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Post-operative Complications in Paediatric Patients Treated under GA: A Quality Improvement Project

Nikita Visaria-Shah

 Children admitted for extractions under General Anaesthesia (GA) are likely to experience pain and bleeding following discharge. The 2008 UK Guidelines for the use of GA in paediatric dentistry recommend written and verbal post-operative instructions should be provided following a GA.

The aim of this quality improvement project was to assess the post-operative experience of patients following treatment under GA, evaluating pain and bleeding together with patient satisfaction.

The following standards were used:

No post-operative pain lasting >48 hours

No post-operative bleeding not controlled by local measures

Evaluation of patient satisfaction

The first cycle was a retrospective case note review of 25 children. Data collection included: pre-operative GA assessor, operative surgeon and anaesthetist. Parents were contacted via telephone to complete a patient satisfaction questionnaire (PSQ) and questions on post-operative pain and bleeding experienced following discharge. The outcomes were reviewed in a local meeting and prior to the second cycle a standardised GA assessment template was created and a new GA information sheet was implemented.

Results:

Cycle 1:

No post-operative pain lasting >48 hours= 76%

No post-operative bleeding not controlled by local measures= 100%

Mean Patient Satisfaction Score= 74%

Cycle 2:

No post-operative pain lasting >48 hours= 100%

No post-operative bleeding not controlled by local measures= 100%

Mean Patient Satisfaction Score= 80%

Following these results it is recommended to devise a local protocol for pre-operative, intra-operative and post-operative analgesia regimens. In line with patient feedback it is also recommended to design a social story for or young children undergoing GA