PT  - JOURNAL ARTICLE
AU  - Christian Holland
AU  - Evan C Edmond
AU  - Catherine Moore
AU  - Vanessa Tobert
AU  - Johannes C Klein
AU  - Martin R Turner
TI  - A nudge towards better lumbar puncture practice
AID  - 10.7861/clinmed.2020-0201
DP  - 2020 Sep 01
TA  - Clinical Medicine
PG  - 477--479
VI  - 20
IP  - 5
4099  - http://www.rcpjournals.org/content/20/5/477.short
4100  - http://www.rcpjournals.org/content/20/5/477.full
SO  - Clin Med2020 Sep 01; 20
AB  - Background Despite a body of evidence demonstrating reduced incidence of post-lumbar puncture headache associated with pencil-point (vs bevelled-edge) needles, their use remains variable in the UK.Methods A multimodal longitudinal intervention was performed over a 12-month period at a tertiary neurology referral centre. In addition to simulation training using pencil-point needles and an electronic documentation pro forma, a change in the default needles presented in clinical environments was performed.Results Prior to the intervention, pencil-point needle usage was minimal. Documentation significantly improved throughout the intervention period. Simulation training interventions only resulted in transient, moderate improvements in pencil-point needle usage. However, changing the default produced a marked increase in use that was sustained. No significant changes in operator success rate were found.Conclusions In the context of wider literature on the power of default options in driving behavioural choices, changing defaults may be an effective, inexpensive and acceptable intervention to improve lumbar puncture practice.