Question

Create Your Own Performance Measure:  The surgical floor has anecdotally noticed that patients who have received a spinal anesthetic are complaining more and more frequently of severe, persistent headache within four hours of surgery. The anesthesia department has decided that this needs further investigation. It is well established in the literature that spinal headaches can be avoided with proper education of staff and patients.

1. How can the anesthesia department establish whether a problem exists?

2. Develop a measurable statement that can be used to determine desired performance regarding spinal anesthetic and headache.

3. Create a sample data display of a report you would like to see of these results for the last twelve months.

Answer 1

Spinal Headache occurs as a result of the procedures like spinal tap or epidural block during surgery or delivery.This occurs when more than enough spinal fluid gets drained out.

1) The anesthesia department is responsible to educate the client and the staff regarding the measures to be taken in order to prevent spinal headaches after procedure. The spinal headache can be traced if a client complaints of

• Increased headache in upright position after procedure which subsides when client lies down.
• Dull, throbbing pain that varies in intensity from mild to incapacitating.
• Other symptoms include: dizziness, tinnitus, hearing loss, blurred or double vision, nausea, neck stiffness.

Once the patient leaves the OR or the procedure room, its difficult for the anesthetic department to trace these symptoms of spinal headache. For this, use of a post operative or post procedure checklist to evaluate the presence of these symptoms can be beneficial. This checklist should include all the criteria that will conclude the presence or absence of spinal headache. The checklist will be filled by the staff in charge of the client or the staff in the recovery room. At the time of discharge when the client record reaches to medical record session, it can be collected by the staff of quality department and can be evaluated by the concerned quality inspection staff of the anesthesia department.

2) Spinal headache among clients who received spinal anesthesia is increasing.The proper education of clients and staff can reduce the frequency of spinal headaches.Maintaining bed rest for 24-48 hrs in supine position post procedure can reduces the cases with spinal heahaches.

3) Report of prevalence spinal headache cases within year 2017

MONTHS	TOTAL CASES RECEIVED SPINAL ANESTHESIA	TOTAL CASES WITH SPINAL HEADACHES	CASES WITH ADEQUATE POSITION	CASES HYDRATED ADEQUATELY	CASES WHO COMPLIED WITH THE POSTOP INSTRUCTIONS
January	50	10	42	40	45
February	50	15	38	36	47
March	50	18	36	34	46
April	50	19	30	31	45
May	50	22	40	45	35
June	50	25	42	40	28
July	50	28	38	41	39
August	50	26	39	38	35
September	50	27	32	36	32
October	50	25	28	34	34
November	50	29	36	35	37
December	50	30	42	38	30

The study sample is fixed for the year i.e 50.From the data stated above, its clear that the number of spinal headache cases have frequently increased among clients who received spinal anesthesia. The clients who assume appropriate position post procedure declined with time. The hydration of the clients is also found to be decreased. The compliance of the clients with the instructions given in order to prevent the spinal headaches has also declined.

Therefore we can conclude that proper positioning, adequate hydration and accurate education of the clients and the staff can reduce the number of cases with spinal headache after a spinal anesthesia.