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A TOOL FOR IMPROVING THE QUALITY OF EMLA APPLICATION PRIOR SPINAL ANESTHESIA
Author(s): ,
Dziadzko, M.*
Affiliations:
Hospices Civils de Lyon - Hopital de la Croix-Rousse, Anaesthesiology, Lyon, France
,
Frattinger, C.
Affiliations:
Hôpital d’Instruction des Armées Desgenettes, Service de Santé des Armées, Lyon, France
,
Rouhana, K.
Affiliations:
Hospices Civils de Lyon - Hopital de la Croix-Rousse, Anaesthesiology, Lyon, France
Aubrun, F.
Affiliations:
Hospices Civils de Lyon - Hopital de la Croix-Rousse, Anaesthesiology, Lyon, France
ESRA Academy. Dziadzko M. Sep 13, 2017; 190742; 221
Dr. Mikhail Dziadzko
Dr. Mikhail Dziadzko

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Abstract
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Background and Aims:

Cutaneous application of EMLA cream improves patients’ comfort during lumbar puncture. Correctly applied, it covers zone of skin limited by 2 cm from the median line L2-L5, and protected by a film. The practice of EMLA application is known by nurses, however the quality remains unstable. We conducted a quality improvement initiative and developed a tool to enhance compliance with a practice standard.

Methods:

Before/after observational design. Corpulence of patients and details of EMLA use were analyzed. A questionnaire for nurses on EMLA application practices and spinal anatomy was administered. A tool - transparent film with an orifice corresponding to EMLA zone application, median spinal line, and transversal iliac crests lines marks - was developed, and systematically used for 1 week between 2 phases, with subsequent evaluation of usability (System Usability Scale). Spinal anatomy was recalled. Oral content was obtained from participating nurses.

Results:

A total of 100 consecutive (before/after - 50/50) patients observed. Initial compliance of EMLA application was 70%, non-related to corpulence or prescriptions. 25 nurses were evaluated, 68% provided correct answers regarding EMLA application practices. After 1 week of a tool use there was 96% compliance of EMLA application, and 96% correct answers. The usability of developed tool was 80/100 SUS. 24% of nurses used it only one time, indicating the necessity of a single use version (hygiene).

Conclusions:

Significant improvement of EMLA application quality was achieved using a simple tool.  The usability of this tool was good, the development of a disposable single use version was suggested by nurses.

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