5968 Development of a lumbar puncture box, guideline, and a patient information leaflet in paediatric A & E and paediatric department in a district general hospital

Objectives Lumbar punctures (LP) are commonly performed in neonates and paediatric patients. Discrepancies were informally noted among clinicians' procedural knowledge and practice, including inconsistent recording of consent. The aim of this project was to survey current knowledge and practice across the department, develop a departmental guideline, a patient information leaflet to assist consent and an LP equipment box. Methods Clinicians of all grades were surveyed using a Google form which contained 11 questions on consent, contraindications, preparation, anti-septic usage, procedure, and sample collection. Survey results were presented at the clinical governance meeting (CGM) and assessed against recommendations from NICE and AAGBI safety guidelineson skin antisepsis for central neuraxial blockade.Departmental consensus was sought to finalise a departmental guideline, patient information leaflet and LP box. Results Out of 30 clinicians who responded to the survey, 30% were consultants and 23% were registrars. There was unanimously agreement on the usage of sterile gloves and a sterile field during the procedure, and everyone was aware that a CT head is not a requirement before LP. 27 clinicians obtained verbal consent in their practice while only 21 used a sterile gown during the procedure. Skin antisepsis demonstrated a significantly varied practice with 24 choices for 2% chlorhexidine, and 10 choices for 0.5% chlorhexidine. Clinicians had different answers to the lowest platelet cut off with only 6 clinicians selecting more than 100 x 109. 6 clinicians believed that the preferred LP site was L2/L3. Conclusion Sharing knowledge across the team at our CGM changed departmental practice in line with national recommendations. The guideline, information leaflet and LP box were well received and helped ensuring consistent and safe practice.