Youngest patient was 1 year old and oldest being 84 years of age. 40% of patients were males and 15.4% of surgeries were for emergency reasons. Few new blocks were added into our practice during this year including the erector spinae plane block, quadratus lumborum block and serratus plane block. The overall quality and safety of these new blocks are comparable to Indian national benchmark and available literature.A number of differences in practice compared to national sample data is identified including greater use of ultrasound in our practice(70% vs 31.6% nationally), significantly, more blocks are done pre-operatively (75% compared to 50% nationally). Outcomes in terms of success rates and post-operative analgesia, opioid consumption are comparable.40% of our patients had opioid free surgery and 85% of the patients had no analgesic requirement in their recovery period.Quality assurance audit data shows that only 63.3% of the patients had correct site check/block specific time-out done. Ultrasound probe cover was not used in 95% of the cases. Patient related outcome measures are reported for the first time showing high rates of satisfaction and likelihood of having regional anaesthesia/analgesia again.

Conclusions: This is the first reported audit of peripheral nerve blocks of chest and abdomen in India. This audit was enabled by an e-audit tool (RAD app and database®) which removed many barriers in doing clinical audit in busy day-to-day practice. The audit was done with minimal effort using smart entry system and automated analysis of graphs and charts. The project is ongoing and data from 1st year is reported to identify practice and outcomes of our regional anaesthesia practice. A number of practice changing recommendations are identified to further improve quality and safety of our regional anaesthesia practice.

Recommendations: 1. Correct site check and timeout before block to be 100%. STOP before block to be ensured in 100% of patients.

2. Ultrasound Probe cover to ensure sterility is maintained should be achieved in 100%.

3. Ensure more than 90% complete data collection to measure the Patient related outcome measures as accurately as possible.

Keywords: Peripheral nerve blocks, Audit, Regional Anaesthesia, Truncal blocks, chest and abdominal wall blocks, Database

References

Neal JM, Brull R, Chan VW, Grant SA, Horn JL, Liu SS, et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary. Reg Anesth Pain Med 2010;35:S1-9.
Baeriswyl M, Zeiter F, Piubellini D, Kirkham KR, Albrecht E. The analgesic efficacy of transverse abdominis plane block versus epidural analgesia: A systematic review with meta-analysis. Medicine (Baltimore) 2018;97:e11261.
Fisher ES, Shortell SM. Accountable care organizations: Accountable for what, to whom, and how. JAMA 2010;304:1715-6.
Singh MM, Devi R. Clinical audit: More of a dream than a reality in India. BMJ 2014;348:g2514.
Smith MD. What about a national clinical audit results database? BMJ 2014;348:g1303.
Sites BD, Barrington MJ, Davis M. Using an international clinical registry of regional anesthesia to identify targets for quality improvement. Reg Anesth Pain Med 2014;39:487-95.
Johnston G, Crombie IK, Alder EM, Davies HT, Millard A. Reviewing audit: barriers and facilitating factors for effective clinical audit. BMJ Qual Saf 2000;9:23-36.
Miles A, Bentley P, Polychronis A, Price N, Grey J. Clinical audit in the national health service: Fact or fiction? J Eval Clin Pract 1996;2:29-35.
Nolan M, Scott G. Audit: An exploration of some tensions and paradoxical expectations. J Adv Nurs 1993;18:759-66.
Robinson S. Audit in the therapy professions: Some constraints on progress. Qual Health Care 1996;5:206-14.
Cantore F, Boni L, Di Giuseppe M, Giavarini L, Rovera F, Dionigi G, et al. Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy: A new device for day-case procedure. Int J Surg 2008;6 Suppl 1:S89-92.
Rajivlochan M. Clinical audits and the state of record keeping in India. Ann Neurosci 2015;22:197-8.
Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: A metaanalysis. Br J Anaesth 2013;111:721-35.
Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W, et al. Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013;118:934-44.
Joshi GP, Schug SA, Kehlet H. Procedure-specific pain management and outcome strategies. Best Pract Res Clin Anaesthesiol 2014;28:191-201. 16. Ettorchi-Tardy A, Levif M, Michel P. Benchmarking: A method for continuous quality improvement in health. Healthc Policy 2012;7:e101-19.

How to Cite this Article: Vadera H, Singh S, Murthy G, Vedhabala. One-Year Prospective Audit of Truncal
Blocks Using Regional Anesthesia Database App. Journal of Anaesthesia and Critical Care Case Reports May-Aug 2018; 4(2):9-14.