Evidence-based practice: According to the literature, diagnostic and therapeutic abdominal paracentesis is a procedure which can be performed in a clinic setting or at the bedside. Performing diagnostic paracentesis should be performed promptly, especially if there is concern for spontaneous bacterial peritonitis (SBP). Delays in patients with SBP studies have shown an increase in mortality; every hour delay was associated with a 3.3 percent increase in mortality (Runyon 2019). A diagnostic paracentesis at the time of admission to the hospital in patients with cirrhosis and ascites may decrease mortality rates (Runyon 2019). In December 2018, a patient on 10 South underwent paracentesis x3 until the correct lab tests were ordered, obtained, and resulted until treatment could begin. In September 2020, the paracentesis guide was spread to the other medicine units.
Purpose: To improve the bedside paracentesis procedure by implementing a paracentesis collection guide on Unit 10 South, Montefiore, as evidenced by an increase in obtaining patient consent and the usage of the invasive procedure universal protocol form, with a decrease in rejected specimens and repeat procedures.
Description: After reviewing the root cause analysis a paracentesis guide was developed, which focused on increasing patient consent, following timeout procedures, decreased rejected specimens, and decreased repeat procedures.
Evaluation/outcome: Lab errors decreased to 0 in 2020 on 10 South. Increased compliance in obtaining timeout and procedure consent.
Future work: Roll out to ICUs and possibly the ED @PUH, expand to the system, and match lab orders with the power plan.