Introduction Large volume ascites is a common cause of hospitalisation and and has a two-year mortality of approximately 50%. Therapeutic paracentesis is the first line treatment for patients with large or refractory ascites and is regularly carried out in medical wards and radiology departments. Paracentesis is generally a safe procedure but there are variations in practice and potential complications, so an audit was carried out comparing local practice to recommendations set out by the British Society of Gastroenterology. A small group of junior doctors devised and implemented a number of interventions, after which the audit loop was completed to gauge their impact.
Method A retrospective study was carried out looking at ascitic drain insertions at Queen Elizabeth district general hospital over the three month period up to 31/3/2014. Reason for insertion, documentation of consent, consideration of complications, use of ultrasound, insertion site, vessels used for specimen collection, prescription of plasma expanders and total drainage time were recorded. A number of interventions were devised, including a sticker to put in patient notes to improve documentation and act as a reminder of best practice. A trust guideline was established and multidisciplinary teaching sessions were held for doctors and nurses. A re-audit then evaluated drain insertions over three months up until 31/7/14.
Results 35 drain insertions were evaluated in total (mean age 58), 80% >wards and 20% >interventional radiology. Cirrhosis was the most common cause of cirrhosis (60%), followed by malignancy (37%). Documentation of consent rose from 47% pre-intervention to 86%, while documentated consideration of complications rose from 33% to 79%. Clear instructions relating to drain removal time went from 62% to 100%. Following the interventions, there was also more consistency with the presciption of plasma plasma expanders and improved rates of ascitic fluid inoculation into blood culture bottles.
Conclusion Simple interventions of improved resources, more readily accessible information and multidisciplinary teaching can lead to better documentation and reduction in risk of complications. Care can be made more consistent and aligned with national recommendations. By identifying areas for improvement and taking on contained projects with clear goals, junior staff are capable of making small, precise interventions to a service that can lead to gains in quality and safety of care.
Disclosure of interest None Declared.
Gines P, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology 1987;7:12–18
Lucena MI, et al. Multicenter hospital study on prescribing patterns for prophylaxis and treatment of complications of cirrhosis. Eur J Clin Pharmacol. 2002;58:435–440
Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut 2006;55;1–12
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.