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Abstract
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Background and Aims Peripheral nerve blocks provide anesthesia and pain management benefits but carry approximately a 3% risk of post-operative neurological symptoms (PONS). The risk of long term injury is 2-4 per 10000. Factors which contribute to PONS include surgical, anesthetic and patient factors like positioning, tourniquet ischemia, pre-existing deficits, diabetes and receiving a nerve block. Identifying these risk factors for PONS is crucial, but our institution was limited by inconsistent reporting due to a lack of a standardized referral system. We therefore undertook a Quality Improvement Project (QIP) to address this gap in our practice. We aimed to develop a system to capture, track and manage PONS cases after peripheral nerve blocks at our institution.
Methods A multidisciplinary team (anesthesiologists and informaticians) designed an electronic PONS reporting form within the Electronic Patient Record (Cerner PowerChart(R)), adapting the RA UK pathway to our needs. User feedback and discussions refined the form for usability and comprehensiveness.
Results This collaborative approach led to a user-friendly electronic PONS reporting form within the existing clinical workflow. The form facilitates PONS case tracking, enabling future research into risk factors, incidence, and patient management.
Conclusions A standardized user-friendly electronic PONS reporting system will improve patient outcomes through better case reporting, follow-up and management. Creating a database of PONS in an institution where a high-volume of nerve blocks are performed is vital for patient safety. This approach can be valuable in circumstances where a high-volume of nerve blocks are performed across multiple sites and for multiple surgical services, ultimately enhancing patient safety.
PONS Flowchart
PONS Form on PowerChart
PONS Form Follow-up tab on PowerChart