The Safe Use of Local Anaesthetics in the Emergency Department
Matthew Roe, Cheltenham General Hospital, UK
Background
There are many risks associated with local anaesthetic use in the Emergency Department. When infiltrating around wounds or performing nerve block techniques in the trauma setting it is vital that as a prescription only medicine, local anaesthetic use is clearly documented.
Standard & Aims
A valid prescription should include the time and date that the drug was administered, name of drug, dose or volume, route or site of administration and a signature from the prescribing clinicianą. The aim of this audit was to determine whether these standards were being met.
Methods
A case note search was performed, examining all presentations to the Emergency Department during a two week period where the presenting complaint included the words ‘laceration’ or ‘wound’ . These notes were then examined in detail to determine whether a local anaesthetic agent had, or may have, been used. The level of detail and clarity in the documentation of the local anaesthetic used was then recorded.
Results
24 cases were highlighted where a local anaesthetic was likely to have been used
In 88% of cases documentation was sub-optimal
50% had no mention of the drug used
46% did not record a dose or volume
54% did not mention the route of administration i.e. local infiltration vs. nerve block.
Conclusions
There were no recorded instances of patient harm from the use of local anaesthetic agents in the cases being examined but in an increasingly litigious world it is vital that our documentation and use of all medicines is clear and accurate.
Following this audit, local anaesthetic drug stickers were introduced for use in the Emergency Department notes. A later re-audit revealed a significant improvement in documentation standards.
References
1. British National Formulary, 2011. www.bnf.org
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