Safety Checklist before Lumbar Puncture
Kings College Hospital caters to outpatient LP service for patients
throughout southeast England. Many patients used to arrive without
recent coagulation profile or proper medical history, which made it
difficult to rule of risk of cerebral herniation. This resulted in
multiple cancellations of the scheduled LPs. They decided to email a
safety checklist, containing two important information among others viz
a recent platelet count and coagulation profile and a statement
regarding assessment of raised CSF pressure either clinically or
radiologically, to be filled up by the neurologists, before referring
their patients for LPs.34 Following the implementation
of this simple checklist, the percentage of patients with an available
platelet count and coagulation profile and intracranial imaging,
increased to 89%, 82% and 98%, compared to 25%, 18%, and 75%
respectively, before the safety checklist. This translated into
increased efficiency ,as less procedures needed to be cancelled and,
safety of outpatient LP service,34 with an indirect
gain in the form of increased confidence of the junior doctors
performing the procedure. Using inputs from 9 experts and applying
modified Delphi technique, Berg et al. suggested a 20-point LP checklist
using a modified Delphi technique,35 which provides
step by step guide, before and during the procedure {Figure
4}.