Zeroing in: achieving zero complications in lumbar puncture - a quality improvement initiative to reduce complications at the University Hospital of North Norway.

Abstract

Background: Lumbar puncture (LP) is an essential diagnostic procedure in neurology, but carries risk, with post-lumbar puncture headache being the most frequent complication. In 2017, a severe complication with intracranial haemorrhage following LP in Northern Norway led to an evaluation of LP procedures and resulted in the development of a new unified regional procedure.

Local problem: At the University Hospital of North Norway (UNN), 10% of LPs performed in 2017 resulted in a complication. A survey identified gaps in protocol adherence, physician training, and patient education.

Intervention: Aiming to reduce LP complication rates from 10% to 1% by January 2019, we implemented standardised protocols, introduced smaller gauge needles, enhanced physician training and improved patient education.

Results: Complication rates dropped to 1%, achieving 107 consecutive complication-free procedures by January 2019, with sustained improvement over subsequent years.

Conclusion: Standardised protocols, physician training, introduction of smaller gauge needles and patient education significantly reduced LP complications. Educating patients on expectations and post-procedure care was critical in preventing unnecessary admissions and outpatient visits.