PO005 Improving lumbar puncture practice on the acute medical unit in a major teaching hospital

Lumbar puncture allows sampling of cerebral spinal fluid (CSF) and measurement of the intracranial pressure and is often a vital part of patients’ diagnostic work up. It is noted that in general documentation of opening pressure is often missed and glucose samples are regularly not sent. We obtained records [n=27] of all patients who had had a CSF sample sent from our acute medical unit between October 2015 and March 2016. We then obtained the medical notes for all patients and, assessed adequacy of LP documentation and whether basic investigations had been sent. With regards to documentation indication for LP (29.6%), contraindications (or absence of) (7.4%), needle gauge (18.5%) and positioning (22.2%) were the least frequently documented areas. No variable was documented every time. In line with the literature the opening pressure was missed in over a third of cases.Cell count was sent in all bar one sample (96.3%). CSF Protein and CSF glucose were both sent for 88.9% of cases but serum glucose was only sent for 44.4% of cases. To improve practice both in terms of documentation and sample sending we have designed a ‘Lumbar Puncture Care Bundle’ to be used by clinicians when performing an LP and placed directly into notes. We plan to re-audit in six months.