Improving Patient Safety through Better Record-Keeping: A Quality Improvement Project to Standardize Large-Volume Paracentesis Documentation in the Medicine Unit of a Tertiary Care Hospital in Pakistan

Quality improvement project

Abstract

Background:Large-volume paracentesis (LVP) is a key therapeutic procedure for patients with decompensated cirrhosis and tense ascites. Although technically simple, safe practice depends on adherence to standardized protocols and comprehensive documentation. International guidelines recommend recording indication, consent, aseptic technique, ultrasound use, volume drained, albumin replacement, complications, and post-procedure monitoring. A baseline audit at Ayub Teaching Hospital revealed significant deficiencies in documentation.

 Objective:To evaluate the impact of a standardized documentation proforma on compliance with recommended LVP documentation practices.

 Methods: A quality improvement project was conducted using Plan–Do–Study–Act (PDSA) cycles. A retrospective baseline audit of 50 LVP procedures (June–July 2024) was performed using a structured checklist based on AASLD/EASL guidelines. A standardized proforma was then introduced with staff training and feedback. Post-intervention data from 50 consecutive procedures (August–September 2024) were analyzed. Compliance rates were compared using chi-square and paired t-tests.

 Results:Baseline documentation was poor, with informed consent recorded in 42%, aseptic technique in 38%, ultrasound use in 22%, albumin replacement in 32%, and complete documentation in 16% of cases. Following intervention, compliance improved significantly: consent (92%), aseptic technique (88%), fluid volume (96%), albumin replacement (86%), and post-procedure monitoring (84%). Overall compliance increased from 50.3% to 89.2% (p < 0.001). The mean documentation score improved from 3.88 ± 1.12 to 7.57 ± 0.86 (p < 0.001; Cohen’s d = 3.1). No major complications were reported post-intervention.

Conclusion: Implementation of a standardized LVP documentation proforma significantly improved compliance, safety monitoring, and accountability. This low-cost intervention offers a scalable model for enhancing procedural quality in resource-limited settings.