- Identify barriers to routine use of atraumatic needles at a specialist neurology hospital

- Convert to atraumatic lumbar puncture (LP) needles for all diagnostic lumbar punctures 

- Provide training and education for clinical teams 

- Audit uptake 

LP is one of the most important and commonly performed diagnostic and therapeutic tools in neurology clinical practice and has a range of potential complications. Recent high-quality evidence has shown that use of atraumatic LP needles significantly reduces the rates post-LP headache, nerve root irritation or a need for a blood patch (Rochwerg et al. BMJ 2018).

During our clinical practice, we have observed that atraumatic needles are not always used at our institution, which led to the quality improvement project.

Data collected: 

- Inspection of ward stock and ordering practices 

- Questionnaire completed by residents and fellows at the start and the end of the assessment period, assessing attitudes towards atraumatic needles and number of LPs performed

Interventions:

- Restocking of atraumatic needles and change in ordering practices

- Introduction of education programme for multidisciplinary teams and senior support for clinical trainees on the use of atraumatic LP needles

- Introduction of an e-learning module and clinical simulation sessions on atraumatic needles for junior residents across other hospitals 

At baseline, majority of the clinical staff reported lack of confidence in using atraumatic needles (45%, n=19, >70% response rate), with minority of LPs (8%, n=134) being performed using the new needles.

At four months, confidence levels have increased (74%, n=22, >70% response rate), resulting in majority of LPs performed in the time period using atraumatic needles (67%, n=175).

We have successfully introduced atraumatic needles to the medical wards at National Hospital for Neurology and Neurosurgery using a range of clinical and educational interventions. Our quality improvement project can act as a blueprint to introduction of atraumatic needles at other institutions.