Standardized LocSSIPs improves risk prevention for in-patient angioplasty in tertiary care hospital

Type of funding sources: None.

acute cardiovascular care

There are no established ESC/NICE guidelines for acceptable Safety Checklists in invasive coronary angiogram. A lack of Quality Assurance Checklists that is indicated by WHO guidelines for coronary angiogram can lead to potentially serious or life-threatening implications such as acute pulmonary and venous thromboembolism, stent thrombosis due to delays in anti-platelet therapy and thromboprophylaxis.

A LocSSIPS audit was conducted to investigate poor compliances of Patient Safety Checklists that are indicated per WHO guidelines. Further objectives were to understand the reasons for poor compliance and to formulate local guidelines to standardize checklists for angioplasty.

A total of 50 patients were assessed for poor compliance in safety checklists from 1st April 2021 to 16thJuly 2021.Out of these 30 received coronary angioplasty (study population for the audit). Poor compliance counted from the day evidence to implants was recorded in local Safety checklist elements. Compliance was assessed in different steps as compliances in anti-platelet therapy, Venous Thrombo-prophylaxis and female aged 11-55 years taken pregnancy test prior radiation exposure and implant verification. An acceptable audit standard was devised as 100% of compliance in Safety Checklists for all patients undergoing angioplasty.

 It was found that only 20 out of 30 patients (67%) achieved the audit standard of FULL compliance. In 10 of the 30 patients, who did not meet the audit standard, the main reasons are lack of VTE prophylaxis, anti-platelets drugs, and implant sterility. A standardized safety checklist was hence devised to improve upon quality of angioplasty. This involved designating the on-call cardiology registrar to flag up the Venous Thrombo- prophylaxis and anti-platelet therapy checks for patients undergoing invasive coronary angiogram.  An electronic LocSSIPs checklist was also devised with alerts to Interventional cardiologists and the procedure booking team. A multi-professional team discussion of raising poor compliance is held in the monthly Clinical Governance meeting as a quality control measure with creation of an Ongoing annual re-audit following implementation of recommendation.

The incorporation of audit recommendations in local cardiology guidelines has led to significant improvement in patient quality of care and potential reduction in risk of serious outcomes due to poor compliance in safety checklists for invasive coronary angiogram.

Abstract Figure. Overall Score Percentage Data Analysis