Background and Aims Regional anaesthesia (RA) is often desirable for multiple reasons but with an increasingly medically complex population, the anaesthetist often manages patients on novel oral anticoagulants (NOACs)1. However, for these drugs variable times are recommended to wait as mistiming can lead to serious complications such as a vertebral canal haematoma2. The authors present a quality improvement project on provision of RA for patients on NOACs.
Methods A survey was taken of anaesthetists who regularly do trauma lists, to identify knowledge of acceptable times post NOACs for safe RA performance against national guidelines. In addition, it also identified numbers of times a RA choice was abandoned due to insufficient time before last dose in the 3 months prior and any report of adverse outcomes. An intervention of implementing a poster and insert of key timings in the trauma booklet was then undertaken and subsequently anaesthetists were resurveyed at 3 months post intervention.
Results A total of 14 anaesthetists were surveyed yet 29% had accurate knowledge against guidelines. Reports of 8 cases occurred in the 3 months where RA choice was abandoned due to mistiming. There were no adverse outcomes reported. Post intervention, in the subsequent 3 months, knowledge of the guidelines had improved to 100% and there were 3 cases reported where RA choice was abandoned.
Conclusions The authors demonstrate that a simple visual aid can improve knowledge of NOACs and RA timing and can reduce incidence of abandoned RA options. Ultimately, this importance lies with improving available care for the patient.
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