PATIENT SAFETY FOR SIJ &

LUMBAR FACET PAIN

INTERVENTION
Ketut Jayati Utami Dewi
 PATIENT SAFETY IN
INTERVENTIONAL PAIN
PROCEDURE
 DEFINITION

• Patient safety is the avoidance of unintended or

unexpected harm to people during the
provision of health care
 KEMENKES RI 2015

• Suatu sistem yang memastikan asuhan pada pasien jauh lebih aman.
• Kejadian tidak Diharapkan (KTD), Kejadian Nyaris Cedera (KNC),
Kejadian Tidak Cedera (KTC) dan Kejadian Potensial Cedera
(KPC)
• Pengkajian risiko, identifikasi insiden, pengelolaan insiden,
pelaporan atau analisis insiden, serta implementasi dan tindak lanjut
suatu insiden untuk meminimalkan terjadinya risiko.
 SCOPE OF ERROR
• Human error
• Knowledge based
• Rule based
• Skill based
• Technical problem
• Communication problem
• Characteristic of patients
TYPES OF MEDICAL ERRORS COMMONLY SEEN

• Diagnosis related
• Treatment related
• Competency of staff
 TREATMENT RELATED
• Direct spinal cord injury
• Direct nerve injury
• Dural puncture
• Epidural hematoma
• Pneumothorax
• Infection
• Falls
• Radiofrequency equipment
• Radiation safety
• Medication toxicity
• Allergy
• Patient identifiers
• Anesthesia complications
• Aspiration pneumonia
• Post procedure monitoring
• Communication related issues
• Organization related issues
SACRO ILIAC JOINT
INTERVENTION
 CONTRAINDICATIONS

• Absolut
• Local malignancy
• Local infection
• Sepsis
• Relative
• Coagulopathy/use of blood
thinning agents
• Pregnancy
• Diabetes mellitus with poor
glycemic control
 COMPLICATIONS

• Procedural and post – procedural pain

• Bleeding
• Infection
• Vasovagal episode
• Skin hypopigmentation
• Subtherapeutic outcome
 PREVENTION OF COMPLICATION
• Fast acting local anesthetic through the ablation needle – wait at least 90 s
• LA + steroid – diminish post neurotomy neuritis
• Small gauge of needle
• SIJ proc – ASRA guidelines 2020 – do not recommend that patient stop anticoagulant unless there
are concomitant bleeding risk (liver & kidney disease)
• Good aseptic technique
• Sterile drape
• Restyletting or flushing the procedure needle with non steroid injectate before removing it
• Dilute the injectant to a maximum concentration 10 mg/cc
LUMBAR FACET JOINT
INTERVENTION
 CONTRAINDICATIONS

• Systemic or local infection at the site of injection

• Bleeding diathesis or anticoagulan use
• Allergic reaction to contrast, anesthetic or
corticosteroid
• Local malignancy
• Patient refusal
 COMPLICATIONS

• Frequent
• Spread of contrast agent into soft tissues
• Increase pain and discomfort
• Intravascular injection
• Complication related to used drugs
 COMPLICATIONS

• Serius but infrequent

• Multifidus atrophy
• Inadvertent subarachnoid or ubdural injection
• Hematoma
• Infection
• Tissue burns
• Problem due to RFT in patient who have implanted devices
• Problem due to RFT in patient with spinal instrumentation
 COMPLICATIONS

• Serius but rare

• Spinal cord injury
• Nerve injury
• Disc injury
 PREVENTION

• Needle tip direction should be controlled

• Checked with fluoroscopy imaging in multiple views before
RFT neurotomy
• Sensory and motor stimulation
• Deep sedation should be avoided – patient awake
PREVENTION STRATEGIES FOR PATIENT SAFETY

• Policy and procedures

• Team rehearsal and checklists
• Quality assurance and improvement process
 SUMMARY

• Patient safety is an important issue

• Patient error can be catastrophic
• Preventing these errors is the key
THANK YOU