Adherence to Protocols for Pleural Fluid Aspiration (Thoracentesis): An Audit Report

Abstract

Background: Thoracentesis is a routinely performed diagnostic and therapeutic procedure for pleural effusions. Adherence to standardized procedural protocols is essential to minimize complications, ensure diagnostic accuracy, and optimize patient outcomes. However, compliance with established guidelines is often suboptimal in busy clinical settings, particularly in low-resource environments. Objective: This audit aimed to evaluate the adherence of healthcare professionals to standard thoracentesis protocols in the Pulmonology Department of Gujranwala Medical College Teaching Hospital and to assess the impact of an educational intervention on improving compliance. Methods: A prospective clinical audit was conducted over a one-week period in April 2024. A total of 30 thoracentesis procedures performed by post-graduate residents and house officers were observed using a structured proforma based on British Thoracic Society and Whittington Health NHS guidelines. Parameters assessed included clotting profile documentation, informed consent, aseptic measures, imaging guidance, correct technique, and post-procedural monitoring. Following the initial audit, a departmental educational intervention was implemented. A re-audit was conducted two weeks later using the same methodology. Results: The initial audit revealed that only 74.9% of procedures met the required standards. Key areas of non-compliance included documentation of clotting profiles and post-procedural chest X-rays. After the intervention, adherence improved to 86.3%, with notable gains in aseptic technique, proper needle selection, and informed consent. Conclusion: The audit demonstrates that protocol adherence in thoracentesis can be significantly improved through structured feedback and targeted educational interventions. Regular clinical audits and reinforcement of procedural standards are vital for enhancing patient safety and maintaining high-quality care.