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}.